Bronchiolitis: assessment and evidence-based management

VIRAL BRONCHIOLITIS is the commonest lower respiratory tract infection in children less than 12 months of age and is the most frequent cause of hospitalisation in infants under 6 months of age.(1,2) It is caused by viral infections of the lower respiratory tract, principally by respiratory syncytial virus (RSV), which gives rise to widespread small-airway narrowing due to airway oedema, resulting in air trapping.(1-4) It is a self-limiting condition, but may be life threatening in a few, especially those with pre-existing cardiac or respiratory conditions.(1,3,4) Treatment, when needed, is supportive in order to maintain adequate hydration and oxygenation.(1,3) Useful antiviral therapy is unavailable.(3) It has been suggested that infants with mildly reduced lung function are predisposed to developing bronchiolitis rather than developing slightly reduced lung function because they have had bronchiolitis.(5) Infants who go on to develop recurrent bouts of wheezing in early childhood following bronchiolitis may do so because their airways are of smaller calibre 6 or have altered compliance,? and these children do not necessarily develop asthma by school age.(5,6)