Intended for healthcare professionals

Letters Acute bronchiolitis

Flawed meta-analysis creates doubt when answers are known

BMJ 2011; 342 doi: (Published 31 May 2011) Cite this as: BMJ 2011;342:d3348
  1. Paul Walsh, research director1,
  2. Stephen J Rothenberg, senior investigator2,
  3. Dale Robbins, physician assistant1,
  4. John Caldwell, research pharmacist3,
  5. Stephen Friese, emergency physician4,
  6. Agustina Garzon, research physician1
  1. 1Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA 93306, USA
  2. 2Centre for Research in Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
  3. 3Pharmacy Department, Kern Medical Center, Bakersfield, CA 93306, USA
  4. 4Department of Emergency Medicine, Community Memorial Hospital Center, Ventura, CA 93003, USA
  1. yousentwhohome{at}

We were disappointed to see a Cochrane review recommend adrenaline and steroids in the outpatient management of bronchiolitis.1 The results of the meta-analysis reflect selection criteria excluding randomised controlled trials which do not support the author’s beliefs rather than the available data.

The stated rationale for excluding studies in which infants have had previous wheezing was to minimise including infants who might later develop asthma …

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