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August 20, 2014

Bronchiolitis, Deception in Research, and Clinical Decision Making

Author Affiliations
  • 1Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
  • 2Editor in Chief, JAMA
JAMA. 2014;312(7):699-700. doi:10.1001/jama.2014.8638

Bronchiolitis is a viral lower respiratory tract infection characterized by increased respiratory effort and wheeze in young infants. Optimal clinical management has been difficult to define because bronchiolitis is a heterogeneous clinical condition and definitive research is lacking. During the past 3 decades, racemic epinephrine, bronchodilators, oral corticosteroids, inhaled corticosteroids, normal saline, and hypertonic normal saline have been suggested as potential therapeutic options for bronchiolitis, but a single best practice has not emerged. In addition to the therapeutic uncertainty, clarity is lacking about admission and discharge criteria and the long-term effect of hypoxia. Coupled with these challenges are data that indicate hospitalization rates for bronchiolitis doubled from 1980 to 1996,1 concomitant with the introduction of oxygen saturation monitoring. Data from 2011 indicate that “acute bronchitis” in infants younger than 1 year remains the most common reason for hospital admission (184 hospitalizations per 10 000 population).2 In many emergency departments, the oxygen saturation reading has become part of the initial set of vital signs and is used by clinicians to guide their clinical assessment of illness severity, their therapeutic approach to the patient, and their decisions about safe discharge, either from the emergency department or an inpatient facility.

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