title: Bronchodilator and steroid use for the management of bronchiolitis in Canadian pediatric emergency departments.
abstract: OBJECTIVE
  Given the recent publication of several large trials and systematic reviews, we undertook a study of the current management of bronchiolitis in Canadian pediatric emergency departments (EDs) and explored physicians' rationale for their treatment decisions. The overarching purpose of this study was to assist in planning a future trial of combined epinephrine and dexamethasone for bronchiolitis.
  
  
  METHODS
  Physicians in the Pediatric Emergency Research Canada (PERC) database received an 18-item electronic survey. A modified Dillman method was used.
  
  
  RESULTS
  Of the 271 physicians surveyed, 191 (70.1%) responded. The majority (120 of 271; 66.5%) reported ''typically'' giving a bronchodilator trial in the ED, with respondents almost evenly divided between treatment with salbutamol (n=62) and treatment with epinephrine (n=61). Of those who use salbutamol, 77.4% indicated that they prefer it because it can be prescribed for home use. Of those who use epinephrine, 80.3% indicated that they believe the medical literature supports its benefit over salbutamol. Few participants (2.6%) reported ''always'' using steroids, whereas the majority (62.8%) reported ''sometimes'' using them. The most common factor reported to influence steroid use was illness severity (73.3%). The majority (60.5%) reported that if corticosteroids were beneficial in bronchiolitis, they prefered treatment with a single dose in the ED as opposed to a multiday course.
  
  
  CONCLUSIONS
  Our results indicate that physicians practicing in Canadian pediatric EDs commonly use bronchodilators to manage bronchiolitis but use corticosteroids less commonly. They appear to be uncomfortable using corticosteroids, particularly longer courses, and have a stated preference for a single dose. Any future trial examining the role of corticosteroids in bronchiolitis should carefully consider the issue of steroid dosage.
authors.affiliation: *Departments of Pediatrics and Emergency Medicine,University of Ottawa,and the Children's Hospital of Eastern Ontario,Ottawa,ON.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Plint
authors.affiliation: †Department of Psychology,University of Ottawa,Ottawa,ON.
authors.forename: Renee
authors.initials: R
authors.lastname: Grenon
authors.affiliation: ‡Manitoba Institute of Child Health,Department of Pediatrics,University of Manitoba,Winnipeg,MB.
authors.forename: Terry P
authors.initials: TP
authors.lastname: Klassen
authors.affiliation: §Departments of Pediatrics and Physiology and Pharmacology,University of Calgary,Calgary,AB.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D001988:Bronchiolitis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002170:Canada; D002648:Child; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids
keywords: emergency department