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PubMed2006

Diagnosis and management of bronchiolitis.

Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm. The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations. This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics. This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis.

Acute Disease↗
PubMed2004

Elevated levels of soluble adhesion molecules in sera of patients with acute bronchiolitis.

The mechanisms of migration of neutrophils into the airway lumen are crucial in the development of airway injury of acute bronchiolitis and are mediated by adhesion molecules. In this study, we have attempted to evaluate the role of serum concentrations of the soluble form of intercellular adhesion molecule-1 (sICAM-1) in the disease activity in acute bronchiolitis and in respiratory syncytial virus (RSV) infection. Circulating levels of sICAM-1 in sera from 10 normal control subjects, and from 47 hospitalized acute bronchiolitis patients at admission, and from 25 patients on the day of discharge were determined by use of commercially available enzyme-linked immunosorbent assay kits. The mean serum level of sICAM-1 in bronchiolitis patients was significantly higher than in the 10 healthy control infants (345.8 +/- 99.7 microg/mL vs 237.1 +/- 81.7 microg/mL; p<0.05). However, the mean sICAM-1 concentration was similar between RSV-positive and RSV-negative patients (337.5 +/- 99.6 microg/mL vs 350.9 +/- 101.1 microg/mL; p=0.65). Although the mean clinical severity score of RSV-positive patients was significantly higher than that of RSV-negative patients (5.94 +/- 1.83 vs 3.48 +/- 1.70; p<0.05). The improvement of clinical severity score was not well correlated with the change of sICAM-1 level (r=0.22). This study provides evidence that serum levels of sICAM-1 are increased in acute bronchiolitis and further confirms the role of adhesion molecules involved in the pathogenesis of the disease. However, the serum concentrations of the soluble adhesion molecules could not reliably reflect the clinical severity of the disease.

Acute Disease↗
PubMed1995

Bronchiolitis with airflow obstruction.

Bronchiolar lesions are becoming increasingly recognized as an important cause of airflow obstruction. For this reason, it is helpful to have an update of the current clinical, radiographic, and immunologic perspective. Among the bronchiolar airflow disorders, diffuse panbronchiolitis is related to HLA antigen Bw54, and low-dose, long-term erythromycin appears to be effective therapy. Bronchiolitis obliterans can be classified histologically as constrictive bronchiolitis and as proliferative bronchiolitis obliterans. Idiopathic, postfume, postinfectious, and connective tissue disease bronchiolitis obliterans continue to be rare and often have a poor prognosis. Bronchiolitis obliterans associated with lung transplantation is undergoing intensive investigation with regard to pathogenesis, immunologic study, early detection, and treatment. The lesion appears to be a form of chronic organ rejection. The recognition of the distinctive differences among the bronchiolar airflow disorders by clinicians and clinical investigators is essential for improved patient care, for a greater understanding of the pathogenesis of the disorder, and for development of new therapeutic advances.

Airway Obstruction↗
PubMed1993

Cryptogenic bronchiolitis.

Cryptogenic bronchiolitis is a unique clinical disorder that causes rapidly progressive, chronic airflow obstruction. In this article, we reviewed the pathology, clinical characteristics, and proposed pathogenesis of cryptogenic bronchiolitis. It is evident that cryptogenic bronchiolitis represents the result of a disordered inflammatory response in the small airways of the lung. The clinical characteristics of cryptogenic bronchiolitis, in most instances, should allow this disorder to be distinguished from other causes of chronic airflow obstruction, as well as from BOOP. In this regard, a high clinical suspicion and an awareness of its unique clinical features are the keys to the diagnosis of cryptogenic bronchiolitis.

Biopsy↗
PubMed2000

Asthma and bronchiolitis hospitalizations among American Indian children.

