The diagnostic and therapeutic approach ito acute bronchiolitis in hospitalized children in Israel: A nationwide survey

Background: Bronchiolitis caused by respiratory syncytial virus is one of t he major causes of hospitalization in young children, especially during the winter. Recent evidence has shown that pharmacological treatment, especial ly nebulized epinephrine, in addition to the traditional supportive treatme nt, can alleviate symptoms and shorten hospitalization, but this approach i s not yet widespread. Objectives: To determine whether the management of bronchiolitis in Israel is moving toward a stronger emphasis on pharmacological care. Methods: A questionnaire on the diagnosis and management of bronchiolitis w as completed by 27 heads of pediatric departments throughout Israel. The qu estionnaire dealt with the frequency of usage of diagnostic and Selected th erapeutic procedures. Results: Chest X-ray and arterial blood gases are commonly used as a diagno stic aid in more than 75% of the departments, and antibiotics are prescribe d routinely in 24%. Corticosteroids are still in use: 48% use systemic ster oids, and 19% nebulized steroids. Nebulized epinephrine is used in 22% of t he departments, while nebulized beta-agonists are used frequently in two-th irds of the departments. Conclusions: Despite convincing data that beta-agonists and steroids have n o positive effect on the outcome of bronchiolitis on the one hand, and that nebulized,epinephrine has advantages in children on the other, we found si gnificant use of the former two agents and sparse use of the latter. Greate r awareness is needed among pediatricians, and measures should be introduce d to incorporate the new recommendations, with further study of the effect of the old and new drugs on bronchiolitis.