title: Overuse of bronchodilators and steroids in bronchiolitis of different severity: bronchiolitis-study of variability, appropriateness, and adequacy.
abstract: BACKGROUND
  In the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings.
  
  
  METHODS
  This is a cross-sectional, descriptive study of 5647 cases of acute bronchiolitis in 91 Spanish hospitals and primary care centres. We classified the appropriateness of the treatments according to the recommendations of a consensus conference.
  
  
  RESULTS
  There was an inappropriate use of treatments in 58.3% of the cases during the acute phase and in 45.4% during the maintenance phase. There was a generalised use of inhaled beta 2 agonists, regardless of the severity of the patients (hospitalised patients 69.3%, emergency care 63.2% and ambulatory 64.1%). Adrenaline was used in 30.1% of hospitalised cases and in 80.2% of intensive care patients. Systemic corticosteroids were not only used in one-third of hospitalised patients but also in 25.8% of ambulatory cases.
  
  
  CONCLUSIONS
  In acute bronchiolitis in Spain there is a wide use of treatments that are not recommended by the available clinical practice guidelines. Beta 2 agonist bronchodilators and corticosteroids are widely used and maintained, regardless of the severity of the patients.
authors.affiliation: Service of Pediatrics, Hospital Virgen de la Concha, Zamora, Spain. Electronic address: cochoas@meditex.es.
authors.forename: C
authors.initials: C
authors.lastname: Ochoa Sangrador
authors.affiliation: Service of Pediatrics, Hospital General Universitario de Alicante, Department of Pediatrics, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: J
authors.initials: J
authors.lastname: González de Dios
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013030:Spain
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents
keywords: Acute bronchiolitis; Bronchodilators; Corticosteroids; Physician's practice patterns; Treatment