Tag Archives: RSV

Which Bronchiolitis Treatment is Best? (Article)

Bronchiolitis, a common viral infection of the lungs in infants, is a very difficult condition for pediatricians to treat. Fortunately, a new study has given doctors a way to improve an old treatment that seems to really help the infants who are afflicted: on-demand nebulized breathing treatments.

In a recent study, researchers who were focusing on the most effective treatments of acute bronchiolitis in infants found that “on-demand” breathing treatment schedules reduced hospital stays more than traditional fixed-treatment intervals. Acute bronchiolitis is a common respiratory virus that limits the passage of air through tiny pathways, known as bronchioles, in infants’ lungs. The bronchioles become inflamed and mucus fills the pathways, making breathing difficult. Acute bronchiolitis is most often caused by a virus called RSV but can also be brought on by the same virus that causes the common cold or even the flu. Symptoms include a stuffy or runny nose, coughing, or a mild fever, followed by worsening coughing and wheezing. The illness sometimes results in hospitalization, mostly in infants less than 4 months of age. There are a wide variety of treatment options available, including inhaled racemic adrenaline, inhaled bronchodilators like albuterol, and inhaled saline, all designed to open these tiny airways.

Both adrenaline and saline mist treatments were found to reduce airway blockage and clear mucosal obstructions in infants with bronchiolitis, but the researchers found that the timing of the treatments made quite a difference; infants who received treatment on-demand, whenever a treatment was deemed necessary, had, on average, a 14 hour shorter hospital stay. Interestingly enough, they also received fewer treatments and had less need of supplemental treatments such as ventilators or oxygen.

A simple change in the timing of breathing treatments is making healthcare better for infants with bronchiolitis.  The shortening of hospitalization time can reduce the costs associated with treatment and  reduce the risk of inadvertently contracting another illnesses by exposure to other sick children. The on-demand schedule also allows infants to have minimal sleep disruption, more comfort, and an even faster recovery.  Good news for everyone!

Your comments are welcome at www.dosmo.com, the home of portable, practical pediatrics. Until next time.

Smo notes:

1.  Håvard Ove Skjerven, M.D., et al, Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis,

N Engl J Med 2013; 368:2286-2293June 13, 2013DOI: 10.1056/NEJMoa1301839

(http://www.nejm.org/doi/full/10.1056/NEJMoa1301839)

The Rhythm of Pediatrics (Pedcast)

Experienced pediatricians are very attuned to the health problems that children have throughout the year.  The cycle is predictable and consistent.  Listen to this week’s podcast to get a glimpse of what pediatricians see throughout the year when it comes to childhood illnesses, season by season.

Transcript:

Welcome

Hope you are having a good day

-Thank you for joining us for another pedcast.

-Weather is changing here in Charlotte

-Colder nights and shorter days can only mean one thing… the seasons are changing and so will the illness that we will see in the office.

-Pediatricians get used to a rhythm of illness that progresses through the year…predictable pattern season by season

-In today’s pedcast I wanted to give my listeners a chance to see things the way a pediatrician views them

-Lets face it, weather has a big influence on your children and their health. We all know this instinctively from our own experience but today lets take a closer look at how the natural world influences the health of your children through the seasons.

-Before we get started today, I want to remind my listeners that my intention in making this blog is not to provide specific medical advice for your child but rather to provide general information that may be useful to parents.
-For specific advice about your child, visit the wonderful person you call your child’s doctor.

 

2. To me, it only makes sense that your child’s health is strongly influenced by the natural world they live in. That natural world is made up of a huge variety of microbes…bacteria, viruses, molds, fungi .  Your child touches disease producing germs constantly.  It is amazing to me that they are not sick all the time. Here are some of the disease producing microbes your child needs to be ready to encounter this year, season by season;

 

3. Lets start with Fall -As soon as school gets back in session, here comes strep.

-School means strep I guess because the school environment provides an opportunity for close secretion contact.  Yuck.  Being in close contact with 30 other children all day, mostly in one classroom provides ample opportunity to spread this nasty germ around.

