ABSTRACT
Introduction: This study is the first of its kind in Lebanon to probe the management of bronchiolitis by pediatricians and family physicians. The American Academy of Pediatrics [APP] guidelines and standard global meta-analyses guided the comparison of patterns of medication treatment in Lebanon with clinical practices elsewhere. The aim of the study is to create a guideline that can assist with the establishment of a protocol for treatment, prevention and public education of the disease
Materials and Methods: A survey was conducted based on the clinical practice recommendations of the 2000 French consensus conference for acute viral bronchiolitis management. The survey included 80 pediatricians and general practitioners representing different regions of Lebanon
Results: The study showed inconsistency in the approach to diagnose and treat bronchiolitis in Lebanon. Results showed that 98.57% of the Lebanese pediatricians confirm the diagnosis clinically, however 41.18% of them do chest X-rays, 48.28% order a blood test and 72.86% search for viral etiology. Concerning the treatment, while all Lebanese pediatricians seemed to be convinced that the treatment of bronchiolitis is supportive [hydration, splitting meals, proclive position at 30 degrees, nasal decongestion], almost 57% said they prescribe bronchodilators, 30% opt for inhaled or oral corticosteroids, and 10% order antibiotics for prevention. When the patient is admitted, more than 80% of the practitioners reported the use of respiratory physiotherapy, while 60% said they make use of inhaled bronchodilators. Nebulized epinephrine is chosen by 65 percent of those surveyed; nebulized hypertonic saline is used by less than 40%, while more than half of the practitioners prefer nebulized physiologic saline. Concerning the administration of palivizumab, significant dissimilarity was detected among the pediatricians: 27.45% said they prescribe three doses as immunoprophylaxis, while 72.55% said they respect the five-dose rule
Conclusion: The management of bronchiolitis in Lebanon remains far from being standardized, with every pediatrician having his or her personal approach. This has led us to carry out the first ever national study to outline a regimen that is clear and based on international standards, which should be validated by the Lebanese Pediatric Society and disseminated to pediatricians and hospitals around the country. We also recommend further studies comparing the cost effectiveness of palivizumab injections with the cost of hospitalization for bronchiolitis on social security systems and health insurance schemes