Recent evidence on the management of bronchiolitis.
Recent evidence on the management of bronchiolitis.
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DOI：
10.1097/mop.0000000000000090
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发表时间：
2014-06
影响因子：
3.6
通讯作者：
Mansbach JM
中科院分区：
文献类型：
--
作者：
Schroeder AR;Mansbach JM
毛细支气管炎是2岁以下儿童的常见疾病，也是导致婴儿住院的主要原因。虽然毛细支气管炎的检测和治疗有很大的差异，但诊断检测很少能改善护理，而且目前还没有可用的药理学选择被证明能提供有意义的益处或改善结果。尽管有证据表明，β-受体激动剂不会减少住院人数或住院时间，但它们仍被频繁使用。总的来说，最初被认为有希望的治疗后来被证明是无效的，这一模式出现在关于皮质类固醇的研究中，最近又出现了雾化外消旋肾上腺素和高渗盐水的情况。最近的研究提高了我们对毛细支气管炎病毒流行病学的了解，对呼吸道合胞病毒以外的病毒的认识越来越多，对病毒合并感染的作用也有了更好的认识。这些发现将如何转化为改善的结果仍不确定。过去几十年毛细支气管炎的临床护理和研究的大部分重点都集中在新疗法的识别和测试上。未来的质量改进工作应该更多地集中在限制不必要的检测和治疗上。未来的研究应该包括确定毛细支气管炎儿童的亚组，这些亚组可能受益于有针对性的临床干预。
Bronchiolitis is a common condition in children < 2 years and is a leading cause of infant hospitalization. While there is significant variability in testing and treatment of children with bronchiolitis, diagnostic testing rarely improves care, and no currently available pharmacologic options have been proven to provide meaningful benefit or improve outcomes. Beta-agonists continue to be used frequently despite evidence that they do not reduce hospital admissions or length-of-stay. In general, therapies initially considered promising were subsequently proven ineffective, a pattern seen in studies on corticosteroids, and more recently with nebulized racemic epinephrine and hypertonic saline. Recent research has improved our understanding of the viral epidemiology of bronchiolitis, with increasing recognition of viruses other than respiratory syncytial virus and better awareness of the role of viral co-infections. How these findings will translate into improved outcomes remains uncertain. Much of the emphasis of the last few decades of bronchiolitis clinical care and research has centered on the identification and testing of novel therapies. Future quality improvement efforts should focus more on the limitation of unnecessary testing and treatments. Future research should include identification of subgroups of children with bronchiolitis that may benefit from focused clinical interventions.