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bronchiolitis

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: 1) respiratory syncytial virus (RSV) swab 2) cultures of blood or urine 3) arterial blood gases 4) pulse oximetry - should not be the sole factor in deciding whether to admit an infant presenting with bronchiolitis [13] 5) limited role of testing [4]; generally not useful [5] Radiology: 1) chest X-ray 2) 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 - infants born at <32 weeks' gestation who needed >21% oxygen during the first 28 days of life [14] - 5 monthly doses during RSV season in high-risk infants

Specific

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)

General

bronchial disease

References

  1. 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: 11815760 - McBride JT Dexamethasone and bronchiolitis: a new look at an old therapy? J Pediatr 140:8, 2002 PMID: 11815756
  2. 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: 12461499
  3. 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: 12756382
  4. 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: 14757602 - King VJ et al Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Arch Pediatr Adolesc Med 158:127, 2004 PMID: 14757604 - Borderly WC et al Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 158:119, 2004 PMID: 14757603 - Hall CB Managing bronchiolitis and respiratory syncytial virus: finding the yellow brick road. Arch Pediatr Adolesc Med 158:111, 2004 PMID: 14757601
  5. Modl M et al, Does bronchodilator responsiveness in infants with bronchiolitis depend on age? J Pediatr. 2005; 147:617 PMID: 16291351 - Amirav I et al, Aerosol delivery in respiratory syncytial virus bronchiolitis: Hood or face mask? J Pediatr 2005; 147:627 PMID: 16291353
  6. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006 Oct;118(4):1774-93. PMID: 17015575
  7. 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
  8. 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: 19884591
  9. Skjerven HO et al Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis. N Engl J Med 2013; 368:2286-2293. June 13, 2013 PMID: 23758233 http://www.nejm.org/doi/full/10.1056/NEJMoa1301839
  10. Thompson M et al Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f7027 PMID: 24335668 http://www.bmj.com/content/347/bmj.f7027
  11. Florin TA et al Nebulized Hypertonic Saline for Bronchiolitis in the Emergency DepartmentA Randomized Clinical Trial. JAMA Pediatr. Published online May 26, 2014. PMID: 24862342 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. PMID: 24862623 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. PMID: 24862208 http://archpedi.jamanetwork.com/article.aspx?articleid=1874075
  12. 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 PMID: 23900970 http://summaries.cochrane.org/CD006458/
  13. Schuh S et al Effect of Oximetry on Hospitalization in Bronchiolitis. A Randomized Clinical Trial. JAMA. 2014;312(7):712-718. PMID: 25138332 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
  14. Ralston SL et al Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis Pediatrics. October 27, 2014 PMID: 25349312 http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.full.pdf+html
  15. 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: 23733383
  16. 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: 21678340
  17. Rothaus C Viral Bronchiolitis Now@NEJM. Jan 8, 2016 http://blogs.nejm.org/now/index.php/viral-bronchiolitis/2016/01/08/
  18. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  19. Hasegawa K, Linnemann RW, Mansbach JM et al The Fecal Microbiota Profile and Bronchiolitis in Infants. Pediatrics Jun 2016, e20160218 PMID: 27354456 - Seed PC Do Bacteria in the Gut Set the Stage for Who Gets Viral Bronchiolitis and Its Severity? Pediatrics Jun 2016, e20161377 PMID: 27354455