Viral bronchiolitis in children: A common condition with few therapeutic options

Abstract

Even though bronchiolitis is a disease that has been recognized for many years, there are still few therapeutic strategies beyond supportive therapies. Bronchiolitis is the most frequent cause of hospital admission in children less than 1 year of age. The incidence is estimated to be about 150° million cases a year worldwide, and 2-3% of these cases require hospitalization. It is acknowledged that viruses cause bronchiolitis, but most of the studies focus on RSV. The RSV causes a more severe form of bronchiolitis in children with risk factors including prematurity, cardiovascular disease and immunodeficiency. Other viruses involved in causing bronchiolitis include RV, hMPV, hBoV and co-infections. The RV seems to be associated with a less severe acute disease, but there is a correlation between the early infection and subsequent wheezing bronchitis and asthma in later childhood and adulthood. The supportive therapies used are intravenous fluids and oxygen supplement administered by nasal cannula or CPAP in most complicated patients. Additional pharmacological therapies include epinephrine, 3% hypertonic saline and corticosteroids. The Epinephrine seems to have the greatest short-term benefits and reduces the need of hospital admission, whereas hypertonic saline and corticosteroids seem to reduce the length of hospital stay. As bronchiolitis is such a prevalent disease in children and RV seems to play an important role, perhaps more studies should center around the RV's contribution to the initial disease and following pathology.

Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation

“…AVB is the most prevalent respiratory illness among children under two years old; its severity is higher among premature infants and infants with previous pulmonary disease, immunodeficiency, or congenital heart defects. ( 23 ) In the present study of infants with AVB subjected to MV (conducted along three consecutive winter seasons), we were able to confirm these data, as 25% of the patients were premature and 27% exhibited anemia requiring blood transfusion.…”

Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO)

“…Bronchiolitis is the most common acute lower respiratory tract viral infection in infants <2 years of age. [ 1 2 ] This is a pathological description while bronchiolitis is a clinical description. Acutely, the inflammation is not limited to the bronchioles and is found in all parts of the airway further.…”

Etiology and clinical features of viral bronchiolitis in infancy

“…According to AAP, rales are among the possible signs of bronhiolitis on auscultation. [3] However, in Europe [5,6] and Australia, [7,8] till recently it was considered that the hallmark for the diagnosis was fine crackles on auscultation and that wheezing is not a prerequisite for the diagnosis. The most recent guidelines from the United Kingdom [9,10] state that the presence of fi ne inspiratory crackles and/or high pitched expiratory wheeze on auscultation lead to a diagnosis of bronchiolitis for children under two years of age.…”