UK Trial Reveals Surfactant Therapy Fails to Help Severe Infant Bronchiolitis

A major UK clinical trial has tested surfactant therapy for infants with severe bronchiolitis. The study, known as the BESS trial, focused on babies needing mechanical ventilation due to the respiratory illness. Results showed the treatment was safe but did not improve patient outcomes.

Bronchiolitis is a serious viral lung infection mainly caused by respiratory syncytial virus (RSV). It inflames the small airways, leading to breathing difficulties, especially in young children. Around 25,000 UK infants are hospitalised yearly with RSV bronchiolitis, with roughly 1,000 requiring intensive ventilatory support.

The BESS trial ran over six winter seasons, from 2019 to 2024, across 15 paediatric hospitals in England, Scotland, and Northern Ireland. A total of 232 infants took part in the research. The study was a joint effort between the UKRI Medical Research Council (MRC), the National Institute for Health and Care Research (NIHR), and pharmaceutical company Chiesi Farmaceutici SpA.

Despite hopes, surfactant therapy did not shorten the time infants spent on ventilation. While the treatment posed no safety risks, it failed to alter the illness's progression. Professor Calum Semple OBE, the trial's lead investigator, stressed the need to investigate other treatment approaches beyond surfactant replacement.

The findings highlight the importance of evidence-based strategies for severe bronchiolitis. Meanwhile, preventative measures like maternal RSV vaccination could help lower infection rates and reduce the severity of cases.

The BESS trial confirms surfactant therapy is safe but ineffective for improving outcomes in ventilated bronchiolitis patients. Researchers now aim to explore alternative treatments for this common yet serious illness. Preventative vaccination remains a key focus for reducing future cases.