Evidence base care (Clinical Assessment)

Treatment of bronchiolitis. Evidence base care (Clinical Assessment).

Bronchiolitis is the most common L.R.T.I characterized by acute inflammation, oedema and       necrosis of the epithelial cells lining the small airways, increase mucous production and bronchospasm.

Asses diagnosis:

Should diagnose on the basis of history and clinical examination.

Should not routinely order laboratory and radiological studies.

Should access risks factors for severe disease such as age < 12 weeks, prematurity and underlying cardio vascular disordes.

Evidence base high value care

  1. Airway clearance

  2. Nutritional support

  3. O2

  4. Avoid the sacred cow of Bronchodilators – Steroids – pulse oxymetry

Bronchodilators: Short acting beta agonist have no clear benefit for children < 2 years

                     (1 – 2 % of nebulized dose reach lungs)

Corticosteroids: Should not be used routinely in the management of bronchiolitis.

Continuous O2 monitoring not necessary

Chest physiotherapy not beneficial.

The issue of passive smoking should be addressed  (Tobacco Smoking Exposure)

Breast feeding is recommended to decrease the risk of lower respiratory tract infection.

By using Evidence Base criteria I will reduce the Hospital admissions. The expenses of treating a self limiting disease in the majority of cases will fall dramatically. In U.S.A. the cost of over treatment in 2011 reached the astronomical level of 80 bil.

But, I am a creature of habit. I don’t know how I can persuade myself, my colleagues and my patients to abandon the strategy of “do something”.

 I should review my practice at the end of the bronchiolitis seaso