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Bronchiolitis

Bronchiolitis is an acute respiratory illness precipitated by a viral infection and resulting in obstruction of the small airways. While mortality due to bronchiolitis is low in developed countries, it remains an important illness because of the frequency with which infants require hospitalization and because of the potential association with asthma during later life.

Definition

An enduring definition of bronchiolitis has been the first episode during infancy of an illness beginning as an upper respiratory infection that progresses to the development of wheezing. This definition is inadequate for a number of reasons. First, infants who have obstructive airway disease do not always wheeze audibly. Second, many infants have two or more episodes of viral bronchiolitis within an interval of only a few months. The recurrent wheezing episodes are clinically quite similar to the first episode. Finally, some children may have their first episode of virus-induced wheezing during the second year of life, with the age of onset being the only feature that is different from a typical episode of bronchiolitis.

It has been suggested that clinicians use the response of the wheezing infant to a single subcutaneous dose of epinephrine to distinguish bronchiolitis from asthma. This is inappropriate because a small number of infants who have true bronchiolitis respond to the first course of beta-adrenergic agents while many patients with status asthmaticus do not.

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