OBJECTIVE: To compare asthma and bronchiolitis hospitalization rates in American Indian and Alaskan native (AI/AN) children and all children in Washington State. METHODS: A retrospective data analysis using Washington State hospitalization data for 1987 through 1996. Patients were included if asthma or bronchiolitis was the first-listed diagnosis. American Indian and Alaskan native children were identified by linking state hospitalization data with Indian Health Service enrollment data. RESULTS: Similar rates of asthma hospitalization were found for AI/AN children older than 1 year compared with all children. In AI/AN children younger than 1 year, hospitalization rates for asthma (528 per 100,000 population; 95% confidence interval [CI], 346-761) and bronchiolitis (2954 per 100,000 population; 95% CI, 2501-3456) were 2 to 3 times higher than the rates in all children (232 per 100,000 population [95% CI, 215-251] and 1190 per 100,000 population [95% CI, 1149-1232], respectively). Hospitalization rates for asthma and bronchiolitis increased 50% between 1987 and 1996 for all children younger than 1 year and almost doubled for AI/AN children younger than 1 year. CONCLUSIONS: American Indian and Alaskan native children have significantly higher rates of hospitalization for wheezing illnesses during the first year of life compared with children of other age groups and races. Furthermore, the disparities in rates have increased significantly over time. Future public health measures directed at managing asthma and bronchiolitis should target AI/AN infants.

Adolescent↗
PubMed1997

Serum eosinophil cationic protein as a predictor of wheezing after bronchiolitis.

We have evaluated the role of eosinophil cationic protein (ECP) concentrations in serum in predicting wheezing after bronchiolitis, during infancy and early childhood. A prospective study at a university hospital serving all pediatric patients in a defined area was designed. Serum ECP concentrations were measured in 92 infants under the age of 2 years on admission for acute bronchiolitis, and 6 and 16 weeks after hospitalization. Nebulized anti-inflammatory therapy was initiated during hospitalization: 32 patients received cromolyn sodium and 32 patients received budesonide for 16 weeks; 30 control patients received no maintenance therapy. The numbers of subsequent physician-diagnosed wheezing episodes and hospital admissions for obstructive airway disease were recorded during 16 weeks of follow-up. At entry, 14 of 92 (15%) children had high (> or = 16 micrograms/L) levels of ECP in their serum. During the 16-week follow-up period, this group of patients had significantly more physician-diagnosed episodes of wheezing (86% vs. 43%, P < 0.01) and hospital admissions for wheezing (64% vs. 19%, P = 0.001) than those with serum levels of ECP < 16 micrograms/L. The number of patients with serum ECP > or = 8 micrograms/L was 25 (27%); 76% of this group developed physician-diagnosed wheezing (P < 0.01), and 48% had hospital admissions for wheezing (P < 0.01). Serum ECP levels decreased significantly with respect to time after bronchiolitis and did not differ among the three intervention groups. We conclude that a high serum ECP concentration during the acute phase of bronchiolitis is a specific but insensitive predictor of wheezing after bronchiolitis.

Acute Disease↗
PubMed1998

Efficacy of corticosteroids in acute bronchiolitis: short-term and long-term follow-up.

Corticosteroids continue to be used by many physicians to treat infants with bronchiolitis. The aim of this study was to examine the short-term and long-term efficacy of oral corticosteroid therapy when added to beta2-agonists in infants with mild to moderate bronchiolitis (defined as the first episode of wheezing associated with low grade fever, rhinitis, tachypnea, and increased respiratory effort in a previously healthy infant during the winter months). Infants with mild to moderate bronchiolitis, were randomly assigned to receive either oral prednisone (2 mg/kg/day) or placebo for 3 days. All patients received nebulized albuterol q.i.d. during this period. Upon admission and after 3 days of therapy, a clinical score was assigned based on respiratory rate, use of accessory muscle, and the presence of wheeze. Oxygen saturation (SaO2) was also measured. On day 7, we inquired as to the well-being of each child. Two years later, the development of chronic respiratory symptoms was assessed. Thirty-eight infants were enrolled in the study; 20 received prednisone and 18 received placebo. Both groups were similar in terms of age, duration of illness prior to enrollment, pretrial medication use, clinical severity of bronchiolitis, history of atopy, and family history of atopy. After 3 and 7 days of treatment, both groups showed similar clinical improvement and there were no statistically significant differences between the two groups in the clinical score or in the SaO2. No major side effects were observed. Two years later, 32% of the infants continued to suffer from chronic respiratory symptoms, with a similar prevalence in both groups. We conclude that a 3-day course of oral corticosteroids is of no benefit to infants with mild to moderate bronchiolitis who are also treated with an inhaled beta2-agonist.

Acute Disease↗
PubMed2000

Long-term effects of prednisolone in the acute phase of bronchiolitis caused by respiratory syncytial virus.

