Conditions of Vulnerability to Inadequate Treatment of Bronchiolitis

Goals: To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis.

Methods: A cross-sectional study included hospitalized infants with bronchiolitis caused by respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records.

Results: Among 120 cases, 90% used inhaled beta agonists, 72.5% corticosteroids, 40% antibiotics and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time.

Conclusions: Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.