 Bronchiolitis is an infectious, self-limited disease.
Its therapy is based on supportive care, oxygenation, hydration, and fever control.
 The pathology results in obstruction of bronchioles from inflammation, edema, and debris, leading to hyperinflation, increased airway resistance, atelectasis, and ventilation-perfusion mismatching (decreased O2 saturations)
 Bronchoconstriction has not been described.

 Despite the prominent role that inflammation plays in the pathogenesis of airway obstruction, corticosteroids have not proven beneficial in improving clinical status in several large, controlled multiinstitutional studies.
 American Academy of Pediatrics -
Diagnosis and Management of
Bronchiolitis



Developed from a large longitudinal study from the Tuscon Children ’ s Respiratory Study which identified 3 groups of children who wheeze:
» Early wheezers
» Late onset wheezers
» Persistent wheezers
– API developed to differentiate “ Early wheezers ” from
“
Persistent wheezers
” or children who will develop asthma
API is the basis for the NHLBI recommendations for Initiating Long-term Controller Therapy in
Young Children (0-4 years)
The Asthma Predictive Index: a very useful tool for predicting asthma in young children.
Source: Journal of allergy and clinical immunology [0091-6749] Castro
Rodriguez, Jose yr:2010 vol:126

NHLBI Guidelines for Initiating Long-term
Controller Therapy in Young Children (0-4 years)
 To reduce impairment in children who have:
– 1) 4 or more episodes of wheezing in the past year
» Wheezing lasted more than 1 day
» Affected sleep
» Risk factors for the development of asthma
 1 of the following:
– Parental history of asthma OR
– Physician diagnosed atopic dermatitis
– Evidence of sensitization to aeroallergens
 OR 2 of the following:
– Evidence of food allergy
– Wheezing apart from colds
– Peripheral blood eosinophilia (> 4%)

Initiating Long-term Controller Therapy in
Young Children (0-4 years)
 To reduce impairment in children who have:
2) Consistently required symptomatic treatment
(reliever) more than 2 times/week for greater than 4 weeks
 Should be considered for reducing risk in infants and young children who have 2 exacerbations requiring systemic steroids within 6 months

 Treatment is often in the form of a therapeutic trial
– Monitor response over 4-6 weeks
» If no response, stop therapy and reevaluate for other diagnosis
» If a clear positive response for at least 3 months
(good asthma control) step down as tolerated