Follow-up studies have demonstrated that bronchiolitis caused by respiratory syncytial virus (RSV) is strongly associated with wheezing in the ensuing years. During the acute infection the immune response may induce long-lasting detrimental effects, thereby contributing to post-bronchiolitis wheezing (PBW). Therefore, immune-modulating drugs like corticosteroids, administered in the acute phase of RSV bronchiolitis, may prevent PBW and asthma. To evaluate this, we performed a controlled prospective follow-up study after a randomized double-blind placebo-controlled intervention in the acute phase with oral prednisolone. Fifty-four patients under 2 years of age and hospitalized for RSV bronchiolitis between 1992 and 1995 were randomly assigned to prednisolone 1 mg/kg/day for 7 days or placebo. At the mean age of 5 years, 47 patients had completed their follow-up. Patients were divided into four groups: no wheezing, transient wheezing (wheezing during the first year of life); persistent wheezing (wheezing during the first year of life and asthma at the age of 5); and late-onset wheezing (no wheezing during the first year of life but asthma at the age of 5). Prevalence of wheezing and asthma were investigated through an interview by telephone, using a standardized questionnaire. We found no significant differences between the prednisolone- and the placebo-treated group in the number of patients with transient wheezing (8% vs. 17%), persistent wheezing (42% vs. 31%), or late-onset wheezing (17% vs. 13%). We conclude that oral prednisolone during the acute phase of RSV bronchiolitis is not effective in preventing PBW or asthma at the mean age of 5 years. Pediatr Pulmonol. 2000; 30: 92-96.

Acute Disease↗
PubMed2006

Bronchodilators for bronchiolitis.

BACKGROUND: Bronchiolitis is an acute, highly infectious lower respiratory tract infection. Bronchodilators are commonly used in the management of bronchiolitis in North America but not in the United Kingdom. OBJECTIVES: The objective of this review was to assess the effects of bronchodilators on clinical outcomes in infants with acute bronchiolitis. SEARCH STRATEGY: In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to October 2005), EMBASE (2003 to September 2005) and the reference lists of articles. The files of one author (AG) were also reviewed. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing bronchodilators (other than epinephrine) with placebo in the treatment of bronchiolitis. DATA COLLECTION AND ANALYSIS: For this updated review, one author assessed trial quality and extracted data. Unpublished data were requested from study authors when necessary. MAIN RESULTS: Twenty-two clinical trials with 1428 infants with bronchiolitis were included in this review. In eight trials, with 468 infants, there was no improvement in clinical score for 43% of those treated with bronchodilators compared to 57% of those treated with placebo (odds ratio (OR) for no improvement 0.45, 95% confidence interval (CI) 0.15 to 1.29). There was a statistically significant but clinically modest improvement in the overall average clinical score (standardized mean difference (SMD) -0.48, 95% CI -0.62 to -0.33). However there was no statistically significant improvement in oxygenation overall (weighted mean difference (WMD) -0.57, 95% CI -1.17 to 0.03). Subgroup analyses showed a slightly greater effect size in outpatient studies, where there were shorter follow up durations, than in inpatient studies for both oximetry (outpatients WMD -0.84, 95% CI -1.59 to -0.10 versus inpatients WMD -0.25, 95% CI -1.18 to 0.67) and average clinical score (outpatients SMD -0.68, 95% CI -0.87 to -0.49 versus inpatients SMD -0.23, 95% CI -0.44 to -0.01). Bronchodilator recipients showed no improvement in the rate of hospital admission after treatment as outpatients (18% versus 26%, OR 0.70, 95% CI 0.36 to 1.35) or duration of hospitalization for inpatients (WMD 0.02, 95% CI -0.32 to 0.36). The inclusion of studies that enrolled infants with recurrent wheezing may have biased the results in favor of bronchodilators. AUTHORS' CONCLUSIONS: Bronchodilators produce small short-term improvements in clinical scores. This small benefit must be weighed against the costs and adverse effects of these agents.

Acute Disease↗
PubMed1996

Bronchiolitis obliterans syndrome (BOS) following heart-lung transplantation.

