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Italian Journal of Pediatrics Sep 2023Acute viral bronchiolitis is the most common cause of hospitalization in children under 12 months of age. The variable clinical presentation and the potential for sudden... (Review)
Review
Acute viral bronchiolitis is the most common cause of hospitalization in children under 12 months of age. The variable clinical presentation and the potential for sudden deterioration of the clinical conditions require a close monitoring by healthcare professionals.In Italy, first access care for children is provided by primary care physicians (PCPs) who often must face to a heterogeneous disease presentation that, in some cases, make the management of patient with bronchiolitis challenging. Consequently, Italian studies report poor adherence to national and international guidelines processed to guide the clinicians in decision making in acute viral bronchiolitis.This paper aims to identify the potential factors contributing to the lack of adherence to the suggested guidelines derived by clear and evidence-based recommendations among primary care physicians operating in an outpatient setting, with a specific focus on the context of Italy. Particularly, we focus on the prescription of medications such as β2-agonists, systemic steroids, and antibiotics which are commonly prescribed by PCPs to address conditions that can mimic bronchiolitis.
Topics: Child; Humans; Bronchiolitis, Viral; Bronchiolitis; Anti-Bacterial Agents; Italy; Primary Health Care
PubMed: 37726761
DOI: 10.1186/s13052-023-01527-3 -
Expert Review of Clinical Immunology 2015Acute respiratory infections (ARIs), such as bronchiolitis and pneumonia, are the leading cause of hospitalization of infants in the US. While the incidence and severity...
Acute respiratory infections (ARIs), such as bronchiolitis and pneumonia, are the leading cause of hospitalization of infants in the US. While the incidence and severity of ARI can vary widely among children, the reasons for these differences are not fully explained by traditional risk factors (e.g., prematurity, viral pathogens). The recent advent of molecular diagnostic techniques has revealed the presence of highly functional communities of microbes inhabiting the human body (i.e., microbiota) that appear to influence development of local and systemic immune response. We propose a 'risk and resilience' model in which airway microbiota are associated with an increased (risk microbiota) or decreased (resilience microbiota) incidence and severity of ARI in children. We also propose that modulating airway microbiota (e.g., from risk to resilience microbiota) during early childhood will optimize airway immunity and, thereby, decrease ARI incidence and severity in children.
Topics: Acute Disease; Animals; Bronchiolitis; Child; Child, Preschool; Humans; Microbiota; Pneumonia; Portraits as Topic; Risk Factors
PubMed: 25961472
DOI: 10.1586/1744666X.2015.1045417 -
Georgian Medical News Mar 2017Bronchiolitis is a common condition in children less than 2 years of age and is a leading cause of infant hospitalization. Acute bronchiolitis is characterized by acute... (Review)
Review
Bronchiolitis is a common condition in children less than 2 years of age and is a leading cause of infant hospitalization. Acute bronchiolitis is characterized by acute wheezing in infants or children and is associated with signs or symptoms of respiratory infection; the most common etiologic agent is respiratory syncytial virus. There is a lack of consensus regarding the clinical definition of acute viral bronchiolitis in children and hence the management varies across the globe. Usually it does not require investigation, treatment is merely supportive and a conservative approach seems adequate in the majority of children, especially for the youngest ones. Managing bronchiolitis, both in the outpatient and inpatient setting remains a challenge to the treating pediatrician. Several recent evidence-based reviews have suggested that bronchodilators or corticosteroids lack efficacy in bronchiolitis and should not be routinely used. The cornerstones of the management of viral bronchiolitis are the administration of oxygen and appropriate fluid therapy, and overall a "minimal handling approach" is recommended. Inhaled adrenaline is commonly used in some countries, but the evidences are sparse. Recently, inhalation with hypertonic saline has been suggested as an optional treatment. When medical treatment fails to stabilize the infants, non-invasive and invasive ventilation may be necessary to prevent respiratory failure. The key to reducing the morbidity and mortality in children with RSV bronchiolitis is through prevention of infection through immunoprophylaxis especially in high-risk children. This review focuses on the epidemiological, clinical, radiographic, and pathologic characteristics, as well as the recent advances in management of acute bronchiolitis.
