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A Systematic Review

Valerie J. King, MD, MPH; Meera Viswanathan, PhD; W. Clayton Bordley, MD, MPH; Anne M. Jackman, MSW; Sonya F. Sutton, BSPH; Kathleen N. Lohr, PhD; Timothy S. Carey, MD, MPH

Arch Pediatr Adolesc Med. 2004;158:127-137.

Background  Bronchiolitis is the most common lower respiratory tract infection in infants. Up to 3% of all children in their first year of life are hospitalized with bronchiolitis. Bronchodilators and corticosteroids are commonly used treatments, but little consensus exists about optimal management strategies.

Objective  To conduct a systematic review of the effectiveness of commonly used treatments for bronchiolitis in infants and children.

Data Sources  We searched MEDLINE and the Cochrane Controlled Trials Register for references to randomized controlled trials of bronchiolitis treatment published since 1980.

Study Selection  Randomized controlled trials of interventions for bronchiolitis in infants and children were included if they were published in English between 1980 and November 2002 and had a minimum sample size of 10.

Data Extraction  We abstracted data on characteristics of the study population, interventions used, and results of studies meeting entry criteria into evidence tables and analyzed them by drug category.

Data Synthesis  Interventions were grouped by drug category and qualitatively synthesized.

Results  Of 797 abstracts identified in the literature search, we included 54 randomized controlled trials. This review includes 44 studies of the most common interventions: epinephrine (n = 8), 2-agonist bronchodilators (n = 13), corticosteroids (n = 13), and ribavirin (n = 10). Studies were, in general, underpowered to detect statistically significant outcome differences between study groups. Few studies collected data on outcomes that are of great importance to parents and clinicians, such as the need for and duration of hospitalization.

Conclusions  Overall, little evidence supports a routine role for any of these drugs in treating patients with bronchiolitis. A sufficiently large, well-designed pragmatic trial of the commonly used interventions for bronchiolitis is needed to determine the most effective treatment strategies for managing this condition.

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