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. 2005 Dec;97(12):1708–1713.

Respiratory syncytial virus bronchiolitis.

Alexander K C Leung 1, James D Kellner 1, H Dele Davies 1
PMCID: PMC2640754  PMID: 16396064

Abstract

Respiratory syncytial virus, the most common cause of bronchiolitis, is the leading cause of infant hospitalization in developed countries and accounts for substantial mortality and morbidity in developing countries. Children at increased risk of developing severe bronchiolitis are those <6 weeks of age, those born prematurely and those with an underlying cardiopulmonary disorder or immunodeficiency. Approximately 80% of cases occur in the first year of life. By two years of age, virtually all children have been infected by at least one strain of the virus. Classically, respiratory syncytial virus bronchiolitis manifests as cough, wheezing and respiratory distress. The mainstay of treatment is supportive care, consisting of adequate fluid intake, antipyretics to control fever and use of supplemental oxygen if necessary. Frequent and meticulous hand-washing is the best measure to prevent secondary spread. Treatment of respiratory syncytial virus bronchiolitis beyond supportive care should be individualized. Palivizumab has been shown to be effective in preventing severe respiratory syncytial virus bronchiolitis in high-risk children when given prophylactically. In the majority of cases, the disease is usually self-limited. The mortality rate is <1% and occurs predominantly in children at high risk for severe disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abul-Ainine A., Luyt D. Short term effects of adrenaline in bronchiolitis: a randomised controlled trial. Arch Dis Child. 2002 Apr;86(4):276–279. doi: 10.1136/adc.86.4.276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Al-balkhi A., Klonin H., Marinaki K., Southall D. P., Thomas D. A., Jones P., Samuels M. P. Review of treatment of bronchiolitis related apnoea in two centres. Arch Dis Child. 2005 Mar;90(3):288–291. doi: 10.1136/adc.2003.039404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Pediatrics. 2003 Dec;112(6 Pt 1):1442–1446. [PubMed] [Google Scholar]
  4. Barben J. U., Robertson C. F., Robinson P. J. Implementation of evidence-based management of acute bronchiolitis. J Paediatr Child Health. 2000 Oct;36(5):491–497. doi: 10.1046/j.1440-1754.2000.00558.x. [DOI] [PubMed] [Google Scholar]
  5. Bisgaard Hans, Study Group on Montelukast and Respiratory Syncytial Virus A randomized trial of montelukast in respiratory syncytial virus postbronchiolitis. Am J Respir Crit Care Med. 2002 Oct 3;167(3):379–383. doi: 10.1164/rccm.200207-747OC. [DOI] [PubMed] [Google Scholar]
  6. Bordley W. Clayton, Viswanathan Meera, King Valerie J., Sutton Sonya F., Jackman Anne M., Sterling Laura, Lohr Kathleen N. Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med. 2004 Feb;158(2):119–126. doi: 10.1001/archpedi.158.2.119. [DOI] [PubMed] [Google Scholar]
  7. Chávez-Bueno Susana, Mejías Asunción, Jafri Hasan S., Ramilo Octavio. Respiratory syncytial virus: old challenges and new approaches. Pediatr Ann. 2005 Jan;34(1):62–68. doi: 10.3928/0090-4481-20050101-14. [DOI] [PubMed] [Google Scholar]
  8. Cooper Allison C., Banasiak Nancy Cantey, Allen Patricia Jackson. Management and prevention strategies for respiratory syncytial virus (RSV) bronchiolitis in infants and young children: a review of evidence-based practice interventions. Pediatr Nurs. 2003 Nov-Dec;29(6):452–456. [PubMed] [Google Scholar]
  9. Davies H. D., Matlow A., Petric M., Glazier R., Wang E. E. Prospective comparative study of viral, bacterial and atypical organisms identified in pneumonia and bronchiolitis in hospitalized Canadian infants. Pediatr Infect Dis J. 1996 Apr;15(4):371–375. doi: 10.1097/00006454-199604000-00017. [DOI] [PubMed] [Google Scholar]