Topics: Acute Disease; Antiviral Agents; Bronchiolitis, Viral; Humans; Infant; Infant, Newborn; Respiratory Syncytial Viruses
PubMed: 28480848
DOI: No ID Found -
The Cochrane Database of Systematic... Mar 2015Acute lower respiratory tract infections (LRTI) range from acute bronchitis and acute exacerbations of chronic bronchitis to pneumonia. Approximately five million people... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute lower respiratory tract infections (LRTI) range from acute bronchitis and acute exacerbations of chronic bronchitis to pneumonia. Approximately five million people die from acute respiratory tract infections annually. Among these, pneumonia represents the most frequent cause of mortality, hospitalisation and medical consultation. Azithromycin is a macrolide antibiotic, structurally modified from erythromycin and noted for its activity against some gram-negative organisms associated with respiratory tract infections, particularly Haemophilus influenzae (H. influenzae).
OBJECTIVES
To compare the effectiveness of azithromycin to amoxycillin or amoxycillin/clavulanic acid (amoxyclav) in the treatment of LRTI, in terms of clinical failure, incidence of adverse events and microbial eradication.
SEARCH METHODS
We searched CENTRAL (2014, Issue 10), MEDLINE (January 1966 to October week 4, 2014) and EMBASE (January 1974 to November 2014).
SELECTION CRITERIA
Randomised controlled trials (RCTs) and quasi-RCTs, comparing azithromycin to amoxycillin or amoxycillin/clavulanic acid in participants with clinical evidence of an acute LRTI, such as acute bronchitis, pneumonia and acute exacerbation of chronic bronchitis.
DATA COLLECTION AND ANALYSIS
The review authors independently assessed all potential studies identified from the searches for methodological quality. We extracted and analysed relevant data separately. We resolved discrepancies through discussion. We initially pooled all types of acute LRTI in the meta-analyses. We investigated the heterogeneity of results using the forest plot and Chi(2) test. We also used the index of the I(2) statistic to measure inconsistent results among trials. We conducted subgroup and sensitivity analyses.
MAIN RESULTS
We included 16 trials involving 2648 participants. We were able to analyse 15 of the trials with 2496 participants. The pooled analysis of all the trials showed that there was no significant difference in the incidence of clinical failure on about days 10 to 14 between the two groups (risk ratio (RR), random-effects 1.09; 95% confidence interval (CI) 0.64 to 1.85). A subgroup analysis in trials with acute bronchitis participants showed significantly lower clinical failure in the azithromycin group compared to amoxycillin or amoxyclav (RR random-effects 0.63; 95% CI 0.45 to 0.88). A sensitivity analysis showed a non-significant reduction in clinical failure in azithromycin-treated participants (RR 0.55; 95% CI 0.25 to 1.21) in three adequately concealed studies, compared to RR 1.32; 95% CI 0.70 to 2.49 in 12 studies with inadequate concealment. Twelve trials reported the incidence of microbial eradication and there was no significant difference between the two groups (RR 0.95; 95% CI 0.87 to 1.03). The reduction of adverse events in the azithromycin group was RR 0.76 (95% CI 0.57 to 1.00).
AUTHORS' CONCLUSIONS
There is unclear evidence that azithromycin is superior to amoxycillin or amoxyclav in treating acute LRTI. In patients with acute bronchitis of a suspected bacterial cause, azithromycin tends to be more effective in terms of lower incidence of treatment failure and adverse events than amoxycillin or amoxyclav. However, most studies were of unclear methodological quality and had small sample sizes; future trials of high methodological quality and adequate sizes are needed.
Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Bronchitis; Drug Therapy, Combination; Humans; Pneumonia; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Treatment Failure
PubMed: 25749735
DOI: 10.1002/14651858.CD001954.pub4 -
American Journal of Respiratory and... Dec 2023
Topics: Humans; Minocycline; Pneumonia; Cryptogenic Organizing Pneumonia
PubMed: 37703394
DOI: 10.1164/rccm.202305-0885IM -
Phytomedicine : International Journal... Jul 2023Tropaeolum majus herb (nasturtium) and Armoracia rusticana root (horseradish) produce three different isothiocyanates as secondary metabolites, which exert... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Tropaeolum majus herb (nasturtium) and Armoracia rusticana root (horseradish) produce three different isothiocyanates as secondary metabolites, which exert antibacterial, anti-inflammatory, and immune-modulatory functions in humans.
PURPOSE
Combined in the medicinal product ANGOCIN® Anti-Infekt N, the two natural components demonstrated promising effects against acute bronchitis.
STUDY DESIGN
A randomized, two-armed, placebo-controlled, double-blind, phase IV study revealed the healing fostering effect of the two herbal plant components METHODS: This study included 384 patients, with 195 in the treatment and 189 in the placebo group. The 'bronchitis severity score' (BSS) was utilized as primary endpoint. This score sums the ratings for five significant bronchitis symptoms, which are established at the patient's visits to the clinic.
