Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Ralston, Shawn L.; Lieberthal, Allan S.; Meissner, H. Cody; Alverson, Brian; Baley, Jill E.; Gadomski, Anne; Johnson, David W.; Light, Michael J.; Maraqa, Nizar; Mendonça, Eneida A.; Phelan, Kieran J.; Zorc, Joseph J.; Stanko-Lopp, Danette; Brown, Mark A.; Nathanson, Ian; Rosenblum, Elizabeth; Sayles, Stephen; Hernández-Cancio, Sinsi

doi:10.1542/peds.2014-2742

Cited by 1,352 publications

(1,815 citation statements)

References 219 publications

(196 reference statements)

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“…, 27 For the prevention of RSV-infections, palivizumab administration is only recommended for high risk-infants 8 . The development of new approaches and therapeutic modalities are thus needed.…”

Section: Discussionmentioning

confidence: 99%

“…The natural individual susceptibiliy of hRSV infection in the lambs may explain part of this observation. Similarly, most clinicians recognize bronchiolitis as a “constellation of clinical signs and symptoms occurring in children younger than 2 years, including a viral upper respiratory tract prodrome followed by increased respiratory effort and wheezing” 27 with a high heterogeneity in disease severity likely due to a combination of host and viral factors 45 . Study procedures may also explain part of the variability seen in the clinical parameters as the procedures for clinical assessments were adapted for study 3, allowing for increased observation times and more robust scoring of lamb behavioral changes.…”

Section: Discussionmentioning

confidence: 99%

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Delivery of ALX-0171 by inhalation greatly reduces respiratory syncytial virus disease in newborn lambs

Mora

Detalle

Gallup

et al. 2018

mAbs

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Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory disease in infants and young children worldwide. Currently, treatment is supportive and no vaccines are available. The use of newborn lambs to model hRSV infection in human infants may provide a valuable tool to assess safety and efficacy of new antiviral drugs and vaccines. ALX-0171 is a trivalent Nanobody targeting the hRSV fusion (F) protein and its therapeutic potential was evaluated in newborn lambs infected with a human strain of RSV followed by daily ALX-0171 nebulization for 3 or 5 consecutive days.Colostrum-deprived newborn lambs were infected with hRSV-M37 before being treated by daily nebulization with either ALX-0171 or placebo. Two different treatment regimens were examined: day 1–5 or day 3–5 post-infection. Lambs were monitored daily for general well-being and clinical parameters. Respiratory tissues and bronchoalveolar lavage fluid were collected at day 6 post-inoculation for the quantification of viral lesions, lung viral titers, viral antigen and lung histopathology.Administration by inhalation of ALX-0171 was well-tolerated in these hRSV-infected newborn lambs. Robust antiviral effects and positive effects on hRSV-induced lung lesions and reduction in symptoms of illness were noted. These effects were still apparent when treatment start was delayed and coincided with peak viral loads (day 3 post-infection) and at a time point when signs of RSV disease were apparent. The latter design is expected to have high translational value for planned clinical trials. These results are indicative of the therapeutic potential of ALX-0171 in infants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delivery of ALX-0171 by inhalation greatly reduces respiratory syncytial virus disease in newborn lambs

Mora

Detalle

Gallup

et al. 2018

mAbs

View full text Add to dashboard Cite

show abstract

“…To date, there is no effective acute treatment for RSV, even in high risk groups such as preterm infants. Current recommendations advocate supportive measures only such as respiratory support and hydration [89]. Nevertheless, new RSV treatments such as vaccines and therapeutic agents are currently under development [90].…”

Section: Viral Infection Requiring Readmission In Early Lifementioning

confidence: 99%

The impact of respiratory viruses on lung health after preterm birth

Townsi

Laing

Hall

et al. 2018

European Clinical Respiratory Journal

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Children born preterm, less than 37 weeks’ gestation, are at increased risk of viral respiratory infections and associated complications both during their initial birth hospitalisation and in their first years following discharge. This increased burden of viral respiratory infections is likely to have long term implications for lung health and function in individuals born preterm, particularly those with bronchopulmonary dysplasia. Several hypotheses have been put forward to explain the association between early life viral respiratory infection and development of suboptimal lung health and function later in life following preterm birth. Although preterm infants with diminished lung function, particularly small airways, might be particularly susceptible to asthma and wheezing disorders following viral infection, there is evidence that respiratory viruses can activate number of inflammatory and airway re-modelling pathways. Therefore, the aim of this review is to highlight the perinatal and early life risk factors that may contribute to increased susceptibility to viral respiratory infections among preterm infants during early life and to understand how respiratory viral infection may influence the development of abnormal lung health and function later in life.

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“…1,2 These extensive documents, building on the very welcome inaugural AAP guidelines released in 2006, 3 can be summarized as follows: bronchiolitis is a very common illness without treatment options other than supportive care and, perhaps (based on "weak" evidence), inhaled hypertonic saline for inpatients only. In the previous AAP guideline, 3 we were advised to consider a trial of bronchodilator in these obviously wheezing infants, but now even this solitary option has been withdrawn owing to lack of efficacy.…”

Section: Where Are We Now?mentioning

confidence: 99%

“…1 The AAP guideline tells us that bronchiolitis is "a constellation of clinical signs and symptoms occurring in children younger than two years, including a viral upper respiratory tract prodrome followed by increased respiratory effort and wheezing," but children with recurrent wheezing are excluded. 2 Although respiratory syncytial virus is the most common etiologic agent, many different viruses (almost universally sampled from the upper airway only) are responsible for clinically identical lower airway obstruction. 1,2 Unfortunately, it remains unclear if these viruses in the upper respiratory tract routinely infect the bronchioles or simply trigger inflammation in the lower airways, or both.…”

Section: Have We Been Studying the Wrong Infants?mentioning

confidence: 99%

Maybe there is no such thing as bronchiolitis

Kuzik

2016

CMAJ

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Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Cited by 1,352 publications

References 219 publications

Delivery of ALX-0171 by inhalation greatly reduces respiratory syncytial virus disease in newborn lambs

Delivery of ALX-0171 by inhalation greatly reduces respiratory syncytial virus disease in newborn lambs

The impact of respiratory viruses on lung health after preterm birth

Maybe there is no such thing as bronchiolitis

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