Bronchiolitis natural history: Difference between revisions
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Complications are usually observed in patients younger than 2 months, premature infants and patients with associated conditions ([[congenital heart disease]], chronic pulmonary disease and [[immunodeficiencies]]). A list of common complications is listed below: | Complications are usually observed in patients younger than 2 months, premature infants and patients with associated conditions ([[congenital heart disease]], chronic pulmonary disease and [[immunodeficiencies]]). A list of common complications is listed below: | ||
*[[Apnea]]: More common in children under 2 months of age and [[premature infants]], it is observed in 3% to 25% of the patients. Several times it appears as the presenting manifestation; however it may be the consequence of previous mild respiratory symptoms.<ref name="Mandell">{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = | pages = }}</ref><ref name="pmid19209271">{{cite journal| author=Wright M, Mullett CJ, Piedimonte G| title=Pharmacological management of acute bronchiolitis. | journal=Ther Clin Risk Manag | year= 2008 | volume= 4 | issue= 5 | pages= 895-903 | pmid=19209271 | doi= | pmc=PMC2621418 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19209271 }} </ref> | *[[Apnea]]: More common in children under 2 months of age and [[premature infants]], it is observed in 3% to 25% of the patients. Several times it appears as the presenting manifestation; however it may be the consequence of previous mild respiratory symptoms.<ref name="Mandell">{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = | pages = }}</ref><ref name="pmid19209271">{{cite journal| author=Wright M, Mullett CJ, Piedimonte G| title=Pharmacological management of acute bronchiolitis. | journal=Ther Clin Risk Manag | year= 2008 | volume= 4 | issue= 5 | pages= 895-903 | pmid=19209271 | doi= | pmc=PMC2621418 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19209271 }} </ref> | ||
*[[Aspiration]] | *[[Aspiration]] | ||
*Recurrent [[wheezing]] episodes: 30%-50% of hospitalized patients with bronchiolitis present recurrent [[wheezing]] episodes, however, episodes usually disappear before [[adolescence]]. | *Recurrent [[wheezing]] episodes: 30%-50% of hospitalized patients with bronchiolitis present recurrent [[wheezing]] episodes, however, episodes usually disappear before [[adolescence]]. | ||
*Associated [[bacterial]] infections: Most common association is with [[urinary tract infections]] (UTI) and [[Otitis media classification#Acute otitis media|acute otitis media]] (AOM), usually not related to the respiratory infection. [[Bacterial]] co-infections appear in 0%-7% of patients with bronchiolitis. | *Associated [[bacterial]] infections: Most common association is with [[urinary tract infections]] (UTI) and [[Otitis media classification#Acute otitis media|acute otitis media]] (AOM), usually not related to the respiratory infection. [[Bacterial]] co-infections appear in 0%-7% of patients with bronchiolitis. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
The first 2-3 days the patient with bronchiolitis presents with mild upper respiratory symptoms. Shortness of breath, wheezing, persistent prominent cough, tachypnea, chest wall retraction and nasal flaring usually develop between the third and seventh day. Symptoms gradually disappear within the next 2 weeks. Complications are usually observed among patients younger than 2 months of age, premature infants, and patients with other medical conditions (congenital heart disease, chronic pulmonary disease and immunodeficiencies). Severity scores can be used to estimate the prognosis.
Natural History
- Patients usually develop symptoms 1 week after the contact with a symptomatic patient.
- The first 2-3 days the patient presents with mild upper respiratory symptoms (cough, rhinorrhea and low fever).
- Acute phase (shortness of breath, wheezing, persistent prominent cough, tachypnea, chest wall retraction and nasal flaring) usually develops between the third and seventh day.
- Symptoms gradually disappear within the next 2 weeks (the cough may take longer).
- Bronchiolitis is usually a self-limited infection which should be eliminated during the next 2 weeks after infection in immunocompetent patients. However, dissemination of virus in immunocompromised patients could remain for several months after initial infection.[1]
Complications
Complications are usually observed in patients younger than 2 months, premature infants and patients with associated conditions (congenital heart disease, chronic pulmonary disease and immunodeficiencies). A list of common complications is listed below:
- Apnea: More common in children under 2 months of age and premature infants, it is observed in 3% to 25% of the patients. Several times it appears as the presenting manifestation; however it may be the consequence of previous mild respiratory symptoms.[2][3]
- Aspiration
- Recurrent wheezing episodes: 30%-50% of hospitalized patients with bronchiolitis present recurrent wheezing episodes, however, episodes usually disappear before adolescence.
- Associated bacterial infections: Most common association is with urinary tract infections (UTI) and acute otitis media (AOM), usually not related to the respiratory infection. Bacterial co-infections appear in 0%-7% of patients with bronchiolitis.
Prognosis
Prognosis is generally good, as most children show gradual symptomatic improvement within 2 weeks after symptoms begin. Though the rate of hospitalizations is high (71 per 1000 infants for 2003) and has increased in the last 2 decades, the mortality rate is very low (2 deaths per 100 000 livebirths in the U.S. and 1.82 per 100 000 livebirths in the UK).
Clinical scoring systems may help estimate prognosis:
- Bronchiolitis severity score (BSS)[4]
- Court's scale[5]
- Respiratory distress assessment instrument (RDAI)[6]
- Respiratory distress observation scale (RDOS)[7]
- Tal and modified-Tal scoring systems[8]
References
- ↑ Wright M, Mullett CJ, Piedimonte G (2008). "Pharmacological management of acute bronchiolitis". Ther Clin Risk Manag. 4 (5): 895–903. PMC 2621418. PMID 19209271.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier.
- ↑ Wright M, Mullett CJ, Piedimonte G (2008). "Pharmacological management of acute bronchiolitis". Ther Clin Risk Manag. 4 (5): 895–903. PMC 2621418. PMID 19209271.
- ↑ Wang EE, Milner RA, Navas L, Maj H (1992). "Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections". Am Rev Respir Dis. 145 (1): 106–9. doi:10.1164/ajrccm/145.1.106. PMID 1731571.
- ↑ Court SD (1973). "The definition of acute respiratory illnesses in children". Postgrad Med J. 49 (577): 771–6. PMC 2495839. PMID 4806395.
- ↑ Lowell DI, Lister G, Von Koss H, McCarthy P (1987). "Wheezing in infants: the response to epinephrine". Pediatrics. 79 (6): 939–45. PMID 3295741.
- ↑ Campbell ML (2008). "Psychometric testing of a respiratory distress observation scale". J Palliat Med. 11 (1): 44–50. doi:10.1089/jpm.2007.0090. PMID 18370892.
- ↑ McCallum GB, Morris PS, Wilson CC, Versteegh LA, Ward LM, Chatfield MD; et al. (2013). "Severity scoring systems: are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?". Pediatr Pulmonol. 48 (8): 797–803. doi:10.1002/ppul.22627. PMID 22949369.