A baby who coughs, breathes badly and whose chest whistles: bronchiolitis is the obsession of young parents. To better treat it, new official guidelines come out Thursday and do not recommend the respiratory medicine, yet widely practiced.
It is necessary "to leave the idea according to which bronchiolite = kiné", explains the pediatrician Christophe Marguet, who took part in the drafting of these new recommendations of the High authority of health (HAS).
Bronchiolitis is a common respiratory disease, affecting 30% of babies under 2 years of age each year, or 480,000 cases per year, according to official estimates. Caused by a virus, it is very contagious.
Main symptoms: coughing and difficulty breathing, which becomes fast and wheezing.
Although this disease is mostly benign, "it is extremely distressing for parents," says HAS President Dominique Le Guludec.
"Its acute phase lasts an average of 10 days, the first two of which require increased attention," according to HAS.
Today, bronchiolitis is very often taken care of by respiratory physiotherapy sessions. Often impressive manipulations, supposed to help the baby breathe better by evacuating the secretions that bother him.
The new guidelines, which only apply to infants under 12 months of age, do not recommend respiratory medicine. Reason relied on by HAS: the studies have not provided scientific proof of its effectiveness against bronchiolitis.
The physiotherapist also did not appear in the previous recommendations, which dated back to 2000. This did not prevent it from being massively prescribed.
"We are in habits", judges Professor Pierre-Louis Druais, HAS.
"We are the only country with Belgium where the physio is done in a large way in the cases of bronchiolite", adds Professor Le Guludec, according to which there are however "particular cases where that can be useful, for example among disabled children ".
- Nose wash -
The debate on the respiratory physiotherapy is not new. In 2012, the Prescrire magazine judged that it was not effective against bronchiolitis, which had provoked the protests of physiotherapists.
And the recommendations gave rise to "a strong disagreement" within the working group that developed them, it is indicated in appendix: out of 18 members, four (three physiotherapists and a generalist) disapproved the final version.
These recommendations "do not mean that we diminish the role of physiotherapists", wants to reassure Professor Le Guludec. "This role can change" and become "a monitoring role, monitoring", including the Bronchiolitis Networks, structures set up in times of epidemic.
In addition, drug treatment is not recommended, either bronchodilators such as Ventolin, corticosteroids or antibiotics (reserved for "rare cases of bacterial superinfection").
The main novelty of the recommendations is to classify the cases according to three levels of severity, so that the doctors can better orient the small patients.
The mild forms do not require hospitalization, the moderate forms can lead to it on a case-by-case basis and the severe forms are directed from the outset to the hospital.
Currently, 2 to 3% of infants under one year are hospitalized for bronchiolitis each year, says the health agency Public Health France.
In general, the new recommendations base management on "regular nose washing and monitoring for signs of worsening".
Nose washing is necessary for babies to breathe because they are unable to blow their noses on their own. To evacuate the snot, you must empty a dose of saline into the nostril of the infant lying on its side.
Easy to say but not necessarily to do on a struggling baby, as experienced by young parents.
This gesture "anguish: there is a technique, and it is important that health professionals learn them," says Professor Druais, according to which the physiotherapists have their role to play in this training.
© 2019 AFP