Diagnosis, management, and prevention of bronchiolitis in primary care: a survey of Italian family paediatricians

TL;DR

This survey explores how Italian pediatricians diagnose and treat bronchiolitis, revealing inconsistent practices and a need for standardized guidelines.

Contribution

The study is the first to survey Italian primary care pediatricians on bronchiolitis management, highlighting variability in diagnostic and treatment approaches.

Findings

Diagnostic criteria for bronchiolitis varied widely among pediatricians, with inconsistent age limits and symptom-based approaches.

Use of non-recommended treatments like antibiotics and bronchodilators was common, influenced by diagnostic methods and age criteria.

Nirsevimab prophylaxis was widely accepted and had high compliance, suggesting potential for reducing bronchiolitis burden.

Abstract

Primary care paediatricians play a key role in the diagnosis, management, and prevention of bronchiolitis, but data on their clinical practices remain limited.

An online survey was conducted via email by the Lombardy section of the Italian Primary Care Paediatrics Society (SICuPP) between January 1 and April 30, 2025. Primary care paediatricians were invited to participate via email. Associations were assessed using the chi-square or Fisher’s exact test. Multivariable logistic regression identified factors associated with the prescription of antibiotics, corticosteroids, and bronchodilators—three drug categories commonly used in bronchiolitis despite not being recommended by current guidelines.

The response rate was 28.8%, yielding 306 valid responses. Most respondents (62.1%) had over 20 years of clinical experience. Diagnostic criteria varied: 42.8% used 12 months as the upper age limit, 42.2% used 24 months, and 5.6% applied no age limit. Diagnostic approaches differed, with 45.1% relying on wheezing/grunting and 36.9% on wet sounds. Pulse oximetry was always used by 39.5%, and 67.9% never used rapid viral tests. Bronchodilators and steroids were recommended by 37.6% and 32.3%, respectively. Antibiotics were prescribed in 30.1% of cases with poor general condition and 18.6% with fever. Nirsevimab prophylaxis was well accepted (96.4%), with high caregiver compliance (97.7%). Paediatricians diagnosing bronchiolitis up to 36 months were less likely to report never prescribing antibiotics (OR 0.13, 95% CI 0.02–0.51), whereas those relying on widespread sounds were more likely than those using grunting or wheezing (OR 2.42, 95% CI 1.23–4.83). Bronchodilator use was lower with diagnosis based on widespread sounds (OR 0.38, 95% CI 0.18–0.77). Steroid use was higher without an age limit (OR 3.09, 95% CI 1.09–9.25) and lower with widespread sounds (OR 0.31, 95% CI 0.13–0.66).

This first Italian survey on bronchiolitis management in primary care reveals substantial variability in diagnostic and treatment practices. Diagnostic inconsistency is associated with non-guideline-recommended prescribing. Standardized diagnostic criteria are needed. Nirsevimab prophylaxis was widely accepted, supporting its continued use to reduce the burden of bronchiolitis.

The online version contains supplementary material available at 10.1186/s13052-025-02152-y.