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Paediatric Pulmonology and Allergology
2005 April, Vol. VIII, No. 1 (2852-2857)
RSV AND NON-RSV BRONCHIOLITIS: CRITICAL APPROACH ON THE MANAGEMENT AND OUTCOME
Matti Korppi
Kuopio University Children’s Hospital, Kuopio, Finland
Bronchiolitis is the most common lower respiratory tract infection in young children. Respiratory syncytial virus is the most common causative agent in < 12 months old children, whereas other viruses, especially rhinoviruses, most often induce wheezing in > 12 months old children. RSV and non-RSV bronchiolitis can not be separated clinically. However, the outcomes are different, parental asthma, later asthma in children, and early and later atopy in children being linked more with non-RSV than with RSV bronchiolitis. Recent systematic reviews have resulted that ribavirin, anticholinergics, bronchodilators or glucocorticoids are not efficacious in infants with bronchiolitis. Inhaled racemic adrenalin may be useful when given on demand basis but not on regular basis. In acute treatment, a carefully monitored trial of inhaled bronchodilators is indicated in infants with respiratory distress. The clinical response must be evaluated, including assessment of wheezing, respiratory rate, heart rate and oxygen saturation, and the treatment should be continued only, if the response is beneficial. The prefered drug is racemic adrenalin for < 12 month old children, and salbutamol for > 12 month old children or for children with parental asthma, atopic dermatitis or earlier wheezing. In preventive treatment, a carefully monitored trial of inhaled steroids or leukotriene modifiers are justified in > 6 month old children, in whom wheezing repeats after bronchiolitis, and who have risk factors for asthma, such as parental asthma, atopic dermatitis or eosinophilia during wheezing episodes.