Bronchiolitis natural history

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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

If left untreated, bronchiolitis may progress to develop mild upper respiratory symptoms including, cough, rhinorrhea and low grade fever during the first 1-2 days. 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

Complications

Complications are usually observed in patients younger than 2 months, premature infants and patients with various comorbidities (congenital heart disease, chronic pulmonary disease, and immunodeficiencies). Common complications of bronchiolitis include the following:

Prognosis

The prognosis of bronchiolitis is generally good, as most children show gradual symptomatic improvement within 2 weeks of symptom onset. Albeit the good prognosis, the rate of hospitalization is high (71 per 1000 infants for 2003) and has increased during the last two decades. The mortality rate of bronchiolitis 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).[2]

Clinical scoring systems such as the following may help predict the prognosis:

References

  1. 1.0 1.1 Wright M, Mullett CJ, Piedimonte G (2008). "Pharmacological management of acute bronchiolitis". Ther Clin Risk Manag. 4 (5): 895–903. PMC 2621418. PMID 19209271.
  2. Smyth RL, Openshaw PJ (2006). "Bronchiolitis". Lancet. 368 (9532): 312–22. doi:10.1016/S0140-6736(06)69077-6. PMID 16860701.
  3. 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.
  4. Court SD (1973). "The definition of acute respiratory illnesses in children". Postgrad Med J. 49 (577): 771–6. PMC 2495839. PMID 4806395.
  5. Lowell DI, Lister G, Von Koss H, McCarthy P (1987). "Wheezing in infants: the response to epinephrine". Pediatrics. 79 (6): 939–45. PMID 3295741.
  6. 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.
  7. 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.

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