 

Fall also brings us some cool nights along with a distinctive barky cough illness we call croup.  The croup syndrome consists of a sore throat, maybe some fever, followed a few days later by a deep wet cough that comes from the bronchioles

Croup…First shot across the bow of winter. Of course babies first, then the older children.   Lots of germs can cause the croup syndrome but most commonly a virus called parinfluenza

 

Again, school provides the vehicle for germs to easily travel.  Remember this  DocSmo pearl – Germs can’t run, jog, or walk, … they need to be dragged from nose to nose and the dragging happens on your child’s hands.   In other words, clean hands mean a lot less illness.  Teach your children to wash before eating and after the potty… and teach them the elbow cough!

 

 

4. OK, next comes winter…It is getting colder and darker and here comes the big bad players of the year.  The really mean, dangerous germs of the year…the dreaded winter diseases.

The season opener is usually Bronchiolitis- an infection that affects your child’s lungs a little deeper than croup , in the smaller air tubes called bronchioles- usually caused by a germ called RSV.

By December, in the Northern hemisphere where it is winter, we are getting a sneak preview of the worst illness of the year, influenza–  By mid December this disease starts to take hold and then…

Kids get out of school….  wanes

School is back in session and the explosion of flu occurs. Attack rates as high as 90%.  That’s when the kids start coming to the office in their pajamas and lovies and not sitting up when you go into the exam room…bad sign.

Finally, as if the winter hadn’t been bad enough, here comes the stomach flu caused by a germ called Rotavirus. Often with this illness, the parents look as bad as the kids.  Thankfully we now have a vaccine to make this illness milder in our most vulnerable children, babies.  Make sure you take advantage of this vaccine.

 

5. With the change of seasons into spring comes another shift in pediatric illness…

 

Now it’s time for “allergies” along with a surge in cases of streptococcal diseases.  Scarlet fever, Strep throat, Impetigo, and even Rheumatic fever.  More on that later in another podcast.

 

6. Finally summer comes Summer

Major drop off in illness…but now they are getting hurt! Sunburns, poison ivy, lacerations, and broken this and that.

When the pool opens, here comes water borne and food borne diseases…diarrhea caused by a group of germs called entero viruses ( entero being a word that means stomach)  Some of the common ones that you might have heard about are HandFootMouth, and Herpangina.  In years past, before the miracle of vaccines, polio was caused by one of these entero that came around in the summer and could devastate a child for life. Great grandma’s was so afraid of this germ that she insisted that  grandpa not go swimming or out in public during community outbreaks for fear he might contract the disease.  Pools were closed and get togethers canceled.   Communities just shut down. Once again, Grandma showed her genius.  She understood how germs travel without ever taking a microbiology class.   How did that lady know.

 

That reminds me of another DocSmo pearl…

Germs love get togethers so they can get it together!  In other words, crowds of young children means germs can be on the move and make your child sick.  Limit your child’s exposure to large groups of children.

 

7. So that’s the Rhythm of Pediatrics. Croup and strep in the fall, Bronchiolitis, flu, and severe rotavirus diarrhea in the winter, strep and allergies in the spring, and finally injuries and enteroviral illnesses in the summer.  Each year the cycle gets repeated.  Vaccines have made the list of germs that children have to deal with much shorter thank goodness but as you can see, kids still have a lot to deal with.

 

8.

I want to thank you for joining me today.  Please be sure to check out the next episode of DocSmo.com when Dr Sheila Kilbane will give us her insight into how to “Winterize” your children.  She is always full of great information both practical and thought provoking.

If you enjoyed today’s talk, go ahead, take the plunge and subsribe either through itunes, face book or twitter.  Alternatively you can go to my website, DocSmo.com and hit the rss button and subscribe that way.

 

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This is Dr Paul Smolen, broadcasting from Studio 1E, first child’s bedroom, east side of the house, hoping you have a little more smarts as the next season starts!

 

Until next time
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