With the increasing number of successfully performed lung transplants and a longer follow up of patients, there is an interest in the analysis of long-term complications and their impact on patient survival. Heart-lung transplantation was performed in 157 patients with 126 patients surviving at least 6 months. Early death was mainly caused by bacterial and viral infection. Long-term patient survival was decisively influenced by obliterative bronchiolitis. With the new international definition of bronchiolitis obliterans syndrome (BOS) based on an irreversible decline of FEV1 from baseline values, it became possible to analyse the incidence of BOS and the impact on patient mortality in long-term survivors. FEV1 reached a peak value of 102% predicted at a median of 219 days. In 106 of 126 patients (84%), FEV1 showed no decline within the first year. A total of 60 patients (47.6%) developed BOS grade 1 with progression to BOS grade 2 in 85% of these patients. The incidence of BOS was 12.6% at 1 year increasing to more than 50% 5 years after transplantation. Patient mortality due to obliterative bronchiolitis increased from 1% at 1 year to 18% more than 5 years after transplantation. Almost all deaths (86%; 32/37) more than 1 year after HLT were associated with bronchiolitis obliterans. In summary, bronchiolitis obliterans decisively contributes to long-term patient morbidity and mortality after heart-lung transplantation. Clinical and research efforts should be directed towards avoiding this important complication.

Bronchiolitis Obliterans↗
PubMed1990

Acute and long-term effects of viral bronchiolitis in infancy.

About 1% of infants are admitted to hospital with acute bronchiolitis; 85% of cases are caused by infection with Respiratory Syncytial Virus (RSV). The pathophysiological changes during the acute illness are inflammatory obstruction in the small airways with submucosal cellular infiltration, epithelial necrosis and mucous plugging; FRC increases and dynamic compliance falls. Failure to respond to bronchodilator drugs suggests that muscle spasm contributes relatively little to the airway narrowing. Affected infants become increasingly dyspnoeic and hypoxic for 3-4 days then spontaneously improve. After an attack of acute bronchiolitis up to 75% of children have recurrent lower respiratory tract symptoms, many continue to have hyperinflated lungs and bronchial hyperresponsiveness. In the majority, symptoms of cough and wheezing have subsided by the time they start school, but abnormalities of small airway function are detectable at least 13 years later. Children with a genetic predisposition to atopy do not appear to have an increased risk of developing bronchiolitis. Evidence of genetic predisposition to bronchial hyperresponsiveness in those with persistent wheezing is controversial. There is little to suggest that neonatal lung damage or an adverse home environment are important factors in determining susceptibility to post-bronchiolitis wheezing. IgE antibodies to RSV, and leukotriene C4, are found more frequently in the respiratory secretions of infants who wheeze during and after bronchiolitis than in those who do not. The possibility of viral-induced alteration of the immune response at the time of infection needs further investigation.

Bronchial Provocation Tests↗
PubMed1994

Experimental large-animal model of obliterative bronchiolitis after lung transplantation.

Obliterative bronchiolitis is a major cause of long-term morbidity after lung transplantation. It is characterized by small-airway inflammation and occlusion by fibrous tissue. The pathogenesis is uncertain. To study this disease, we developed a model of posttransplantation obliterative bronchiolitis using genetically defined miniature swine. Group 1 (n = 2) received a left lung autograft; group 2 (n = 7), a left lung allograft. Group 2 recipients were given cyclosporine, prednisone, and azathioprine for 3 months, then immunosuppression was tapered and discontinued over 1 month. The animals were observed for an additional 2 months, then sacrificed. Lung grafts in both groups were monitored with serial bronchoalveolar lavages and transbronchial biopsies for 6 months. After sacrifice, lung grafts underwent histopathologic and immunohistochemical examination. No allograft had histologic evidence of acute rejection or peribronchiolar infiltrate during the first 3 months of immunosuppression. During the tapering period, airway changes characterized by severe peribronchiolar lymphocytic infiltrates were seen. Bronchoalveolar lavages of allografts showed significantly increased lymphocyte counts with CD8+ cells predominating. After the discontinuation of immunosuppression, transbronchial biopsy and autopsy specimens showed progressive fibrous inflammatory occlusion of bronchioles. Immunohistochemical staining demonstrated increased expression of MCH class II antigen on the bronchiolar epithelium and increased dendritic cells and CD4+ lymphocytes. None of these changes were seen in group 1. Our findings suggest obliterative bronchiolitis is an immunologically mediated phenomenon related to chronic graft rejection after lung transplantation. This model will allow systematic study of the pathogenesis of obliterative bronchiolitis and possible therapeutic intervention.

