We greatly appreciated the article by King et al1 for the thorough information that it gives about the pharmacologic treatment of bronchiolitis in infants. Nevertheless, we believe that in a systematic review about the pharmacologic treatment of bronchiolitis, surfactant should have been considered. Even if the interest for this treatment was limited to intubated children with very severe disease, these are the very children most in need of an efficacious therapy. There is convincing physiopathological evidence of the role played by surfactant’s genetics2 and deficiency3 in the most severe forms of bronchiolitis. Furthermore, limited but repeated evidence from small clinical trials suggests that surfactant treatment is likely to be beneficial, playing a role in maintaining small-airway patency as well as lung compliance in children infected with respiratory syncytial virus.4,5
Barbi E, Faleschini E, Bassanese S. Do We Really Need More Trials About the Efficacy of Commonly Used Treatments for Bronchiolitis? Arch Pediatr Adolesc Med. 2005;159(2):195–197. doi:10.1001/archpedi.159.2.196
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