A clinical companion to the NICE guide on bronchiolitis

Abstract

The National Institute for Health and Care Excellence (NICE) ( 2015 ) defines bronchiolitis as a lower respiratory tract infection affecting children under two years, peaking between three and six months. It affects about one in three infants in the first year of life, making it the most common respiratory infection in infants ( NICE 2015 , 2016 ). Of these infants, 2-3% will require admission to hospital ( NICE 2016 ). Respiratory syncytial virus (RSV) is the most common organism detected in the nasopharyngeal aspirate in hospitalised infants, although other viruses such as rhinovirus, parainfluenza virus, influenza virus, adenovirus and human metapneumovirus are increasingly being recognised ( Paul et al 2016 ). As most infants with bronchiolitis are managed at home, the data available from the literature is not reflective of the true incidence and may represent only the 'tip of the iceberg'.

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era

“…It is generally recognized that bronchiolitis is a respiratory condition of children up to the age of 2 years [108]. Several reports have shown that only clinical symptoms are enough for the management of children with bronchiolitis, and viral testing is generally considered unnecessary [109,110].…”

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis reveal a weak role played by the SARS-CoV-2

“…It is generally recognized that bronchiolitis is a respiratory condition of children up to the age of 2 years. 115 Several reports have shown that only clinical symptoms are enough for the management of children with bronchiolitis, and viral testing is generally considered unnecessary. 116,117 Data on the impact of multiple viral infections on the severity of bronchiolitis is controversial and does not justify recommendations of routinely virological examinations in most guidelines.…”

“…117 However, virological tests are still used in children with severe bronchiolitis to reduce the unnecessary use of antibiotics and interventions such as chest X-rays. 115,120 In It is important to mention that the small number of studies in some subgroups analyses restricts our ability to draw definitive conclusions. A second limitation in our study is that we did not consider multiple other factors that could further explain the variability in the prevalence of viruses in bronchiolitis such as comorbidities, anti-HRSV prophylaxis and the number of virus types sought in studies for multi-species such as mild HCoV and HPIV.…”

Aplicabilidad y beneficios de la terapia nebulizada en el tratamiento de la bronquiolitis a través de un sistema de alto flujo

“…Las razones de este incremento no son del todo conocidas, pero parecen tener un origen multifactorial (18) (19). Incluso puede que esté infraestimada, porque el cuidado domiciliario de un alto porcentaje de los pacientes hace que la literatura no refleje la verdadera incidencia de esta patología representando sólo la "punta del iceberg" (20).…”

“…Esto nos permitió, entre otras cosas, obtener un láser de difracción Malvern Spraytec (Malvern Instruments Ltd., Malvern, UK) (Figura 10), cuyas características de reproducibilidad y capacidad para estratificar según los distintos tamaños lo ha convertido en un herramienta validada en la medición de las partículas producidas por los nebulizadores(137)(136). La medición de la densidad de la partícula nebulizada nos permitió comparar los resultados obtenidos medidos como diámetro volumen medio (Dv50) con la medida de El disconfort durante la nebulización, evaluado mediante CBS fue mayor con el sistema JN que con NHF: 17(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) vs 13 (9-15) (P = 0,001). La monitorización NIPE no detectó diferencias significativas entre ambos sistemas de nebulización (P = 0,706).…”