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35 A COMPARISON OF PROVIDER AND PRACTICE SETTINGS IN THE USE OF BETA-2-AGONIST BRONCHODILATORS FOR THE TREATMENT OF BRONCHIOLITIS.
  1. K. C. Willis,
  2. M. E. Hare,
  3. R. I. Shorr
  1. Department of Pediatrics and Preventative Medicine, University of Tennessee, Memphis, TN

Abstract

Purpose There is minimal evidence showing that beta-2-agonist bronchodilators (BDs) improve outcomes in bronchiolitis. The use of these agents in ambulatory settings for children with bronchiolitis has not been well studied.

Methods Data from emergency department and physician office visits were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 1995-2003. Visits surveyed included those of children less than or equal to 2 years old who were seen by a physician and given the primary, secondary, or tertiary diagnosis of bronchiolitis. We excluded children with concomitant diagnoses that would otherwise justify the use of BDs (eg, asthma). BDs included albuterol, albuterol sulfate, levalbuterol, or salmeterol.

Results 491 visits met study criteria. BDs were prescribed in 311 (63%) visits. Children seen in the emergency department were more likely to receive BDs compared to children seen in office settings; 66% versus 57% (OR = 1.51 [95% CI = 1.03-2.23]). BD use did not vary with other factors, such as patient race, insurance status, hospital teaching status, or physician level of training. There was no significant trend over time toward decreasing beta-2-agonist bronchodilator use (p = .7447).

Conclusion Despite lack of efficacy, nearly 2/3 of children with bronchiolitis are treated with BDs in ambulatory settings—especially in emergency rooms.

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