Title:Acute Bronchiolitis: The Less, the Better?
Volume: 20
Issue: 3
Author(s): Fabrizio Virgili*, Raffaella Nenna, Greta Di Mattia, Luigi Matera, Laura Petrarca, Maria Giulia Conti and Fabio Midulla
Affiliation:
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
Keywords:
Asthma, bronchiolitis, COVID-19, guideline, management, respiratory syncytial virus, rhinovirus.
Abstract:
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.