Animals↗
PubMed2006

Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea.

STUDY OBJECTIVE: Young infants with bronchiolitis are at risk for apnea. We seek to determine the rate of apnea in young infants with bronchiolitis and evaluate the performance of a predefined set of risk criteria for identifying infants at high risk for the development of apnea. METHODS: We identified a retrospective cohort study of patients treated in the emergency department (ED) of an urban pediatric tertiary care hospital from November 1995 to June 2000. All infants younger than 6 months who met our study definition of bronchiolitis and were admitted to the hospital were included. We developed, a priori, a set of risk criteria for identifying patients at high risk for apnea. Children were considered to be at high risk for apnea if (1) they were born at full term and were younger than 1 month, (2) they were born preterm (<37 weeks estimated gestational age) and were younger than 48 weeks postconception, or (3) the child's parents or a clinician had already witnessed an apnea episode with this illness before inpatient admission. Data pertaining to these risk criteria were collected from the ED physician's note. The primary outcome variable, the development of inhospital apnea, was assessed by review of the inpatient discharge summaries and medical records. RESULTS: Nineteen of 691 (2.7%; 95% confidence interval [CI] 1.7% to 4.3%) infants admitted with bronchiolitis developed apnea while hospitalized. All 19 patients with apnea were identified by our risk criteria (100% sensitivity; 1-sided 97.5% CI 82% to 100%). No patient classified as low risk subsequently developed apnea (100% negative predictive value; 1-sided 97.5% CI 99% to 100%). CONCLUSION: The rate of apnea among young infants hospitalized with bronchiolitis is low. Our clinical risk criteria successfully identified a low-risk group of infants whose risk of apnea is less than 1%.

Age Factors↗
PubMed2004

Association study suggests opposite effects of polymorphisms within IL8 on bronchial asthma and respiratory syncytial virus bronchiolitis.

BACKGROUND: IL-8 is a strong inductor of inflammation. Accordingly, it plays a pivotal role in acute inflammatory responses during respiratory syncytial virus (RSV) infections and in chronic inflammatory diseases such as bronchial asthma and juvenile idiopathic arthritis. Recently, 2 studies have found association of the polymorphism -251A of IL8 with RSV bronchiolitis. Furthermore, epidemiologic studies have demonstrated an increased risk for the development of asthma after RSV bronchiolitis, and a common genetic background for the 2 diseases is currently being discussed. OBJECTIVE: This study investigated whether IL-8 is in association with asthma and/or arthritis and whether the results can confirm a common genetic background of RSV bronchiolitis and asthma. METHODS: The polymorphisms -A251T, C781T, C1633T, and A2767T within IL8 were genotyped in the following 4 populations: children with asthma, atopic children, children with juvenile idiopathic arthritis, and control subjects. Statistical analysis made use of the Armitage trend test and the software program Arlequine. RESULTS: Association of all polymorphisms was found with asthma ( P =.008 to P =.03). Surprisingly -251T was associated with asthma, which is the opposite allele as described in association with RSV bronchiolitis. Furthermore, all polymorphisms were significantly more common in children with arthritis than in asthmatic children ( P =.006 to P =.02). No association was seen with the diagnosis of arthritis per se or with atopy. CONCLUSION: This is the first study to describe association of IL-8 with asthma and a significant inverse distribution of the polymorphisms in juvenile idiopathic arthritis. In addition, the results of this study might suggest that RSV bronchiolitis and bronchial asthma have at least some different genetic factors.

Adolescent↗
PubMed2006

Association of respiratory picornaviruses with acute bronchiolitis in French infants.

