Acute Bronchiolitis Management in Primary Care

Abstract

Abstract

Acute bronchiolitis is the most common lower respiratory tract infection to affect infants and toddlers. Respiratory syncytial virus is the most common viral cause of bronchiolitis. It typically affects children in the first year of life peaking between three andsix months of age. Infants will have a coryzal prodrome lasting one to three days before developing a persistent cough followed by increased respiratory effort, wheezing anddiffuse bilateral crackles. Clinicians should diagnose bronchiolitis and assess disease severity on the basis of history and physical examination. They should not routinely order laboratory and radiologic studies for diagnosis. Most children have mild disease andcan be managed with supportive care at home or primary care setting. Treatment is merely supportive. If the children have apnoea, inadequate oral fluid intake and persistingsevere respiratory distress, they should be referred the secondary care setting.

Keywords

• bronchiolitis,children,res-piratory syncytial virus,evdence-based guidelines

Birinci Basamakta Akut Bronşiolit Yönetimi

Öz

Öz

Akut bronşiolit bebek ve çocukları etkileyen en sık alt solunum yolu infeksiyonudur.Respiratuvar sinsityal virüs bronşiolite en sık neden olan virüstür. Tipik olarak yaşamın ilk yılındaki bebekleri etkiler. Üç-6 aylıkta pik yapar. Bebeklerde 1-3 gün süren korizalprodromdan sonra solunum çabaları, hışıltı ve yaygın ince rallerin izlediği inatçı öksürükle seyreder. Hekimler bronşiolite öykü ve fizik muayene bulgularına dayanarak tanı koymalı ve hastalığın ağırlığını değerlendirmelidirler. Tanı için rutin laboratuvar ve radyolojik testler yapılmamalıdır. Çoğu çocukta enfeksiyon hafif seyreder ve evde ve birinci basamakta destekleyici bakımla tedavi edilebilir. Apne, uygun olmayan sıvı alımı ve ağır solunum yetersizliği varsa çocuk ikinci basamağa sevk edilmelidir.

