Diagnosis and Management of Bronchiolitis

Abstract

Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm.The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations.This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics.This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis. INTRODUCTIONTHIS GUIDELINE EXAMINES the published evidence on diagnosis and acute management of the child with bronchiolitis in both outpatient and hospital settings, including the roles of supportive therapy, oxygen, bronchodilators, antiinflammatory agents, antibacterial agents, and antiviral agents and make recommendations to influence clinician behavior on the basis of the evidence. Methods of prevention All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Key Word bronchiolitisAbbreviations CAM-complementary and alternative medicine LRTI-lower respiratory tract infection AHRQ-Agency for Healthcare Research and Quality RSV-respiratory syncytial virus AAP-American Academy of Pediatrics AAFP-American Academy...

Evaluation of Serum 25-Hydroxy Vitamin D Levels in Children with Acute Bronchiolitis

“…This hospital is the only teaching and pediatric referral hospital in Qazvin province. This study was performed from Children with a first-time episode of wheezing after viral infections of the upper respiratory tract were considered to have acute bronchiolitis (2,3,5,7,8). Inclusion criteria for the case group included the following: 1) an age between 1 and 24 months, 2) the first wheezing attack, 3) a disease duration of less than two weeks, 4) evidence of viral upper respiratory infection (such as rhinorrhea, coryza, cough, and fever), 5) the existence of wheezing with or without crackles, 6) increased respiratory effort, including tachypnea, intercostal retraction, and nostril flaring, 7) and a lack of consolidation on CXR.…”

“…Inclusion criteria for the case group included the following: 1) an age between 1 and 24 months, 2) the first wheezing attack, 3) a disease duration of less than two weeks, 4) evidence of viral upper respiratory infection (such as rhinorrhea, coryza, cough, and fever), 5) the existence of wheezing with or without crackles, 6) increased respiratory effort, including tachypnea, intercostal retraction, and nostril flaring, 7) and a lack of consolidation on CXR. Tachypnea was defined as 60 breaths per minute or more for infants less than two months old, 50 breaths per minute or more for children greater than 2 months to 12 months of age, and 40 breaths per minute or more for children aged 13 to 24 months (3,5,7,8).…”

Managing Children with Bronchopulmonary Dysplasia

“…Использование препарата должно быть продолжено только в том случае, если регистрируется четкая клиническая реакция [55]. Некоторые исследования, проведенные у детей, страда-ющих бронхиолитом, показали улучшение в клинических показателях и SatO 2 сразу же после приема сальбутамола [56,57].…”

Respiratory syncytial virus and adenovirus in acute lower respiratory infections in hospitalized infants and children

“…Bronchiolitis was defined in the presence of tachypnea, wheezing, cough and crackles preceeded by rhinitis and absence of documented alveolar consolidation by both chest radiographs and clinical examination; pneumonia was defined as alveolar consolidation (chest radiographs, auscultation of rales and/or bronchial breathing); bronchitis was defined in a child with cough and at least one of the following symptoms: fever, wheezing, or dyspnea without radiological and clinical suspicion of bronchiolitis or pneumonia [24][25][26]. Exclusion criteria were congenital cardiac disease and severe airway anomaly.…”