Across Canada, thousands of babies are hospitalized every year for a common lung infection called bronchiolitis, causing undue stress to family members and racking up millions of dollars in costs to the health care system. But a group of Canadian pediatricians has found a promising way to treat the condition—one that could reduce the number of hospitalizations by over one-third.
In a national study, the results of which are published today in the New England Journal of Medicine, the team showed that treating bronchiolitis with two common drugs could reduce hospitalizations by 35 per cent. It’s an astonishing finding. “We were blown away,” says Dr. Terry Klassen, a co-principal author of the study and professor in the department of pediatrics at the University of Alberta‘s Faculty of Medicine and Dentistry. “A reduction rate that size is pretty significant.”
Bronchiolitis, an inflammation of the lung’s airways generally caused by viral infections, generally starts off with a cough and runny nose. This can turn into laboured breathing, and might even lead to depleted levels of oxygen in the blood. “It’s probably the most common lower respiratory tract infection in kids less than a year of age,” says Dr. Amy Plint, a pediatric emergency physician at the Children’s Hospital of Eastern Ontario and the lead study investigator. In Canada, about 35 in 1,000 babies are hospitalized each year for the condition, and about two per cent of those who come to the emergency room end up in the intensive care unit, she notes. Treating bronchiolitis in hospital isn’t cheap: in the U.S., annual hospitalization costs for the condition have been estimated at $700 million.
But bronchiolitis isn’t just a drain on hospital resources; it creates stress for family members, too. “From a parent’s point of view, it’s a long and frustrating illness,” Plint says. “The symptoms can last for up to three weeks. Children have a hard time breathing; they’re fussy and irritable. It creates a lot of sleepless nights.” A 35 per cent reduction in hospital visits, then, would have a huge impact both on health care costs, and on the countless families affected.
In the study, babies were treated with epinephrine, which helps open airways, and dexamethasone, a steroid that reduces inflammation. While these drugs have been used to treat bronchiolitis in the past, studies haven’t supported their effectiveness when used separately. “Each one alone didn’t do much,” Klassen says. “But when you put them together, there’s a synergistic effect. That was surprising.”
In the randomized clinical trial, babies aged six weeks to 12 months who were suffering from bronchiolitis were randomly assigned to one of four study groups. One was treated only with epinephrine; one with dexamethasone; one with the two drugs combined; and one with a placebo. Babies who received the combined drug treatment recovered faster; one week later, they were also 35 per cent less likely to have been hospitalized.
“We now have something, for the first time ever, that’s been shown to reduce [infants’] hospitalizations [due to bronchiolitis],” says Plint, who says the treatment is already been used in limited ways across Canada. For the thousands of parents who’ve cared for a wheezy baby, that’s something to celebrate.