  10. Davies H. D., Wang E. E., Manson D., Babyn P., Shuckett B. Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. Pediatr Infect Dis J. 1996 Jul;15(7):600–604. doi: 10.1097/00006454-199607000-00008. [DOI] [PubMed] [Google Scholar]
  11. Duttweiler L., Nadal D., Frey B. Pulmonary and systemic bacterial co-infections in severe RSV bronchiolitis. Arch Dis Child. 2004 Dec;89(12):1155–1157. doi: 10.1136/adc.2004.049551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Feltes Timothy F., Cabalka Allison K., Meissner H. Cody, Piazza Franco M., Carlin David A., Top Franklin H., Jr, Connor Edward M., Sondheimer Henry M., Cardiac Synagis Study Group Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr. 2003 Oct;143(4):532–540. doi: 10.1067/s0022-3476(03)00454-2. [DOI] [PubMed] [Google Scholar]
  13. Fitzgerald Dominic A., Kilham Henry A. Bronchiolitis: assessment and evidence-based management. Med J Aust. 2004 Apr 19;180(8):399–404. doi: 10.5694/j.1326-5377.2004.tb05993.x. [DOI] [PubMed] [Google Scholar]
  14. Goebel J., Estrada B., Quinonez J., Nagji N., Sanford D., Boerth R. C. Prednisolone plus albuterol versus albuterol alone in mild to moderate bronchiolitis. Clin Pediatr (Phila) 2000 Apr;39(4):213–220. doi: 10.1177/000992280003900404. [DOI] [PubMed] [Google Scholar]
  15. Hall C. B., Powell K. R., Schnabel K. C., Gala C. L., Pincus P. H. Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection. J Pediatr. 1988 Aug;113(2):266–271. [PubMed] [Google Scholar]
  16. Hanna S., Tibby S. M., Durward A., Murdoch I. A. Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr. 2003 Apr;92(4):430–434. doi: 10.1111/j.1651-2227.2003.tb00573.x. [DOI] [PubMed] [Google Scholar]
  17. Hartling L., Wiebe N., Russell K., Patel H., Klassen T. P. Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2004;(1):CD003123–CD003123. doi: 10.1002/14651858.CD003123.pub2. [DOI] [PubMed] [Google Scholar]
  18. Holman Robert C., Shay David K., Curns Aaron T., Lingappa Jairam R., Anderson Larry J. Risk factors for bronchiolitis-associated deaths among infants in the United States. Pediatr Infect Dis J. 2003 Jun;22(6):483–490. doi: 10.1097/01.inf.0000069765.43405.3b. [DOI] [PubMed] [Google Scholar]
  19. Jafri Hasan S. Treatment of respiratory syncytial virus: antiviral therapies. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S89–S93. doi: 10.1097/01.inf.0000053892.99856.ef. [DOI] [PubMed] [Google Scholar]
  20. Jhawar Sanjay. Severe bronchiolitis in children. Clin Rev Allergy Immunol. 2003 Dec;25(3):249–257. doi: 10.1385/CRIAI:25:3:249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Kamal-Bahl Sachin, Doshi Jalpa, Campbell James. Economic analyses of respiratory syncytial virus immunoprophylaxis in high-risk infants: a systematic review. Arch Pediatr Adolesc Med. 2002 Oct;156(10):1034–1041. doi: 10.1001/archpedi.156.10.1034. [DOI] [PubMed] [Google Scholar]
  22. Kellner J. D., Ohlsson A., Gadomski A. M., Wang E. E. Efficacy of bronchodilator therapy in bronchiolitis. A meta-analysis. Arch Pediatr Adolesc Med. 1996 Nov;150(11):1166–1172. doi: 10.1001/archpedi.1996.02170360056009. [DOI] [PubMed] [Google Scholar]
  23. Khoshoo V., Edell D. Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis. Pediatrics. 1999 Dec;104(6):1389–1390. doi: 10.1542/peds.104.6.1389. [DOI] [PubMed] [Google Scholar]
  24. King Valerie J., Viswanathan Meera, Bordley W. Clayton, Jackman Anne M., Sutton Sonya F., Lohr Kathleen N., Carey Timothy S. Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Arch Pediatr Adolesc Med. 2004 Feb;158(2):127–137. doi: 10.1001/archpedi.158.2.127. [DOI] [PubMed] [Google Scholar]
