NEW HOPE FOR BRONCHIOLITIS,DR.D.K.JHA,M.D
Bronchiolitis is the most common resspiratory tract infection requiring hospital admission in infants.
The most common organism causing bronchiollitis is Respiratory syncytial virus(RSV).
Most children become infeccted with this virus by the second year of life.
Most of the infections are mild in nature and do not require any attention.
Few children acquire lower respiratory tract infection and some of them require hospitalization.
Other viruses causing bronchiolitis are Human Rhinovirus,Human Metapneumovirus,Bocavirus and many more
Children suffering from Rhinovirus bronchiolitis requiring hospital admission are more susceptible to develop asthma later in life.
Some children with bronchiolitis may be more susceptible to develop COPD later in adult life.
There is no definite treatment available to treat bronchiolitis.We are dependent only on supportive treatment in the form of maintenance of hydration and oxygenation of the child. Various inhalational medications are being used to treat this condition with variable results.Most frequently used inhalational medication is salbutamol.It is not clear that the child responding to salbutamol has a component of atopy and this is the reason for response. Other inhalational agents being used are adrenaline,normal saline,hypertonic saline,combination of salbutamol and ipratropium and inhalational corticosteroid. Some pediatrician use injectible corticosteroid to tide over the situation. Inspite of all the efforts,few childern face severe respiratory distress with prolonged course of hospital stay requiring intravenous fluid and oxygen.In rare instance, mechanical ventilation may be required to save the child.It is very important to note that, in children not requring hospital admission with normal feeding and activities,no treatment is required except saline nasal drop if there is nasal block and oral paracetamol if there is fever.
It has been proved that nitric oxide(NO) delivered at the rate of 160ppm ,effectively eliminate bacteria,virises,and fungi from respiratory tract.It is being used currently to treat serious lower respiratory tract infections in adulds,not responding to standard of care treatment.It is also being used to treat pulmonary arterial hypertension9PAH0 in neonates.
AIT therapeutic inc,has a delivery system which affectively deliver NO at the rate of 160ppm.There has been phase 2 randomized double-blind controlled trial published in prestigious Pediaric Pulmonology journal December 2017.In this trial, 43 infants between the age of 2-11 months suffering from moderatly severe bronchiolitis were enrolled. All received daily doses of inhalational nitric oxide 160ppm intermittently for 30 minutes ,five times a day for upto 5 days in addition to standard care in the form of IVF and Oxygen.There was no difference in side effects betwwen the study and control groups ,but length of hospital stay was significantly less in the study group.
Based on this result, Phase 3 trial(NO-BRO trial, nitric oxide in bronchiolitis) has been initiated .It is a prospective ranomized double- blind controlled trial. It will enroll 94 infants between the age of 0-12 months hospitalised with bronchiolitis. The study group will receive nitric oxide inhalation 160ppm for 30 minutes 5 times a day for upto 5 days in addition to standard care and control group will receive only standard care in the form of IVF and Oxygen. The primary endpoint will be length of hospital stay and secondary endpoint will be time to achieve a score of 5 or less on modified Tal score and time to achieve spo2 of 92% or more. The result is expected to come in the second quarter of 2018.
If rersults will be encouraging,it will be the boon for infants suffering from severe bronchiolitis and Pediatrician will breathe easily while facing the situation.
RFERENCES:
December 01, 2017 08:45 ET | Source: AIT Therapeutics, Inc.
Nitric Oxide Inhalations in Bronchiolitis: A Pilot, Randomized, Double-Blinded, Controlled Trial,Pediatric pulmonology Journal December 2017
Steven Lisi, Chief Executive Officer
AIT Therapeutics, Inc.
Steve@AIT-Pharm.com
Bob Yedid
LifeSci Advisors, LLC
Bob@LifeSciAdvisors.com
(646) 597 6989
Tags: Bronchiolitis, Nitric oxide