Bronchiolitis

Abstract

Bronchiolitis is the most frequent disease of the lower respiratory tract in infants. It must be suspected after respiratory symptoms progress with cough, poor intake, and increased effort in breathing. Wheezing and crackles can be heard on auscultation with compensatory signs such as tachypnea and accessory muscle use. Chest X-rays usually show bilateral hyperinflation, peribronchial thickening, and subsegmental atelectasis. Bronchiolitis is commonly caused by the respiratory syncytial virus (RSV), which causes more than 60% of acute viral infections in children and more than 80% in infants under 1 year of age. RSV infection in children almost always causes clinical manifestations, but the severity depends on age, comorbidities, environmental exposure, and history of previous infections. Although many efforts have been made to identify pharmacological therapies, the most effective treatment is still limited to general support measures such as regular hydration and oxygen supplementation. There is some evidence that a nebulized hypertonic solution may reduce the length of hospital stay. For prevention, palivizumab, a humanized monoclonal antibody against RSVF protein, is an effective protection for preterm newborns with bronchopulmonary dysplasia and congenital heart disease and may reduce recurrent wheezing in selected patients.