  25. Kneyber MCJ, Steyerberg E. W., de Groot R., Moll H. A. Long-term effects of respiratory syncytial virus (RSV) bronchiolitis in infants and young children: a quantitative review. Acta Paediatr. 2000 Jun;89(6):654–660. doi: 10.1080/080352500750043945. [DOI] [PubMed] [Google Scholar]
  26. Lozano Juan Manuel. Bronchiolitis. Clin Evid. 2003 Dec;(10):345–359. [PubMed] [Google Scholar]
  27. Maggon Krishan, Barik Sailen. New drugs and treatment for respiratory syncytial virus. Rev Med Virol. 2004 May-Jun;14(3):149–168. doi: 10.1002/rmv.423. [DOI] [PubMed] [Google Scholar]
  28. Martinez Fernando D. Respiratory syncytial virus bronchiolitis and the pathogenesis of childhood asthma. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S76–S82. doi: 10.1097/01.inf.0000053889.39392.a7. [DOI] [PubMed] [Google Scholar]
  29. Martinón-Torres Federico. Current treatment for acute viral bronchiolitis in infants. Expert Opin Pharmacother. 2003 Aug;4(8):1355–1371. doi: 10.1517/14656566.4.8.1355. [DOI] [PubMed] [Google Scholar]
  30. McCarthy Carol A., Hall Caroline Breese. Respiratory syncytial virus: concerns and control. Pediatr Rev. 2003 Sep;24(9):301–309. doi: 10.1542/pir.24-9-301. [DOI] [PubMed] [Google Scholar]
  31. McNamara Paul S., Flanagan Brian F., Baldwin Lisa M., Newland Paul, Hart C. Anthony, Smyth Rosalind L. Interleukin 9 production in the lungs of infants with severe respiratory syncytial virus bronchiolitis. Lancet. 2004 Mar 27;363(9414):1031–1037. doi: 10.1016/S0140-6736(04)15838-8. [DOI] [PubMed] [Google Scholar]
  32. McNamara Paul S., Flanagan Brian F., Hart C. Anthony, Smyth Rosalind L. Production of chemokines in the lungs of infants with severe respiratory syncytial virus bronchiolitis. J Infect Dis. 2005 Mar 14;191(8):1225–1232. doi: 10.1086/428855. [DOI] [PubMed] [Google Scholar]
  33. Meissner H. Cody, Long Sarah S., American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Pediatrics. 2003 Dec;112(6 Pt 1):1447–1452. doi: 10.1542/peds.112.6.1447. [DOI] [PubMed] [Google Scholar]
  34. Meissner H. Cody. Selected populations at increased risk from respiratory syncytial virus infection. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S40–S45. doi: 10.1097/01.inf.0000053884.21238.13. [DOI] [PubMed] [Google Scholar]
  35. Ngai Pakkay, Bye Michael R. Bronchiolitis. Pediatr Ann. 2002 Feb;31(2):90–97. doi: 10.3928/0090-4481-20020201-06. [DOI] [PubMed] [Google Scholar]
  36. Nicolaides N. C., Holroyd K. J., Ewart S. L., Eleff S. M., Kiser M. B., Dragwa C. R., Sullivan C. D., Grasso L., Zhang L. Y., Messler C. J. Interleukin 9: a candidate gene for asthma. Proc Natl Acad Sci U S A. 1997 Nov 25;94(24):13175–13180. doi: 10.1073/pnas.94.24.13175. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Openshaw Peter J., Dean Gillian S., Culley Fiona J. Links between respiratory syncytial virus bronchiolitis and childhood asthma: clinical and research approaches. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S58–S65. doi: 10.1097/01.inf.0000053887.26571.eb. [DOI] [PubMed] [Google Scholar]
  38. Panitch H. B. Bronchiolitis in infants. Curr Opin Pediatr. 2001 Jun;13(3):256–260. doi: 10.1097/00008480-200106000-00008. [DOI] [PubMed] [Google Scholar]
  39. Panitch Howard B. Respiratory syncytial virus bronchiolitis: supportive care and therapies designed to overcome airway obstruction. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S83–S88. doi: 10.1097/01.inf.0000053890.66801.97. [DOI] [PubMed] [Google Scholar]
  40. Patel H., Platt R., Lozano J. M., Wang E. E. L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2004;(3):CD004878–CD004878. doi: 10.1002/14651858.CD004878. [DOI] [PubMed] [Google Scholar]
