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The heterogeneity of viral bronchiolitis: A lack of universal consensus definitions
David G Hancock1, Billie Charles-Britton1, Dani-Louise Dixon2
1Department of Paediatrics and Child Health, Flinders University, Bedford Park, Australia.
Insights
Viral bronchiolitis, a common infant illness, lacks targeted therapies and predictive models for severe cases. Inconsistent definitions hinder research progress for this significant healthcare burden.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Viral bronchiolitis is a leading cause of infant hospitalization globally, posing a substantial healthcare challenge.
- Current management lacks effective targeted therapies, and predicting high-risk infants for severe disease or long-term respiratory issues remains difficult.
Purpose of the Study:
- To review the heterogeneity in current definitions of viral bronchiolitis.
- To highlight how inconsistent definitions impede understanding of the condition and its endotypes.
- To advocate for a universal consensus definition to advance research.
Main Methods:
- Literature review of existing definitions and studies on viral bronchiolitis.
- Analysis of the impact of definitional heterogeneity on research and clinical practice.
Main Results:
- Significant variation exists in published definitions regarding age, symptoms, causative agents, and patient comorbidities.
- This heterogeneity obscures the understanding of viral bronchiolitis and its potential multiple endotypes.
Conclusions:
- The lack of a standardized definition for viral bronchiolitis is a major barrier to progress in the field.
- Establishing a universal consensus definition is crucial for developing effective therapies and improving patient outcomes.
Abstract:
Viral bronchiolitis is one of the most common hospital presentations in infancy and as such represents a major healthcare burden worldwide. However despite this, there are currently no effective targeted therapies nor can those infants at highest risk for developing severe disease or subsequent respiratory morbidity be predicted on initial hospital presentation. Current definitions of bronchiolitis in the published literature vary significantly in terms of the age range at presentation, specific clinical symptoms, causative virus, and the inclusion or exclusion of infants with previous presentations and/or various comorbidities. In this review, we highlight how this heterogeneity among definitions contributes to a lack of clarity on this condition and its likely multiple endotypes. We argue that without a new universal consensus definition or sets of definitions, progress into bronchiolitis will continue to be stalled.
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