The Application Of Glucocorticoid In The Treatment Of Bronchiolitis

Background Bronchiolitis, which is mainly caused by respiratory syncytial virus (RSV), is one of the common lower respiratory tract diseases in infancy. It’s a clinical syndrome including both infectious inflammatory reaction and allergic inflammatory reaction. The main clinical manifestations of bronchiolitis are dyspnea, asthmatic and three depressions sign, which may spread gradually and even endanger life if left untreated. In recent decades, there is a significant increase in the number of hospitalized infants due to bronchiolitis, while there is no specific treatment for bronchiolitis. Glucocorticoid has been widely used as anti-inflammatory for the treatment of bronchiolitis in our country, but there are debates about the curative effect. In this paper, the related issues are discussed as below.Objective To discuss the influence of different administration methods of glucocorticoid on the treatment of bronchiolitis in infants.Method Infants with bronchiolitis, aged from1to12months, in my department from January2012to September2013are chosen as the subjects of clinical research.89infants are divided into three groups randomly:group1, group2and group3. All of the three groups are given the treatment of antiviral (such as with bacterial infection, antibiotics therapy), eliminating phlegm, rehydration and other symptomatic treatment. Group1(32cases) are given small doses of methylprednisolone sodium succinate lmg/Kg at a time and two times per day with5%glucose injection by intravenous drip for3-5days. Group2(28cases) are given fluticasone propionate aerosol125ug and30s-60s at a time, two times a day, inhaled by a spacer with flapper for5-7days. Group3(29cases) are given budesonide suspension0.5mg and10-15min at one time,2times a day for5-7days. The budesonide suspension will join the saline to2ml and be inhaled by mask oxygen devices. The time for heart rate and breathe returning to normal, disappearance time of cough, dyspnoea, lung rale and wheeze, hospital stay, scores of the three groups after5days of treatment have been compared and analyzed.Result1.For group1, the disappearance time of cough is (5.75±1.05) days, the disappearance time of dyspnoea is (4.16±0.77) days, the time for heart rate returning to normal is (2.81±0.74) days, the time for breathe returning to normal is (3.84±0.63) days, the disappearance time of lung rale and wheeze is (5.06±1.16) days. For the group2, the times are accordingly (5.07±0.81) days,(3.75±0.80) days,(2.18±0.77) days,(3.43±0.79) days,(4.39±0.50) days. For the group3, the times are accordingly (4.41±0.83) days,(2.38±0.49) days,(1.66±0.67) days,(2.45±0.63) days,(4.00±0.66) days. There are statistical significant differences between group1and group2(P<0.05) and statistical significant differences between group1and group3(P<0.05). There are statistical significant differences (P<0.05) except in terms of the disappearance time of lung rale and wheeze (P>0.05) between group2and group3.2. The hospital stay are (7.34±1.31) days in group1,(6.46±1.23) days in group2,(5.97±0.68) days in group3. There are statistical significant differences in terms of hospital stay both between group1and group2(P<0.05) and between group1and group3(P<0.05). There are no statistical significant differences between group2and group3(P>0.05).3. The total effective rate is50.00%in group1,75.00%in group2and93.10%in group3.There are statistical significant differences in terms of total effective rate both between group1and group2(P<0.05) and between group1and group3(P<0.05). There are no statistical significant differences between group2and group3(P>0.05).4. The scores before treatment are (5.75±1.22) in group1,(5.68±1.06) in group2and (5.72±1.28) in group3. The scores after5days of treatment are (2.28±0.81) in group1,(1.75±0.75) in group2and (1.17±0.89) in group3. The scores of the three groups after5days of treatment are lower than scores before treatment with statistical significant (P<0.05). There are statistical significant differences in terms of scores after treatment between group1and group2(P<0.05), between group2and group3(P<0.05) and between group1and group2(P<0.05).Conclusion Glucocorticoid especially budesonide suspension should be topically inhaled to increase the cure rate for bronchiolitis and to improve oxygen-deficiency. Furthermore, fluticasone propionate could be inhaled for a short time to shorten the the course. It’s easy to apply and promote in clinic with its safety and less side effect.