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- Tamara Wagner, MD*
- *Assistant Professor, Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore
Objectives
After completing this article, readers should be able to:
Recognize the clinical presentation of bronchiolitis.
Be aware of the recommendations made in the current American Academy of Pediatrics clinical practice guideline for diagnosis and management of bronchiolitis.
Describe the role of laboratory testing in the diagnosis of bronchiolitis.
Delineate the efficacy of current therapeutic interventions in the treatment of bronchiolitis.
Discuss the evaluation for serious bacterial infections in patients who have bronchiolitis.
Outline the prognosis and risk of recurrent wheezing in patients diagnosed with bronchiolitis.
Introduction
Bronchiolitis, defined as inflammation of the bronchioles, usually is caused by an acute viral infection. Viral bronchiolitis is the most common lower respiratory tract infection in infants and children who are 2 years of age and younger. The most commonly identified infectious agent is the respiratory syncytial virus (RSV). Other identified pathogens include adenovirus, human metapneumovirus, influenza virus, and parainfluenza virus.
The pathophysiology of bronchiolitis begins with an acute infection of the epithelial cells lining the small airways within the lungs. Such infection results in edema, increased mucus production, and eventual necrosis and regeneration of these cells. The clinical presentation of bronchiolitis includes rhinitis, cough, tachypnea, use of accessory respiratory muscles, hypoxia, and variable wheezing and crackles on auscultation.
The evaluation and management of bronchiolitis varies substantially. Although bronchiolitis is a well-recognized clinical syndrome, additional tests such as viral isolation, blood serology, and chest radiographs often are ordered, although they have little impact on diagnosis. Most clinical interventions have no significant impact on length of hospital stay, severity of clinical course, or subsequent outcomes such as episodes of recurrent wheezing or ultimate diagnosis of asthma. In 2006, the American Academy of Pediatrics (AAP) released a clinical practice guideline for the diagnosis, testing, and management of bronchiolitis (Table 1). (1) These recommendations are based on current …
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