Journal des maladies infectieuses et de la médecine préventive
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Effect of Previously Administered Medication on Length of Hospital Stay in Patients with Moderate Acute Bronchiolitis

J Carlos Flores-González, Belén Serrano Moyano, Juan J Pérez-Guerrero, Patricia Rodriguez Campoy, Ana Estalella Mendoza, Gema Jiménez-Gomez and Alfonso M Lechuga-Sancho

Background: Bronchiolitis is a leading cause of hospitalization in infants and the most common lower respiratory infection of infancy, yet optimal treatment is still debated. Most inpatients with bronchiolitis have been referred to hospitals by their primary care providers, and are usually prescribed inhaled bronchodilators and/or oral corticosteroids despite current recommendations.

Aim: To assess the efficacy of inhaled salbutamol and oral corticosteroids received prior to admission in patients with acute bronchiolitis.

Methods: Prospective study in the context of a randomized, controlled, double-blind clinical trial. In total, 185 patients with moderate bronchiolitis were included and categorized into 4 groups: patients who received 1) no medication, 2) inhaled salbutamol, 3) oral corticosteroids or 4) a combination of these therapies, prior to admission for more than 24 hours. Patients who received corticosteroids during hospitalization and patients with risk factors for severe bronchiolitis were excluded. Length of stay (LOS) was recorded as the main variable. Secondary variables were clinical status, respiratory rate, and oxygen saturation on admission.

Results: Demographic and clinical data were similar in all 4 groups except age, which was lower in the groups that received no medication (p<0.0001). The group that received combined therapy with salbutamol and corticosteroids before admission had a shorter mean LOS compared to the group that did not receive any medication at all (3.76 ± 1.6 vs. 4.66 ± 2.1; p=0.007). There were, however, no differences in any secondary outcomes: clinical severity score, respiratory rate or oxygen saturation.

Conclusion: Hospital stay is shorter in outpatients with moderate acute bronchiolitis receiving oral corticosteroids and inhaled salbutamol for more than 1 day before admission than in untreated patients. More studies are needed to confirm these results and to help identify which groups benefit from this treatment.