Bronchiolitis natural history
|
Bronchiolitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Bronchiolitis natural history On the Web |
|
American Roentgen Ray Society Images of Bronchiolitis natural history |
|
Risk calculators and risk factors for Bronchiolitis natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
In the first 2-3 days, patients with bronchiolitis present with mild upper respiratory symptoms. During third to seventh days of infection, patients develop shortness of breath, wheezing, persistent prominent cough, tachypnea, chest wall retraction, and nasal flaring. Symptoms gradually disappear within the next 2 weeks. Complications are usually observed in patients younger than 2 months of age, premature infants, and patients with other medical conditions (including congenital heart disease, chronic pulmonary disease, and immunodeficiencies). Severity scores can be used to estimate the prognosis.
Natural History
- Patients usually develop symptoms one week after contact with a symptomatic patient.
- In the first 2-3 days, patients with bronchiolitis present with mild upper respiratory symptoms (cough, rhinorrhea, and low fever).
- The acute phase (shortness of breath, wheezing, persistent prominent cough, tachypnea, chest wall retraction, and nasal flaring) usually develops between the third and seventh days.
- Symptoms gradually disappear within the next 2 weeks (the cough may take longer to resolve).
- Bronchiolitis is usually a self-limited infection that should be eliminated in the next two weeks after infection in immunocompetent patients. However, dissemination of the 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 below:
- Apnea: More common in children under 2 months of age and premature infants, it is observed in 3% to 25% of the patients. Apnea may appear as the presenting manifestation; however, it may be the consequence of previous mild respiratory symptoms.[2][3]
- Aspiration pneumonia can be seen.
- Recurrent wheezing episodes: 30%-50% of hospitalized patients with bronchiolitis present recurrent wheezing episodes, however, episodes usually disappear before adolescence.
- Associated bacterial infections: The 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 live births in the U.S. and 1.82 per 100,000 live births in the UK).
Clinical scoring systems such as the following 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.