Respiratory virus type to guide predictive enrichment approaches in the management of the first episode of bronchiolitis: A systematic review

Abstract

It has become clear that severe bronchiolitis is a heterogeneous disease; even so, current bronchiolitis management guidelines rely on the one-size-fits-all approach regarding achieving both short-term and chronic outcomes. It has been speculated that the use of molecular markers could guide more effective pharmacological management and achieve the prevention of chronic respiratory sequelae. Existing data suggest that asthma-like treatment (systemic corticosteroids and beta2-agonists) in infants with rhinovirus-induced bronchiolitis is associated with improved short-term and chronic outcomes, but robust data is still lacking. We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane’s Library to identify eligible randomized controlled trials to determine the efficacy of a personalized, virus-dependent application of systemic corticosteroids in children with severe bronchiolitis. Twelve studies with heterogeneous methodology were included. The analysis of the available results comparing the respiratory syncytial virus (RSV)-positive and RSV-negative children did not reveal significant differences in the associatons between systemic corticosteroid use in acute episode and duration of hospitalization (short-term outcome). However, this systematic review identified a trend of the positive association between the use of systematic corticosteroids and duration of hospitalization in RSV-negative infants hospitalized with the first episode of bronchiolitis (two studies). This evidence is not conclusive. Taken together, we suggest the design for future studies to assess the respiratory virus type in guiding predictive enrichment approaches in infants presenting with the first episode of bronchiolitis.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42020173686

Inhaled nitric oxide in acute bronchiolitis: A systematic review and meta‐analysis

“…For example, non-RSV induced acute bronchiolitis infants may benefit from oral corticosteroids, whereas RSV positive infants most likely not. 19 Furthermore, the classification of acute bronchiolitis have been varying in previous studies, and thus, studies conducted in more homogenous infant populations, could possibly find effective treatments. Thus, it could be possible that nitric oxide could be beneficial in some subgroups, and more studies would be needed to confirm this.…”

“…The recent findings have more better started to find different subtypes of acute bronchiolitis, which may react differently to treatments. For example, non‐RSV induced acute bronchiolitis infants may benefit from oral corticosteroids, whereas RSV positive infants most likely not 19 . Furthermore, the classification of acute bronchiolitis have been varying in previous studies, and thus, studies conducted in more homogenous infant populations, could possibly find effective treatments.…”

Bronchial reactivity and asthma at school age after early-life metapneumovirus infection

“…However, there are experimental studies that support similar responses in RSV and MPV towards T-helper type 2 cells and ineffective viral clearance that in turn may be linked to asthma development [ 34 ]. For prevention, there is some evidence that prednisolone after non-RSV bronchiolitis can reduce wheeze during the first 12 months [ 35 ]. To design good randomised controlled trials for asthma prevention, it is important to continue defining these risk subgroups presenting with LRTI.…”

Severe bronchiolitis profiling as the first step towards prevention of asthma

“…However, a robust data is still lacking. 68,78,79 In a randomized clinical trial of children with bronchiolitis, treatment with prednisolone was associated with less…”