Bronchiolitis; Respiratory Syncytial Virus Clinical Trial
Official title:
Steroid Therapy in Acute Bronchiolitis A New Old Line of Therapy.
The aim of the present study is to evaluate the efficacy of steroid therapy and hospital stay in patients with acute bronchiolitis at assiut university children hospital.
Bronchiolitis is an acute lower respiratory tract infection in early childhood.A subcommittee
of the American Academy of Pediatrics (AAP) together with the European Respiratory Society
(ERS) underlined that is a clinical diagnosis, recognized as "a constellation of clinical
symptoms and signs including a viral upper respiratory prodrome followed by increased
respiratory effort and wheezing in children less than 2 years of age".
Bronchiolitis is the common reason for hospitalization of children in many countries,
challenging both economy, area and staffing in pediatric departments. A substantial
proportion of children will experience at least one episode with bronchiolitis, and as much
as 2-3% of all children will be hospitalized with bronchiolitis during their first year of
life. Bronchiolitis is the most common medical reason for admission of children to intensive
care units (ICU) particularly those with risk Factors will have a severe course of
bronchiolitis, providing challenges regarding ventilation, fluid balance and general support
This may be a particular challenge for ICUs without a specialized pediatric section.
Many respiratory viruses have been associated with acute viral bronchiolitis although
Respiratory Syncytial Virus (RSV) remains the most common identified virus causing
bronchiolitis, occurring in epidemics during winter months.The infection starts in the upper
respiratory tract, spreading to the lower airways within few days.The inflammation in the
bronchioles is characterized by a peri-bronchial infiltration of white blood cell types,
mostly mono nuclear cells, and oedema of the submucosa and adventitia. Damage may occur by a
direct viral injury to the respiratory airway epithelium, or indirectly by activating immune
responses. Oedema, mucus secretion, and damage of airway epithelium with necrosis may cause
partial or total airflow obstruction, distal air trapping, atelectasis and a ventilation
perfusion mismatch leading to hypoxemia and increased work of breathing. Smooth-muscle
constriction seems to play a minor role in the pathologic process of bronchiolitis.
Risk factors for bronchiolitis are male gender, a history of prematurity, young age, being
born in relation to the RSV season, pre-existing disease such as broncho pulmonary- dysplasia
, underlying chronic lung disease , neuromuscular disease, congenital heart- disease ,
exposure to environmental tobacco smoke , high parity, young maternal age, short duration/no
breast feeding , maternal asthma and poor socioeconomic factors.
Bronchiolitis often starts with rhinorrhoea and fever, thereafter gradually increasing with
signs of a lower respiratory tract infection including tachypnoea, wheezing and cough. Very
young children, particularly those with a history of prematurity, may appear with apnea as
their major symptom.Feeding problems are common.
On clinical examination, the major finding in the youngest children may be fine inspiratory
crackles on auscultation, whereas high-pitched expiratory wheeze may be prominent in older
children. By observation, the infants may have increased respiratory rate, chest movements,
prolonged expiration, recessions, use of accessory muscles, cyanosis and decreased general
condition.
No routine laboratory or radio graphic diagnostic tests for bronchiolitis except for pulse
oxymetry , have been shown to have a substantial impact on the clinical course of bron-
chiolitis , and recent guidelines and evidence-based reviews recommend that no diagnostic
tests are used routinely.
The present study describes the efficacy of steroid therapy in patients with acute
bronchiolitis. Theoretically, corticosteroid, an anti-inflammatory agent, should be helpful
in the treatment of bronchiolitis because airway inflammation and edema are the main
pathophysiologies. Recent evidence has shown elevation of interleukins and other inflammatory
mediators in the respiratory tracts of children with acute bronchiolitis. Eosinophil cationic
protein, implicated in the pathogenesis of asthma, was found to have a significant role in
RSV bronchiolitis. Most of these mediators could be found during the period of virus
replication.The clinical effect of dexamethasone, with a long half -life of 36-72 hr, may
peak after 3-4 hr of treatment. Corticosteroids widely used in different routes in the
treatment of acute bronchiolitis:
Dexamethasone injection used in hospitalized children with acute bronchiolitis showed
significantly reduction in the mean respiratory distress duration, mean duration of oxygen
therapy and the mean length of hospital stay.
Oral dexamethasone used in pediatric out patients with acute bronchiolitis produced
demonstrable clinical improvement in the initial 4 hr of treatment and reduced the
hospitalization rate.
Corticosteroid inhalation therapy used in RSV- bronchiolitis showed evidence of prolonged
positive effects in reduction of the incidence of subsequent respiratory symptoms in the near
future. However, the best and sufficient length of the treatment period, as well as the dose
of the inhaled steroid, need to be determined..
Fluticasone propionate, a potent corticosteroid, has been demonstrated in vitro to inhibit
virus-induced chemokine production by airway cells in patients infected with Respiratory
Syncytial Virus. However, the inhibition was found to take at least 48 hr to reach its full
effect.
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| Status | Clinical Trial | Phase | |
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| Completed |
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| Recruiting |
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