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Bronchiolitis evidence based challenge
It’s the end of winter in the northern hemisphere, and paediatricians at the clinical coalface may be a little bored with the unending stream of small children sounding like old smokers. Bronchiolitis provides those who are interested in practicing evidence based medicine a great challenge: it is a common problem, desperately miserable for the children and families affected, and asks a multitude of clinical questions. How should we diagnose this condition? Should we investigate the children affected? How should we intervene to improve their lot—both generally and specifically? What is the outcome over time—and in the long term?
Archimedes has frequently taken up the challenge of offering some aspects of bronchiolitis care to a review of their evidence.1–4 We would like to take this time to point out some additional and pertinent evidence based resources. On the BestBets site you can read in more detail questions of the effectiveness of DNAse, and monteleukast5,6 (though we are still not aware of any research on the utility of dropping saline into a small child’s nostrils). An evidence based medicine journal contains a summary of a recent wide ranging systematic review of standard therapeutic options (bronchodilators and steroids).7 An original review of the usefulness of diagnostic testing is also available (though not as readable).8 We would also urge readers not to forget that all “snuffle and stop breathing” episodes are not bronchiolitis,9 and offer some alternative approaches to the treatment of pertussis.10
And finally we’d like to offer a further challenge. Can we advance studies of bronchiolitis beyond enrolling only tens or hundreds of infants among the thousands that pour through our fingers, and achieve such numbers in therapeutic trials that we may truly be able to distinguish which therapies (if any) are helpful?
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