Anahtar Kelimeler

• Bronşiolit,çocuk,respira-tuvarsinsityal virüs,kanıtadayalı rehber

Kaynakça

1. Kaynaklar 1.Meissner HC. Viral Bronchiolitis in Children. N Engl J Med2016;374:62-72. DOI: 10.1056/NEJMra14134562.Smith DK, Seales S, Budzic C. Respiratory Syncytial Virus Bronc-hiolitis in Children. Am Fam Physician. 2017;95(2):94-99.3.Mansbach JM, Piedra PA, Teach SJ, et al.; MARC-30 Inves-tigators. Pro spective multicenter study of viral etiology andhospital length of stay in children with severe bronchiolitis.Arch Pediatr Adolesc Med. 2012;166(8):700-7064.Drysdale SB, Green CA, Sande CJ. Best practice in the pre-vention and management of paediatric respiratory syncytialvirus infection. Ther Adv Infect Dis. (2016) 3(2) 63_715.Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncyti-al virus-associated hospitalizations among children lessthan 24 months of age. Pediatrics 2013; 132(2): e341-8.6.Dornelles CT, Piva JP, Marostica PJ. Nutritional status, bre-astfeeding, and evolution of Infants with acute viral bronchio-litis. J Health Popul Nutr. 2007:25(3):336-43.7.Bronchiolitis in children: diagnosis and Management. NICEguideline 2015. nice.org.uk/guidance/ng98.Friedman JN, Rieder MJ, Walton JM, Canadian PaediatricSociety Acute Care Committee, Drug Therapy and Hazardo-us Substances Committee. Bronchiolitis: Recommendations fordiagnosis, monitoring and management of children one to 24months of age. Paediatr Child Health 2014;19(9):485-919.Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Globalestimate of the incidence of clinical pneumonia among child-ren under five years of age. Bull World Health Organ.2004;82(12):895-90310.Yusuf S, Piedimonte G, Auais A, et al. The relationship of me-teorological conditions to the epidemic activity of respiratorysyncytial virus. Epidemiol Infect 2007; 135: 1077-90.11.Foxman EF, Storer JA, Fitzgerald ME, et al. Temperature-de-pendent innate defense against the common cold virus limitsviral replication at warm temperature in mouse airway cells.Proc Natl Acad Sci U S A 2015; 112: 827-32. 12.Salah B, Dinh Xuan AT, Fouilladieu JL, Lockhart A, RegnardJ. Nasal mucociliary transport in healthy subjects is slowerwhen breathing dry air. Eur Respir J 1988; 1: 852-5.13.Meissner HC. Selected populations at increased risk from res-piratory syncytial viral infection. Pediatric Infectious Disea-se. 2003;22:40-4214.Wright M, Mullett CJ, Piedimonte G. Pharmacological ma-nagement of acute bronchiolitis. Therapeutics and Clinical RiskManagement. 2008;4(5):895-903.15.Schroeder AR, Mansbach JM, Stevenson M, et al. Apnea inchildren hospitalized with bronchiolitis. Pediatrics 2013;132(5): e1194-e1201.16.Wainwright C. Acute viral bronchiolitis in children- a very com-mon condition with few therapeutic options. Paediatr RespirRev. 2010;11:39–45. 17.Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagno-sis and management. Pediatrics. 2010;125:342–9. 18.Murray J, Bottle A, Sharland M, Modi N, Aylin P, Majeed A,Saxena S. Medicines for Neonates Investigator G. Risk fac-tors for hospital admission with RSV bronchiolitis in England:a population-based birth cohort study. PLoS One.2014;9:e89186. 19.Panitch HB. Bronchiolitis in infants. Curr Opin Pediatr.2001;13:256–60. doi: 20.Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Ba-ley JE, Gadomski AM, et al.Clinical Practice Guideline: TheDiagnosis, Management, and Prevention of Bronchiolitis. Pe-diatrics 2014,134 (5) e1474-e150221.Friedman JN, Rieder MJ, Walton JM, Canadian PaediatricSociety Acute Care Committee, Drug Therapy and Hazardo-us Substances Committee Bronchiolitis: Recommendations fordiagnosis, monitoring and management of children one to 24months of age. Paediatr Child Health 2014;19(9):485-9122.Diagnosis and management of bronchiolitis. AAFP clinicalpractice guideline. http://www.aafp.org/patient-care/clini-cal-recommendations/all/bronchiolitis.html23.HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=McNaughten%20B%5BAuthor%5D&cauthor=true&caut-hor_uid=26514055" McNaughten B,  HYPERLINK"https://www.ncbi.nlm.nih.gov/pubmed/?term=Bourke%20TW%5BAuthor%5D&cauthor=true&cauthor_uid=26514055"Bourke TW. Optimising the management of bronchiolitis ininfants. HYPERLINK "https://www.ncbi.nlm.nih.gov/pub-med/26514055"Practitioner. 2015;259(1784):13-5, 2.24.Skjerven HO, Hunderi JO, Brugmann-Pieper SK, Brun AC,Engen H, Eskedal L et al. Racemic adrenaline and inhalati-on strategies in acute bronchiolitis. N Engl J Med.2013;368:2286–93. doi: 10.1056/NEJMoa130183925.Zhang L,Mendoza-Sassi RA,Klassen TP, Wainwright C.Ne-bulize dhypertonic saline for acute bronchiolitis:asystematicreview.Pediatrics.2015; 136(4):687-701.26.Badgett RG,Vindhyal M,Stirnaman JT, Gibson CM, Halaby R.A living systematic review of nebulized hypertonic saline for acu-te bronchiolitis in infants. JAMA Pediatr.2015;169(8): 788-789.27.Yayla ME, Cihan FG, Yavuz E. Traditional patient miscon-ceptions about the causes and care of the common cold. An-kara Med J. 2016;(3):263-9.