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Acute Bronchiolitis: The Less, the Better?
Fabrizio Virgili1, Raffaella Nenna1, Greta Di Mattia1
1Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
Insights
Acute bronchiolitis, a common infant viral infection, lacks consistent management despite numerous guidelines. Current treatment remains supportive, with no strong evidence for alternatives like steroids or hypertonic saline.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Acute bronchiolitis is a common viral lower respiratory tract infection in infants under 12 months.
- Respiratory Syncytial Virus (RSV) is the primary causative agent.
- Diagnosis is clinical, with treatment primarily supportive, yet management varies widely.
Purpose of the Study:
- To comprehensively review current knowledge on acute bronchiolitis.
- Emphasis on epidemiology, pathophysiology, clinical presentation, diagnosis, and management.
- Focus on updated evidence and future directions for treatment and prevention.
Main Methods:
- Systematic review of Cochrane and PubMed literature from the last 10 years.
- Keywords included "bronchiolitis", "RSV", "epidemiology", "management", "prevention", and related terms.
- Analysis of international guidelines from UK, USA, Canada, Italy, and Spain.
Main Results:
- Despite extensive research, therapeutic approaches for acute bronchiolitis remain largely unchanged, focusing on supportive care.
- No significant evidence supports the efficacy of alternative treatments such as steroids or inhaled hypertonic solutions.
- The condition is recognized as encompassing diverse clinical entities influenced by individual predispositions.
Conclusions:
- Current management of acute bronchiolitis is limited to respiratory and metabolic support.
- Therapeutic alternatives lack robust evidence and are not recommended.
- Future research should aim to subcategorize patients to enable personalized, evidence-based treatment strategies.
Background:
Acute bronchiolitis is a viral infection of the lower respiratory tract affecting infants aged under 12 months, variably presenting with respiratory distress, diffuse crackles and inflammatory wheezing. The main causative agent is Respiratory Syncytial Virus (RSV). The diagnosis is clinical and treatment mainly supportive. Despite the availability of more than 30 international guidelines, consistent management recommendations are lacking and considerable variability in patients' care persists among different providers.
Objective:
To review and describe current knowledge about epidemiology, physiopathology, clinic, diagnosis and management of acute bronchiolitis, with particular emphasis on updated evidence and future perspectives in terms of treatment and prevention.
Methods And Results:
We searched Cochrane for systematic reviews and PubMed for scientific articles published in the last 10 years, using a combination of the following search terms: "bronchiolitis", "respiratory syncytial virus", "epidemiology", "risk factors", "severity", "diagnosis", "clinic", "diagnostic imaging", "management", "asthma", "wheezing", "bronchodilator", "steroids", "hypertonic saline", "oxygen", "blood gas analysis", "HHHFNC", "rehydration", "enteral feeding", "parenteral hydration", "prevention", "vaccine" and "COVID-19 or SARS-CoV2". We accordingly performed a deep and extensive selection of the most updated and considerable literature on the matter, summarizing the most significant evidence concerning all aspects of acute bronchiolitis (epidemiology, clinic, diagnosis, management and prevention). Furthermore, we examined references and available guidelines from UK, USA, Canada, Italy and Spain. Results are extensively discussed below.
Conclusion:
Although acute bronchiolitis has been a widely known disease for decades, its therapeutic approach remained unchanged and essentially limited to respiratory and metabolic support. Despite the abundance of studies, there is no significant evidence concerning therapeutic alternatives (e.g. steroids, inhaled hypertonic solution), which are therefore not recommended. According to most recent data, "acute bronchiolitis" definition encompasses a plethora of different clinical entities related to each subject's genetic and immune predisposition. Therefore, future research should focus on the precise characterization of such subcategories in order to individualize therapeutic management and ensure the most appropriate evidence-based care.
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