Acute viral bronchiolitis phenotype in response to glucocorticoid and bronchodilator treatment

Chacorowski, Andressa Roberta Paschoarelli; Lima, Vanessa de Oliveira; Menezes, Eniuce; Teixeira, Jorge Juarez Vieira; Bertolini, Dennis Armando

doi:10.1016/j.clinsp.2024.100396

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • Clinics 79 • 2024 • https://doi.org/10.1016/j.clinsp.2024.100396 copy

Acute viral bronchiolitis phenotype in response to glucocorticoid and bronchodilator treatment

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze whether infants admitted to hospital with Acute Viral Bronchiolitis (AVB), who received glucocorticoids and bronchodilators, and who had an atopic phenotype, spent less time in hospital and/or less time on oxygen therapy when compared to those who did not have the phenotype.

Method

A cross-sectional, retrospective epidemiological study was developed with data from medical records of infants admitted to hospital due to AVB from 2012 to 2019 in a sentinel public hospital. It was verified that the frequency of prescription of glucocorticoids, bronchodilators and antibiotics. Length of stay and oxygen therapy duration were then compared in the group that used glucocorticoids and bronchodilators between those who had a personal or family history of atopy and those who did not. Subsequently, the length of hospital stay was compared among infants who received antibiotic therapy and those who did not.

Results

Fifty-eight infants were included. Of these, 62.1 % received an antibiotic, 100 % a bronchodilator and 98.3 % a glucocorticoid. When comparing infants without a family history of atopy, those who received antibiotics had a longer hospital stay (p = 0.01).

Conclusion

The presence of an atopic phenotype did not interfere with the length of stay and/or oxygen therapy duration of those who received bronchodilators and glucocorticoids. Increased length of stay of infants without a family history of atopy, who used antibiotics without evidence of bacterial co-infection, and the high frequency of prescription of non-recommended drugs call attention to stricter protocol implementation and professional training in AVB diagnosis and care.

Keywords
Bronchiolitis; Treatment; Phenotype; Glucocorticoid; Bronchodilator; Respiratory syncytial virus

Highlights

The frequency of prescription of medications not recommended for bronchiolitis is high.
Atopic phenotype did not interfere with the response to bronchodilators and glucocorticoids.
The lower the respiratory rate, the shorter the oxygen therapy duration for bronchiolitis.

Age (days)	n (%)
0‒60	17 (29.3)
61‒180	23 (39.7)
181‒365	13 (22.4)
> 365	5 (8.6)
Mean:	144.9 days
Exclusive Breastfeeding (EBF) duration in those over 180 days	n (%)
Still in EBF^a a 203-days.	1 (5.5)
Less than 30 days	1 (5.5)
30‒119 days	8 (44.4)
120‒180 days	2 (11.1)
Undetermined	6 (33.3)
Nutritional (z-score)	n (%)
High weight for age (> +2)	1 (1.8)
Adequate weight for age (≥ −2 and ≤ +2)	51 (89.4)
Low weight for age (< −2 and ≥ −3)	4 (7.0))
Very low weight for age (< −3)	1 (1.8)
Length of hospital stay (days)	n (%)
0‒3	17 (33.3)
4‒6	16 (31.3)
7‒10	15 (29.4)
+ than 10	3 (6)
Mean:	5.4± 3.2
ICU length of stay (days)	n (%)
1‒2	12 (57.1)
3‒4	5 (23.8)
5‒6	3 (14.3)
7 or more	1 (4.8)
Mean:	2.6 ± 1.9
Oxygen therapy duration	n (%)
Did not use	13 (22.4)
Less than 24 h	4 (7)
Undetermined	5 (8.6)
1‒2 days	22 (37.9)
3‒4 days	9 (15.5)
More than 4 days	5 (8.6)
Mean among those who used more than 24 h:	2 days
VIP score	n (%)
Blue (0)	5 (9.6)
Green (1‒2)	6 (11.5)
Yellow (3‒5)	14 (26.9)
Orange (6‒9)	26 (50.0)
Red (≥ 10)	1 (1.9)
History of atopy (eczema, previous wheezing, allergic rhinitis)	n (%)
Yes	5 (8.6)
No	44 (75.9)
Undetermined	9 (15.5)
Family history of atopy (eczema, asthma, allergic rhinitis)	N (%)
Yes	22 (37.9)
No	24 (41.4)
Undetermined	12 (20.7)

Variables	Length of hospital stay (n)	p	Oxygen therapy duration (n)	p
EBF
≥ 120 days	8	0.6	5	0.23
< 120 days	2	0.6	2	0.23
SpO₂
≤ 1	16	0.14	14
> 1	20	0.14	21	0.26
HR
≤ 1	10	0.66	11
> 1	29	0.66	26	0.20
RR
≤ 1	22		21	0.03
> 1	17	0.82	16	0.03
Vipe score
≤ 1	4	0.96	4
> 1	32	0.96	31	0.10
History of atopy
With a history of atopy	4		3
No history of atopy	36	0.57	34	0.73
Family history of atopy
With a family history of atopy	20		17
No family history of atopy	20	0.46	20	0.34
Fever
With fever	26		19
No fever	14	0.69	18	0.36
Sex
Male	22		25
Female	18	0.76	12	0.97
Antibiotic
With antibiotic	26	0.07	25
No antibiotic	14	0.07	12	0.06

Group	Received antibiotic	Family history of atopy and history of atopy		p
Group	Received antibiotic	Yes	No	p
Group 1B	Yes	2		1
Group 2B	No	2		1

Group 1B	Yes	2		0.74
Group 3B	Yes		10	0.74

Group 1B	Yes	2		0.16
Group 4B	No		10	0.16

Group 3B	Yes		10	0.83
Group 2B	No	2		0.83

Group 4B	No		10	0.75
Group 2B	No	2		0.75
				0.01
Group 3B	Yes		10
Group 4B	No		10

Country	Bronchodilator (%)	Glucocorticoid (%)	Antibiotic (%)
Brazil - 2022	100	98.3	62
Italy-Manti S. et al., 2021³⁷37 Manti S., Licari A., Brambilla I., Caffarelli C., Calvani M., Cardinale F., et al. Agreements and controversies of national guidelines for bronchiolitis : results from an Italian survey. Immunity, Inflamm Dis. 2021;9(4):1229-36.	39.6	64.5	4.7
Australia and New Zealand - Oakley S. et al., 2018³⁸38 Oakley E., Brys T., Borland M., Neutze J., Phillips N., Krieser D., et al. Medication use in infants admitted with bronchiolitis. Emerg Med Australas. 2018;30(3):389-97.	24.2	11.6	14.1
Jordan-Awad S. et al., 2020³⁹39 Awad S., Hatim R., Khader Y., Alyahya M., Harik N., Rawashdeh A., et al. Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan. Multidiscip Respir Med. 2020;15(1):673.	31.9	5.5	16.5
Spain-Martinez D.A. et al., 2022³²32 Martínez D.A., Pellitero S.E., Nogueira P.V., Cadenas J.A.A., Díaz M.J.M., Torre-Espi M de la, et al. Descenso del uso de broncodilatadores en el manejo de la bronquiolitis tras aplicar iniciativas de mejora. An Pediatr. 2022;96(6):476-84.	51.2	‒	‒

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] ⁎ Corresponding author. E-mail address: andressachacorowski@gmail.com (A.R.P. Chacorowski)