Treatment Of Viral Bronchiolitis Research Articles

Respiratory Syncytial Virus is the Most Common Causative Agent of Viral Bronchiolitis in Young Children: An Updated Review.

Viral bronchiolitis is a common condition and a leading cause of hospitalization in young children. This article provides readers with an update on the evaluation, diagnosis, and treatment of viral bronchiolitis, primarily due to RSV. A PubMed search was conducted in December 2021 in Clinical Queries using the key terms "acute bronchiolitis" OR "respiratory syncytial virus infection". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to children and English literature. The information retrieved from the above search was used in the compilation of this article. Respiratory syncytial virus (RSV) is the most common viral bronchiolitis in young children. Other viruses such as human rhinovirus and coronavirus could be etiological agents. Diagnosis is based on clinical manifestation. Viral testing is useful only for cohort and quarantine purposes. Cochrane evidence-based reviews have been performed on most treatment modalities for RSV and viral bronchiolitis. Treatment for viral bronchiolitis is mainly symptomatic support. Beta-agonists are frequently used despite the lack of evidence that they reduce hospital admissions or length of stay. Nebulized racemic epinephrine, hypertonic saline and corticosteroids are generally not effective. Passive immunoprophylaxis with a monoclonal antibody against RSV, when given intramuscularly and monthly during winter, is effective in preventing severe RSV bronchiolitis in high-risk children who are born prematurely and in children under 2 years with chronic lung disease or hemodynamically significant congenital heart disease. Vaccines for RSV bronchiolitis are being developed. Children with viral bronchiolitis in early life are at increased risk of developing asthma later in childhood. Viral bronchiolitis is common. No current pharmacologic treatment or novel therapy has been proven to improve outcomes compared to supportive treatment. Viral bronchiolitis in early life predisposes asthma development later in childhood.

High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial.

Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal Infant Pain Score (NIPS), treatment duration, treatment failure, and hospitalization length. Median age at inclusion was 2.8 (CPAP group) vs 2.1months (HFNC group). Mean baseline pCO2 was 6.7 in both groups and mean respiratory rate was 60 vs 56 in the CPAP and HFNC group respectively. No differences were observed in development of respiratory rate, pCO2, or M-WCAS. NIPS was higher in the CPAP group. Treatment failure was scarce in both groups. No significant differences in treatment duration or length of hospitalization were observed.Conclusion: In infants and young children with bronchiolitis, HFNC may be an effective and pleasant alternative to CPAP. Larger multicenter studies are needed to further explore differences in treatment failure and treatment duration.Trial registration: www.clinicaltrial.gov. id NCT02618213, registration date December 1, 2015.What is Known:• CPAP has been used for many years for respiratory support in infant bronchiolitis. The method requires special staff skills and may be stressful to the child.• HFNC has been introduced as a newer tool.What is New:• In infants with bronchiolitis, HFNC and CPAP were comparable in decreasing respiratory rate, pCO2, and need for oxygen supply.• Pain score during therapy was lower in the HFNC group.

Factors predicting length of stay in bronchiolitis.

Despite advances in medical knowledge, the treatment of viral bronchiolitis is mainly supportive. Antiviral therapies are being investigated in clinical trials. Identifying population-attributable risk factors for RSV hospitalization may help prioritizing targeted treatment. To utilize MDClone, a data acquisition tool, to examine factors associated with the risk of hospitalization and length of stay (LOS) in bronchiolitis. A single tertiary medical center retrospective study. Infants discharged with a diagnosis of bronchiolitis between January 2001 and March 2019 were included. Demographic, clinical, laboratory, microbiologic parameters and co-morbidities were collected. Correlations with the risk of hospitalization and LOS were examined. A total of 4793 infants with bronchiolitis, 3851 (80.3%) previously healthy, were seen; 975 visited emergency room only; 3311 were hospitalized in pediatric wards and 507 required pediatric intensive care unit. O2 saturation, age and fever correlated with the risk of hospitalization (OR=0.703, p<0.0001, OR=0.4, p=0.024 and OR=2.388, p<0.0001, respectively). Saturation, fever, gestational age and birth weight correlated with LOS (r=-0.283, p=0.000; r=0.16, p=0.000; r=-0.12, p=0.00; and r=-0.117, p=0.00, respectively). Rates of hospitalization were higher (81.1% vs. 75.6%, p=0.0008) and LOS was longer (median 2.97 vs. 2.73 days, p<0.001) in Arabs than in Jews. In a multivariate model, saturation, fever, gestational age and age predicted LOS. Saturation and ethnicity predicted LOS for previously healthy infants. Prematurity and cardiac anomalies increased LOS (p=0.016 and p<0.0001, respectively). Population-based data may enable predicting disease severity and LOS in bronchiolitis. Focusing on children at greatest risk may aid targeting new therapies.

PGD2/DP2 Receptor Activation Promotes Severe Viral Bronchiolitis by Suppressing IFN-λ Production

Respiratory syncytial virus (RSV) bronchiolitis is a major risk factor for the development of asthma. Prostaglandin D2 (PGD2) is an established chemoattractant that signals via prostaglandin D2 receptor 2 (DP2) on type 2 effector cells to promote asthma pathogenesis. The purpose of this study is to understand the role of PGD2 during RSV bronchiolitis and investigate whether DP2 antagonists or prostaglandin D2 receptor 1 (DP1) agonists are a useful treatment against viral bronchiolitis and a primary preventive against asthma development.The study included infants hospitalized with RSV bronchiolitis and healthy subjects from the surgical ward without bronchiolitis or respiratory complications.The authors collected nasopharyngeal samples from infants with RSV bronchiolitis and healthy subjects and measured the PGD2 production in both groups. In the study, the authors also used cultured human primary airway epithelial cells from healthy pediatric donors and a neonatal mouse model of severe viral bronchiolitis. Specific DP1 and DP2 antagonists and agonists were used in vivo and in vitro to measure effects on viral load, immunopathology, and phenotypic outcome.Nasopharyngeal samples from infants with RSV bronchiolitis revealed an increased PGD2 production compared with those from healthy subjects. RSV-infected cultured human primary airway epithelial cells also revealed increased PGD2 production. In a neonatal mouse model of severe viral bronchiolitis, DP2 antagonism decreased viral load, promoted antiviral immunity, and ameliorated type 2 inflammation and bronchiolitis. This protective effect was replicated with a specific DP1 agonist and lost with DP1/DP2 antagonism.The authors conclude that PGD2 contributes to disease severity by suppressing antiviral immunity and promoting type 2 inflammation. DP2 blockade or DP1 agonism increased interferon-I expression and viral clearance. Thus, DP2 antagonists or DP1 agonists may be a useful treatment of viral bronchiolitis and a possible preventive for asthma and other diseases with pathogeneses related to viruses.The authors of this study highlight the importance of PGD2 during RSV bronchiolitis and suggest a similar role in the development of asthma after an RSV infection. PGD2 suppression may boost immune defenses against RSV bronchiolitis. The findings from this study could lead to clinical studies to determine if DP2 antagonism and DP1 agonism could be used to treat viral bronchiolitis and perhaps prevent the subsequent development of asthma.

Nebulized Hypertonic Saline in the Treatment of Viral Bronchiolitis in Infants

Nebulized Hypertonic Saline in the Treatment of Viral Bronchiolitis in Infants