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Bronchiolitis

Bronchiolitis The 3 studies of bronchiolitis reported in the February issue of Archives of Pediatrics and Adolescent Medicine1-3 demonstrate the disconnect between the evidence and the practice of pediatrics in America. The study of Mull et al1 comparing epinephrine and albuterol sulfate found no important difference in efficacy. They assert that both medications "work." The treatment groups were blinded. But since there was no placebo group, a placebo effect of medications (on the physicians) cannot be ruled out. The Respiratory Distress Assessment Instrument is the most subjective and showed the most medication effect. The respiratory rate is perhaps less subjective, and it did go down some. The mean room air oxygen saturation should be the least subjective assessment and that got worse with treatment according to Figure 4. However, they reported a "significant improvement" in this. Does that represent an error? Mull et al state that taking chest radiographs and performing respiratory syncytial virus testing were left to the discretion of the emergency department physician but were not reported. They also state, "Although it is likely that a benefit of epinephrine therapy would have been demonstrated had it been compared with placebo, we believe it would have been inappropriate to compare epinephrine with a placebo."1(p118) These 2 statements contradict the conclusions of the next 2 reports by Bordley et al2 and King et al3 in that same issue. We should not do any more comparisons of bronchodilators until it can be shown that any is beneficial. Correspondence: Dr DiTraglia, Pediatrics, 717 Fifth St, Portsmouth, OH 45662 (jditrag@zoomnet.net). References 1. Mull CCScarfone RJFerri LR et al. A randomized trial of nebulized epinephrine vs albuterol in the emergency department treatment of bronchiolitis. Arch Pediatr Adolesc Med. 2004;158113- 118PubMedGoogle ScholarCrossref 2. Bordley WCViswanathan MKing VJ et al. Diagnosis and testing in bronchiolitis. Arch Pediatr Adolesc Med. 2004;158119- 126PubMedGoogle ScholarCrossref 3. King VJViswanathan MBordley WC et al. Pharmacologic treatment of bronchiolitis in infants and children. Arch Pediatr Adolesc Med. 2004;158127- 137PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.158.7.707-a
Publisher site
See Article on Publisher Site

Abstract

The 3 studies of bronchiolitis reported in the February issue of Archives of Pediatrics and Adolescent Medicine1-3 demonstrate the disconnect between the evidence and the practice of pediatrics in America. The study of Mull et al1 comparing epinephrine and albuterol sulfate found no important difference in efficacy. They assert that both medications "work." The treatment groups were blinded. But since there was no placebo group, a placebo effect of medications (on the physicians) cannot be ruled out. The Respiratory Distress Assessment Instrument is the most subjective and showed the most medication effect. The respiratory rate is perhaps less subjective, and it did go down some. The mean room air oxygen saturation should be the least subjective assessment and that got worse with treatment according to Figure 4. However, they reported a "significant improvement" in this. Does that represent an error? Mull et al state that taking chest radiographs and performing respiratory syncytial virus testing were left to the discretion of the emergency department physician but were not reported. They also state, "Although it is likely that a benefit of epinephrine therapy would have been demonstrated had it been compared with placebo, we believe it would have been inappropriate to compare epinephrine with a placebo."1(p118) These 2 statements contradict the conclusions of the next 2 reports by Bordley et al2 and King et al3 in that same issue. We should not do any more comparisons of bronchodilators until it can be shown that any is beneficial. Correspondence: Dr DiTraglia, Pediatrics, 717 Fifth St, Portsmouth, OH 45662 (jditrag@zoomnet.net). References 1. Mull CCScarfone RJFerri LR et al. A randomized trial of nebulized epinephrine vs albuterol in the emergency department treatment of bronchiolitis. Arch Pediatr Adolesc Med. 2004;158113- 118PubMedGoogle ScholarCrossref 2. Bordley WCViswanathan MKing VJ et al. Diagnosis and testing in bronchiolitis. Arch Pediatr Adolesc Med. 2004;158119- 126PubMedGoogle ScholarCrossref 3. King VJViswanathan MBordley WC et al. Pharmacologic treatment of bronchiolitis in infants and children. Arch Pediatr Adolesc Med. 2004;158127- 137PubMedGoogle ScholarCrossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Jul 1, 2004

Keywords: bronchiolitis

References