bronchiolitis
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Etiology
- respiratory syncytial virus (RSV)
- risk factors
- gut microbiota dominated by Bacteroides[19]
Epidemiology
- most commoly occurs in winter & spring
- most common cause of infant hospitalization during winter months
- span & during of RSV infection is region-dependent in North America[14]
Clinical manifestations
- generally resolves within 13 days in 50% of children & within 21 days in 90%[10]
Laboratory
- respiratory syncytial virus (RSV) swab
- cultures of blood or urine
- arterial blood gases
- pulse oximetry
- should not be the sole factor in deciding whether to admit an infant presenting with bronchiolitis[13]
- limited role of testing[4]; generally not useful[5]
Radiology
- chest X-ray
- limited role of testing[4]; generally not useful[5]
Management
- infants:
- nebulized albuterol (or salmeterol) (do not use)[14]
- of questionable benefit
- of no benefit[14]
- nebulized epinephrine
- do not use[14]; of no benefit[9][14]
- number needed to treat (NNT) to prevent 1 hospitalization = 17[16]
- nebulized 3% saline
- in conjunction with bronchodilators of benefit[7]
- nebulized 3% saline no better than normal saline[8]
- may be some role for nebulized 3% saline[11]
- may be used in hospitalized infants, but not in the emergency department[14]
- inhalation treatments given on demand are superior to those given on a fixed schedule[9]
- oral albuterol of no benefit[3]
- do not use systemic glucocorticoids[14][15]
- dexamethasone 1 mg/kg PO single dose may be of benefit
- glucocorticoids do not prevent hospital admission or reduce the length of hospital stay[15]
- limited benefit of any agent[4][5]
- do not use chest physiotherapy[14]
- palivizumab for prevention
- nebulized albuterol (or salmeterol) (do not use)[14]
More general terms
More specific terms
- bronchiolitis obliterans; constrictive bronchiolitis; cryptogenic organizing pneumonia; bronchiolitis obliterans with organizing pneumonia (BOOP)
- diffuse panbronchiolitis
- respiratory bronchiolitis associated interstitial lung disease; desquamative interstitial pneumonia (RBILD)
References
- ↑ Journal Watch 22(5):41, 2002 Schuh S et al Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. J Pediatr 140:27, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11815760
McBride JT Dexamethasone and bronchiolitis: a new look at an old therapy? J Pediatr 140:8, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11815756 - ↑ Journal Watch 23(3):26, 2003
Patel H et al A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis. J Pediatr 141:818, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12461499 - ↑ Jump up to: 3.0 3.1 Journal Watch 23(14):114, 2003 Patel H et al Randomized, double-blind, placebo-controlled trial of oral albuterol in infants with mild-to-moderate acute viral bronchiolitis. J Pediatr 142:509, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12756382
- ↑ Jump up to: 4.0 4.1 4.2 4.3 Journal Watch 24(5):40-41, 2004
Mull CC et al A randomized trial of nebulized epinephrine vs albuterol in the emergency department treatment of bronchiolitis. Arch Pediatr Adolesc Med 158:113, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14757602
King VJ et al Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Arch Pediatr Adolesc Med 158:127, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14757604
Borderly WC et al Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 158:119, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14757603
Hall CB Managing bronchiolitis and respiratory syncytial virus: finding the yellow brick road. Arch Pediatr Adolesc Med 158:111, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14757601 - ↑ Jump up to: 5.0 5.1 5.2 5.3 Modl M et al, Does bronchodilator responsiveness in infants with bronchiolitis depend on age? J Pediatr. 2005; 147:617 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16291351
Amirav I et al, Aerosol delivery in respiratory syncytial virus bronchiolitis: Hood or face mask? J Pediatr 2005; 147:627 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16291353 - ↑ American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006 Oct;118(4):1774-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17015575
- ↑ Jump up to: 7.0 7.1 Zhang L et al Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2008 Oct 8. http://dx.doi.org/10.1002/14651858.CD006458.pub2
- ↑ Jump up to: 8.0 8.1 Grewal S et al A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department. Arch Pediatr Adolesc Med 2009 Nov; 163:1007. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19884591
- ↑ Jump up to: 9.0 9.1 9.2 Skjerven HO et al Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis. N Engl J Med 2013; 368:2286-2293. June 13, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23758233 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1301839
- ↑ Jump up to: 10.0 10.1 Thompson M et al Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f7027 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24335668 <Internet> http://www.bmj.com/content/347/bmj.f7027
- ↑ Jump up to: 11.0 11.1 Florin TA et al Nebulized Hypertonic Saline for Bronchiolitis in the Emergency DepartmentA Randomized Clinical Trial. JAMA Pediatr. Published online May 26, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24862342 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=1874076
Wu S et al Nebulized Hypertonic Saline for Bronchiolitis. A Randomized Clinical Trial. JAMA Pediatr. Published online May 26, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24862623 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=1874078
Grewal S and Klassen TP The Tale of 2 Trials. Disentangling Contradictory Evidence on Hypertonic Saline for Acute Bronchiolitis. JAMA Pediatr. Published online May 26, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24862208 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=1874075 - ↑ Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP Hypertonic saline solution administered via nebuliser for acute bronchiolitis in infants. Cochrane Summaries. July 31, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23900970 <Internet> http://summaries.cochrane.org/CD006458/
- ↑ Jump up to: 13.0 13.1 Schuh S et al Effect of Oximetry on Hospitalization in Bronchiolitis. A Randomized Clinical Trial. JAMA. 2014;312(7):712-718. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25138332 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1896981
Vinci R and Bauchner H Bronchiolitis, Deception in Research, and Clinical Decision Making. JAMA. 2014;312(7):699-700. Vinci R and Bauchner H http://jama.jamanetwork.com/article.aspx?articleid=1896966 - ↑ Jump up to: 14.00 14.01 14.02 14.03 14.04 14.05 14.06 14.07 14.08 14.09 Ralston SL et al Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis Pediatrics. October 27, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25349312 <Internet> http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.full.pdf+html
- ↑ Jump up to: 15.0 15.1 15.2 The NNT: Glucocorticoids for Bronchiolitis. http://www.thennt.com/nnt/steroids-for-bronchiolitis/
Fernandes RM, Bialy LM, Vandermeer B et al Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2013 Jun 4;6:CD004878 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23733383 - ↑ Jump up to: 16.0 16.1 The NNT: Inhaled Epinephrine with or without Steroids for Bronchiolitis. http://www.thennt.com/nnt/inhaled-epinephrine-steroids-for-bronchiolitis/
Hartling L, Bialy LM, Vandermeer B et al Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD003123 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21678340 - ↑ Rothaus C Viral Bronchiolitis Now@NEJM. Jan 8, 2016 http://blogs.nejm.org/now/index.php/viral-bronchiolitis/2016/01/08/
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Jump up to: 19.0 19.1 Hasegawa K, Linnemann RW, Mansbach JM et al The Fecal Microbiota Profile and Bronchiolitis in Infants. Pediatrics Jun 2016, e20160218 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27354456
Seed PC Do Bacteria in the Gut Set the Stage for Who Gets Viral Bronchiolitis and Its Severity? Pediatrics Jun 2016, e20161377 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27354455