Bronchiolitis in children
Rohola Shirzadi.MD,Assistant Professor of Pediatric Pulmonology
Children’s Medical Center,Tehran University of Medical Science
Bronchiolitis is the most common cause of hospitalization among infants during the ﬁrst 12 months of life.Bronchiolitis is characterized by acute inﬂammation, edema, and necrosis of epithelial cells lining small airways, and increased mucus production. Signs and symptoms typically begin with rhinitis and cough, which may progress to tachypnea, wheezing, rales, use of accessory muscles, and/or nasal ﬂaring.
The main goals in the history and physical examination of infants presenting with wheeze or other lower respiratory tract symptoms , particularly in the winter season, is to differentiate infants with probable viral bronchiolitis from those with other disorders. The course of bronchiolitis is variable and dynamic, ranging from transient events, such as apnea, to progressive respiratory distress from lower airway obstruction. Supplemental oxygen provided for infants not requiring additional respiratory support is best initiated with nasal prongs, although exact measurement of fraction of inspired oxygen is unreliable with this method. Pharmacologic agents have largely proven ineffective in the management of bronchiolitis. Cochrane reviews have failed to demonstrate any impact on clinical outcomes with use of albuterol or corticosteroids in bronchiolitis; neither are currently recommended for management.
Response to bronchodilators is unlikely and unpredictable in children younger than 1 yr, and there is no validated method of assessing response in the clinical setting. The use of inhaled or oral steroids in very young children with wheezing has not been shown to prevent the progression of childhood wheezing or development of asthma. Majority of deaths due to bronchiolitis occur in children with complex medical conditions or comorbidities such as bronchopulmonary dysplasia, congenital heart disease, or immunodeficiency. The median duration of symptoms in ambulatory patients is approximately 14 days; 10% may be symptomatic for 3 weeks. Severe lower respiratory tract infection at an early age has been identified as a possible risk factor for the development of asthma, although most children with early childhood