BACKGROUND: Human rhinoviruses and enteroviruses (Picornaviridae) are suspected to be major viral etiological causes of bronchiolitis in infants. OBJECTIVES: In the present study, we assessed the potential role of the respiratory picornaviruses as causative agents of bronchiolitis in French infants. STUDY DESIGN: From September 2001 to June 2002, we prospectively selected 192 infants < or =36 months of age and hospitalized for acute bronchiolitis. The detection of common respiratory viruses (respiratory syncytial virus, influenza virus A and B, parainfluenza virus 1, 2, 3 and adenovirus) was performed using classical immunofluorescence antigen and cell-culture detection assays on nasopharyngeal aspirates whereas the detection of human metapneumovirus (HMPV) was performed by a real-time RT-PCR assay. The presence of rhinovirus and/or enterovirus was assessed in respiratory samples by a picornavirus RT-PCR detection assay followed by a differential Southern blotting procedure. RESULTS: A potential causative virus was detected in 72.5% of the 192 study infants. RSV (30%), rhinovirus (21%), enterovirus (9%), influenza virus A (6%) and human metapneumovirus (4%) were the most frequent causative agents detected. Rhinoviruses or enteroviruses were detected as the only evidence of respiratory viral tract infection in 57 (30%) of 192 infants, whereas rhinovirus or enterovirus occurred in mixed viral infection detected in 25 (13%) of 192 study cases (30% versus 13%, p<10(-3)). CONCLUSIONS: Our data suggest that respiratory picornaviruses are one of the leading etiological causes of bronchiolitis in French infants. These findings highlight the need to implement a rapid picornavirus RT-PCR detection assay for the clinical diagnosis of respiratory infections in pediatric patients with bronchiolitis.

Acute Disease↗
PubMed1997

Mycophenolate mofetil for obliterative bronchiolitis syndrome after lung transplantation.

BACKGROUND: The development of obliterative bronchiolitis after lung transplantation portends a poor long-term outcome because of progressive decline in allograft function. There are currently no effective means of treating this condition. METHODS: Thirteen patients in whom obliterative bronchiolitis syndrome developed after lung transplantation were treated with mycophenolate mofetil, an antimetabolite immunosuppressant, at a dose of 1.5 g orally twice daily. Patients were followed up clinically and with pulmonary function testing. RESULTS: Duration of mycophenolate mofetil therapy ranged from 1 week to 24 months (mean duration, 11.4 months). Pulmonary function test results stabilized in the majority of patients with no significant further decline in forced expiratory volume in 1 second. Two patients died of progressive obliterative bronchiolitis, 1 patient is alive with progressive disease, and 1 patient died of an acute infection. The drug was discontinued in 2 additional patients. In no patient did severe leukopenia or cytomegalovirus infection develop; 1 patient had a fungal infection, and 7 patients experienced gastrointestinal side effects. CONCLUSIONS: In the setting of obliterative bronchiolitis syndrome, mycophenolate mofetil is generally well tolerated and is associated with stabilization of pulmonary function test results. These findings suggest that the otherwise progressive process of obliterative bronchiolitis can be slowed.

Adult↗
PubMed1985

Normal pulmonary function measurements and airway reactivity in childhood after mild bronchiolitis.

Concern about the long-term sequelae of bronchiolitis has been raised through studies of children hospitalized for bronchiolitis, but the long-term sequelae of mild bronchiolitis have not been studied. We assessed the hypothesis that 25 children with mild bronchiolitis (index subjects) were at greater risk for abnormalities of pulmonary function or airway reactivity to cold air between the ages of 8 and 12 years than were randomly selected, matched controls. There were no consistent differences in pulmonary function or airway reactivity between index and control groups. Airway hyperreactivity was found in five control subjects and three index subjects, and all children with symptomatic asthma were identified by cold air challenge. Our data suggest that children with a history of mild bronchiolitis are not at increased risk between ages 8 and 12 years for airway hyperreactivity or for abnormalities in pulmonary function.

Adult↗
PubMed1986

Predictive value of respiratory syncytial virus-specific IgE responses for recurrent wheezing following bronchiolitis.

To determine whether the magnitude of the respiratory syncytial virus (RSV)-specific IgE response at the time of an episode of RSV bronchiolitis in infancy accurately predicts the development of subsequent wheezing episodes, we observed 38 infants prospectively from the time of an episode of infantile bronchiolitis through 48 months of age. Peak RSV-IgE titers were measured at the time of the bronchiolitis episode using an ELISA procedure. Notation was made of both the number of subsequent wheezing episodes reported by parents and the number documented by a physician. Subsequent wheezing was documented by a physician in 20% of infants who did not develop an RSV-IgE response at the time of the bronchiolitis episode and in 70% of those with the highest responses (P less than 0.025). These results suggest that the magnitude of the RSV-IgE response at the time of RSV bronchiolitis is a useful prognostic indicator for recurrent wheezing.

Antibody Specificity↗