RESULTS
Compared to placebo intake, the group of patients treated with the phytomedicine showed statistically significant accelerated healing of bronchitis symptoms after three days of treatment, with reductions in coughing, mucous production, and chest pain. This beneficial effect persisted for the entire duration of treatment until day ten.
CONCLUSION
In conclusion, a combination of Tropaeolum majus herb and Armoracia rusticana root promotes an elevated improvement of bronchitis symptomatology.
Topics: Humans; Armoracia; Tropaeolum; Bronchitis; Plant Extracts; Phytotherapy; Acute Disease
PubMed: 37167822
DOI: 10.1016/j.phymed.2023.154838 -
The Cochrane Database of Systematic... Sep 2015The diagnosis of acute bronchitis is made on clinical grounds and a variety of clinical definitions have been used. There are no clearly effective treatments for the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The diagnosis of acute bronchitis is made on clinical grounds and a variety of clinical definitions have been used. There are no clearly effective treatments for the cough of acute bronchitis. Beta2-agonists are often prescribed, perhaps because clinicians suspect many patients also have reversible airflow restriction (as seen in asthma or chronic obstructive pulmonary disease (COPD)) contributing to the symptoms.
OBJECTIVES
To determine whether beta2-agonists improve acute bronchitis symptoms in people with no underlying pulmonary disease (such as asthma, COPD or pulmonary fibrosis).
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2015, Issue 5, MEDLINE (January 1966 to May 2015), EMBASE (1974 to May 2015), Web of Science (2011 to May 2015) and LILACS (1982 to May 2015).
SELECTION CRITERIA
Randomised controlled trials (RCTs) which allocated people (adults, or children over two years of age) with acute bronchitis or acute cough and without known pulmonary disease to beta2-agonist versus placebo, no treatment or alternative treatment.
DATA COLLECTION AND ANALYSIS
Three review authors independently selected outcomes and extracted data while blinded to study results. Two review authors independently assessed each trial for risk of bias. We analysed trials in children and adults separately.
MAIN RESULTS
Two trials of moderate quality in children (n = 134) with no evidence of airflow restriction did not find any benefits from oral beta2-agonists. Five trials in adults (n = 418) had mixed results but overall summary statistics did not reveal any significant benefits from oral (three trials) nor from inhaled (two trials) beta2-agonists. Three studies with low-quality evidence demonstrated no significant differences in daily cough scores, nor in the percentage of adults still coughing after seven days (control group 71%; risk ratio (RR) 0.86, 95% confidence interval (CI) 0.63 to 1.18; 220 participants). In one trial, subgroups with evidence of airflow limitation had lower symptom scores if given beta2-agonists. The trials that noted quicker resolution of cough with beta2-agonists were those with a higher proportion of people wheezing at baseline. Low-quality evidence suggests that adults given beta2-agonists were more likely to report tremor, shakiness or nervousness (RR 7.94, 95% CI 1.17 to 53.94; 211 participants; number needed to treat for an additional harmful outcome (NNTH) 2).
AUTHORS' CONCLUSIONS
There is no evidence to support the use of beta2-agonists in children with acute cough who do not have evidence of airflow restriction. There is also little evidence that the routine use of beta2-agonists is helpful for adults with acute cough. These agents may reduce symptoms, including cough, in people with evidence of airflow restriction. However, this potential benefit is not well supported by the available data and must be weighed against the adverse effects associated with their use.
Topics: Acute Disease; Adrenergic beta-2 Receptor Agonists; Adult; Airway Obstruction; Bronchitis; Bronchodilator Agents; Child; Child, Preschool; Cough; Humans; Infant; Randomized Controlled Trials as Topic
PubMed: 26333656
DOI: 10.1002/14651858.CD001726.pub5 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2020The aim of the work is to improve the prognosis of acute bronchitis on the basis of the study of etiology, clinical anamnestic and laboratory-instrumental features of...
OBJECTIVE
The aim of the work is to improve the prognosis of acute bronchitis on the basis of the study of etiology, clinical anamnestic and laboratory-instrumental features of acute bronchitis in children infected with Mycoplasma pneumoniae.
PATIENTS AND METHODS
Materials and methods: Medical records of inpatients, data from laboratory and clinical examinations, orders from the Ministry of Health of Ukraine. Statistical processing of the obtained results was carried out with the calculation of parametric and non-parametric criteria. The study included 72 patients with acute obstructive bronchitis, infected with Mycoplasma pneumoniae and patients not infected with intracellular pathogens who were hospitalized under the conditions of pediatric ward of children of younger and older children of the National Children's Clinical Hospital №24.
