Bronchiolitis

Bronchiolitis is an infection of infants and toddlers caused by seasonal viruses that affect the lungs. Specifically, bronchiolitis is defined as a clinical condition associated with a viral infection that causes respiratory distress, wheezing and cough in children less than two years. When these episodes happen recurrently, this could be the potential onset of asthma in these children or a variant which specialists call Reactive Airway Disease (RAD) in which only bronchiolitis illnesses trigger the asthma symptoms. Bronchiolitis is the leading cause of infant hospitalization in the U.S.! As a result, much research has been been dedicated to understanding and determining effective treatments for this condition.

The most cause of bronchiolitis is the Respiratory Syncytial Virus(RSV), accounting for 50-80% of cases. Influenza and parainfluneza are also common viruses involved. These viruses typically are very seasonal and bronchiolitis occurs with their annual outbreaks, mainly in the winter months. More than 1/3 of children will develop bronchiolitis by age two. Of these, approximately 10% require hospitalization. Although common and serious, bronchiolitis is rarely life threatening except in the very young infant, preemies, or infants born with other significant health problems.

The diagnosis of bronchiolitis can be made through clinical findings found on the physical exam in the context of patient age, medical history and time of year. A rapid diagnostic test for RSV is available and used in hospital and ER settings but is not completely accurate (and, of course, not all cases are caused by RSV). Chest XRs to confirm or support a diagnosis of bronchiolitis are not routinely recommended and should be reserved for unusual cases or very sick children.

Therapy for bronchiolitis has been widely researched and remains actively reviewed . Unfortunately, there is no specific “cure” for bronchiolitis and care for patients is mainly “supportive”. However, the use of asthma medications, specifically bronchodilators and steroids, are widely used and have been most studied. Overall, available evidence continues to support the AAP recommendations against the routine use of bronchodilators for bronchiolitis unless a trial of medication shows “documented benefit”. Similarly, steroid administration has not been associated with improved recovery rates and should not be given routinely. The role of oxygen and oxygen monitoring (pulse oximetry) also continues to be studied and the determination of the proper threshold for oxygen therapy and it’s length of usage has played a “confusing” role in patient management, especially in deciding upon length of hospitalization. The use of other treatments, including racemic epinephrine and hypertonic saline, are also being evaluated. Antibiotics are prescribed for complications of the underlying illness, usually either ear infections or pneumonia, but do not treat bronchiolitis per se.

At this time there is no vaccination available for RSV bronchiolitis. A preventive therapy called Synagis is available for high risk infants but expanded use of Synagis seems unlikely at this time.

Thus, bronchiolitis will likely remain a common and potentially serious illness and despite considerable time and research dedicated to treatment and prevention, no effective universal treatment plan has been developed.

For more general information on symptomatic treatments for bronchiolitis, please refer back to the general health websites on our webpage.

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