Жұқпалы вирустың салдарынан кішкентай бронхтардың бітелуі

Blockage of the small airways in the lungs due to a viral infection

Acute bronchiolitis is usually the result of infection by respiratory syncytial virus (72% of cases) or human rhinovirus (26% of cases). Tests such as a chest X ray or viral testing are not routinely needed. Symptomatic treatment at home is generally sufficient. Evidence for antibiotics, antivirals, bronchodilators, or nebulized epinephrine is either unclear or not supportive. About 10% to 30% of children under the age of two years are affected by bronchiolitis at some point in time. It commonly occurs in the winter in the Northern Hemisphere. Outbreaks of the condition were first described in the 1940s.

The diagnosis is typically made by clinical examination. Chest X ray is sometimes useful to exclude bacterial pneumonia, but not indicated in routine cases. Chest x ray may also be useful in people with impending respiratory failure. Additional testing such as blood cultures, complete blood count, and electrolyte analyses are not recommended for routine use although may be useful in children with multiple comorbidities or signs of sepsis or pneumonia. When further evaluated with a urinalysis, infants with bronchiolitis had a concomitant UTI 0.8% of the time. Preliminary studies have suggested that elevated procalcitonin levels may assist clinicians in determining the presence of bacterial co infection, which could prevent unnecessary antibiotic use and costs.

There are many childhood illnesses that can present with respiratory symptoms, particularly persistent cough and wheezing. Respiratory infections were shown to be significantly less common among breastfed infants and fully breastfed RSV positive hospitalized infants had shorter hospital stays than non or partially breastfed infants. Abrysvo is also approved for "immunization of pregnant individuals at 32 through 36 weeks gestational age for the prevention of lower respiratory tract disease (LRTD) and severe LRTD caused by respiratory syncytial virus (RSV) in infants from birth through 6 months of age." Nirsevimab, a monoclonal antibody against RSV, is recommended by the CDC for all children younger than 8 months in their first RSV season. A second monoclonal antibody, Palivizumab, can be administered to prevent bronchiolitis to infants less than one year of age that were born very prematurely or that have underlying heart disease or chronic lung disease of prematurity. Without active treatment, half of cases will go away in 13 days and 90% in three weeks. Children with severe symptoms, especially poor feeding or dehydration, may be considered for hospital admission. Treatments which the evidence does not support include salbutamol, steroids, antibiotics, antivirals, heliox, continuous positive airway pressure (CPAP), and cool mist or steam inhalation.

Maintaining hydration is an important part of management of bronchiolitis. Infants with mild pulmonary symptoms may require only observation if feeding is unaffected. However, evidence is mixed regarding the use of high flow nasal cannula compared to standard oxygen therapy or continuous positive airway pressure. These practices may still be used in severe cases prior to intubation. Blood gas testing is not recommended for people hospitalized with the disease and is not useful in the routine management of bronchiolitis. A 2017 review found tentative evidence that it reduces the risk of hospitalization, duration of hospital stay, and improved the severity of symptoms. The majority of evidence suggests that hypertonic saline is safe and effective at improving respiratory symptoms of mild to moderate bronchiolitis after 24 hours of use. However, it does not appear effective in reducing the rate of hospitalization when used in the emergency room or other outpatient settings in which length of therapy is brief. Additionally, there are adverse effects to the use of bronchodilators in children such as tachycardia and tremors, as well as adding increased financial expenses. Several studies have shown that bronchodilation with β adrenergic agents such as salbutamol may improve symptoms briefly but do not affect the overall course of the illness or reduce the need for hospitalization.

The current state of evidence suggests that nebulized epinephrine is not indicated for children with bronchiolitis except as a trial of rescue therapy for severe cases. A Cochrane meta analysis in 2011 found no benefit to the use of epinephrine in the inpatient setting and suggested that there may be utility in the outpatient setting in reducing the rate of hospitalization. Other studies suggest a synergistic effect of epinephrine with corticosteroids but have not consistently demonstrated benefits in clinical trials. Some are dehydrated and others cannot be fed fluids safely by mouth. Experimental trials with novel antiviral medications in adults are promising but it remains unclear if the same benefit will be present. People with difficulty clearing secretions due to underlying disorders such as spinal muscle atrophy or severe tracheomalacia may be considered for chest physiotherapy. Suctioning of the nares may provide temporarily relief of nasal congestion but deep suctioning of the nasopharynx has been shown prolong length of hospital stay in infants. There are no systematic reviews or controlled trials on the effectiveness of nasal decongestants, such as xylometazoline, for the treatment of bronchiolitits. There is tentative evidence for Chinese herbal medicine, vitamin D, N acetylcysteine, and magnesium but this is insufficient to recommend their use. The risks of bronchiolitis with a concomitant serious bacterial infection among hospitalized febrile infants is minimal and work up and antibiotics are not justified. Corticosteroids, although useful in other respiratory disease such as asthma and croup, have no proven benefit in bronchiolitis treatment and are not advised. Additionally, corticosteroid therapy in children with bronchiolitis may prolong viral shedding and transmissibility. Leukotriene inhibitors, such as montelukast, have not been found to be beneficial and may increase adverse effects. Immunoglobulins are of unclear benefit.

Bronchiolitis typically affects infants and children younger than two years, principally during the autumn and winter. It is the leading cause of hospital admission for respiratory disease among infants in the United States and accounts for one out of every 13 primary care visits. Bronchiolitis accounts for 3% of emergency department visits for children under 2 years old. Bronchiolitis is the most frequent lower respiratory tract infection and hospitalization in infants worldwide.