RESULTS
Results: Found that infected with mycoplasma compared with uninfected intracellular infection, more characteristic course of acute obstructive bronchitis on the background of febrile temperature with its duration of more than 4 days, the presence of midbubble and single dry or wet rales, as well as. In general, in patients infected with mycoplasma, compared with patients infected with chlamydia, there is a higher functional stress of immunity with the phenomena of exhaustion.
CONCLUSION
Conclusions: Attention is drawn to the fact that clinical, laboratory data and immunological examinations with the use of systematic analysis make it possible to predict the consequences in the history of children with intracellular infections of various somatic pathologies. In doing so, multivariate and correlation analyzes make it possible to develop new diagnostic criteria.
Topics: Acute Disease; Adolescent; Bronchitis; Child; Humans; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Ukraine
PubMed: 32723958
DOI: No ID Found -
Family Practice Mar 2023Despite the frequent use of symptomatic therapies in cough, evidence of their benefits is lacking. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Despite the frequent use of symptomatic therapies in cough, evidence of their benefits is lacking.
OBJECTIVE
We compared the effectiveness of 3 symptomatic therapies and usual care in acute bronchitis.
METHODS
Multicenter, pragmatic, multiarm parallel group, open randomized trial in primary care (ClinicalTrials.gov, Identifier: NCT03738917) was conducted in Catalonia. Patients ≥18 with uncomplicated acute bronchitis, with cough<3 weeks as the main symptom, scoring ≥4 in either daytime or nocturnal cough (7-point Likert scale), were randomized to usual care, dextromethorphan 15 mg t.i.d., ipratropium bromide inhaler 20 µg 2 puffs t.i.d, or 30 mg of honey t.i.d., all taken for up to 14 days. The main outcome measure was the number of days with moderate-to-severe cough. A symptom diary was given. A second visit was scheduled at days 2-3 for assessing evolution, with 2 more visits at days 15 and 29 for clinical assessment, evaluation of adverse effects, re-attendance, and complications.
RESULTS
We failed to achieve the sample size scheduled due to the COVID-19 pandemic. We finally recruited 194 patients. The median number of days with moderate-to-severe cough (score ≥ 3) in the usual care arm was 5 (interquartile range [IQR], 4, 8.75), 5 in the ipratropium bromide arm (IQR, 3, 8), 5 in the dextromethorphan arm (IQR, 4, 9.75), and 6 in the honey arm (IQR, 3.5, 7). The same results were obtained in the Kaplan-Meier survival analysis for the median survival time of each arm with the usual care as the reference group.
CONCLUSION
The symptomatic treatment evaluated has shown to be ineffective against cough.
Topics: Humans; Adult; Antitussive Agents; Cough; Dextromethorphan; Honey; Cholinergic Antagonists; Pandemics; COVID-19; Bronchitis; Ipratropium; Acute Disease
PubMed: 36239199
DOI: 10.1093/fampra/cmac112 -
Viruses Aug 2022Studies have associated the human respiratory syncytial virus which causes seasonal childhood acute bronchitis and bronchiolitis (CABs) with climate change and air...
Studies have associated the human respiratory syncytial virus which causes seasonal childhood acute bronchitis and bronchiolitis (CABs) with climate change and air pollution. We investigated this association using the insurance claims data of 3,965,560 children aged ≤ 12 years from Taiwan from 2006−2016. The monthly average incident CABs increased with increasing PM2.5 levels and exhibited an inverse association with temperature. The incidence was 1.6-fold greater in January than in July (13.7/100 versus 8.81/100), declined during winter breaks (February) and summer breaks (June−August). The highest incidence was 698 cases/day at <20 °C with PM2.5 > 37.0 μg/m3, with an adjusted relative risk (aRR) of 1.01 (95% confidence interval [CI] = 0.97−1.04) compared to 568 cases/day at <20 °C with PM2.5 < 15.0 μg/m3 (reference). The incidence at ≥30 °C decreased to 536 cases/day (aRR = 0.95, 95% CI = 0.85−1.06) with PM2.5 > 37.0 μg/m3 and decreased further to 392 cases/day (aRR = 0.61, 95% CI = 0.58−0.65) when PM2.5 was <15.0 μg/m3. In conclusion, CABs infections in children were associated with lowered ambient temperatures and elevated PM2.5 concentrations, and the high PM2.5 levels coincided with low temperature levels. The role of temperature should be considered in the studies of association between PM2.5 and CABs.
Topics: Acute Disease; Bronchiolitis; Bronchitis; Child; Environmental Exposure; Humans; Particulate Matter; Temperature; Virus Diseases
PubMed: 36146739
DOI: 10.3390/v14091932