Introduction
Bronchiolitis (table 1) is one of the main causes of hospitalisation in infants aged <1 yr [1]. Approximately 2–3%, without underlying diseases, are hospitalised for bronchiolitis during epidemics. Recently the number of the hospital admission has increased, with the use of pulse oximetry possibly contributing to the higher admission rate [2]. Respiratory syncytial virus (RSV) infection is the most common cause of severe bronchiolitis [3]. The incidence peaks in December–March. Nearly all children are infected by RSV before the age of 2 [1], usually reporting only a mild upper respiratory tract infection. In some cases, lower respiratory symptoms leading to respiratory failure characterise the clinical course of bronchiolitis. Many risk factors have been found to be associated with the severity of the disease, but the reason why viruses cause lower respiratory infection and consolidation only in some children is still unknown.
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Recently, respiratory viruses other than RSV have been detected in infants with bronchiolitis. Rhinovirus (RV), the major cause of the common cold, was considered to be confined in the upper respiratory tract. Nowadays, RV seems to be as common as RSV, often affecting older children, and those with atopic dermatitis and eosinophilia [4].
The treatment is mainly supportive [5], with supplemental oxygen, nasal washing, i.v. fluids and, in some cases, mechanical ventilation. Clinical trials, testing β2-agonists [6, 7], glucocorticoids [8], epinephrine [9], recombinant human DNase [10, 11] and hypertonic saline [12] in bronchiolitis have been very controversial. Routine use of those different therapies is not recommended. On the contrary, a personalised strategy for each infant is to be performed, in order to reduce hospital stay and health-care expenditures associated with this disease.
Diagnosis
Bronchiolitis is a …