  41. Perlstein P. H., Kotagal U. R., Bolling C., Steele R., Schoettker P. J., Atherton H. D., Farrell M. K. Evaluation of an evidence-based guideline for bronchiolitis. Pediatrics. 1999 Dec;104(6):1334–1341. doi: 10.1542/peds.104.6.1334. [DOI] [PubMed] [Google Scholar]
  42. Piedra Pedro A. Clinical experience with respiratory syncytial virus vaccines. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S94–S99. doi: 10.1097/01.inf.0000053893.15894.ff. [DOI] [PubMed] [Google Scholar]
  43. Pinnington L. L., Smith C. M., Ellis R. E., Morton R. E. Feeding efficiency and respiratory integration in infants with acute viral bronchiolitis. J Pediatr. 2000 Oct;137(4):523–526. doi: 10.1067/mpd.2000.108396. [DOI] [PubMed] [Google Scholar]
  44. Polack Fernando P., Karron Ruth A. The future of respiratory syncytial virus vaccine development. Pediatr Infect Dis J. 2004 Jan;23(1 Suppl):S65–S73. doi: 10.1097/01.inf.0000108194.71892.95. [DOI] [PubMed] [Google Scholar]
  45. Randolph A. G., Wang E. E. Ribavirin for respiratory syncytial virus lower respiratory tract infection. A systematic overview. Arch Pediatr Adolesc Med. 1996 Sep;150(9):942–947. doi: 10.1001/archpedi.1996.02170340056011. [DOI] [PubMed] [Google Scholar]
  46. Scarfone R. J. Bronchiolitis--or is it? Pediatr Ann. 2000 Feb;29(2):89–92. doi: 10.3928/0090-4481-20000201-07. [DOI] [PubMed] [Google Scholar]
  47. Schuh Suzanne, Coates Allan L., Binnie Rosemary, Allin Tracey, Goia Cristina, Corey Mary, Dick Paul T. Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. J Pediatr. 2002 Jan;140(1):27–32. doi: 10.1067/mpd.2002.120271. [DOI] [PubMed] [Google Scholar]
  48. Sharland M., Bedford-Russell A. Preventing respiratory syncitial virus bronchiolitis. BMJ. 2001 Jan 13;322(7278):62–63. doi: 10.1136/bmj.322.7278.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Sigurs N., Bjarnason R., Sigurbergsson F., Kjellman B., Björkstén B. Asthma and immunoglobulin E antibodies after respiratory syncytial virus bronchiolitis: a prospective cohort study with matched controls. Pediatrics. 1995 Apr;95(4):500–505. [PubMed] [Google Scholar]
  50. Smyth Rosalind L., Mobbs Kevin J., O'Hea Una, Ashby Deborah, Hart C. Anthony. Respiratory syncytial virus bronchiolitis: disease severity, interleukin-8, and virus genotype. Pediatr Pulmonol. 2002 May;33(5):339–346. doi: 10.1002/ppul.10080. [DOI] [PubMed] [Google Scholar]
  51. Sreeram N., Watson J. G., Hunter S. Cardiovascular effects of acute bronchiolitis. Acta Paediatr Scand. 1991 Jan;80(1):133–136. doi: 10.1111/j.1651-2227.1991.tb11747.x. [DOI] [PubMed] [Google Scholar]
  52. Steiner Robert William Prasaad. Treating acute bronchiolitis associated with RSV. Am Fam Physician. 2004 Jan 15;69(2):325–330. [PubMed] [Google Scholar]
  53. Straliotto Selir M., Siqueira Marilda M., Machado Vera, Maia Tânia M. R. Respiratory viruses in the pediatric intensive care unit: prevalence and clinical aspects. Mem Inst Oswaldo Cruz. 2005 Mar 4;99(8):883–887. doi: 10.1590/s0074-02762004000800017. [DOI] [PubMed] [Google Scholar]
  54. Wegner Steven, Vann Julie Jacobson, Liu Gordon, Byrns Patricia, Cypra Clement, Campbell William, Stiles Alan. Direct cost analyses of palivizumab treatment in a cohort of at-risk children: evidence from the North Carolina Medicaid Program. Pediatrics. 2004 Dec;114(6):1612–1619. doi: 10.1542/peds.2004-0959. [DOI] [PubMed] [Google Scholar]
  55. Yount Laura E., Mahle William T. Economic analysis of palivizumab in infants with congenital heart disease. Pediatrics. 2004 Dec;114(6):1606–1611. doi: 10.1542/peds.2004-0224. [DOI] [PubMed] [Google Scholar]

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