Short-term impact of bronchiolitis severity on the duration of symptoms and recurrence of
wheezing.
Natalia Paniagua*, MD; Olaia Lopez*, MD; Ainhoa Ibarrola*, MD; June Udaondo*, MD; Raquel
Rubio*, MD; Lorea Martinez**; Javier Benito*, PhDMD.
*Pediatric Emergency Department- Cruces University Hospital.
**Clinic Epidemiology Unit- Cruces University Hospital.
BACKGROUND
Studies have shown the effect of Bronchiolitis on the well-being of children. However, it
remains to be shown whether there is a relationship between disease severity and the
duration of symptoms.
OBJECTIVES
1- To evaluate whether the severity of the episode of bronchiolitis is related with a longer
duration of symptoms. 2- To investigate recurrence of wheezing in correlation with severity of
bronchiolitis.
PATIENTS AND METHODS
This is a prospective cohort study evaluating children presenting in a pediatric emergency
department (PED) diagnosed with bronchiolitis between November-2013 and February-2014.
Two follow-up telephone interviews were completed at 4 and 12 weeks after the PED visit. In
the first telephone interview, parents were asked about the persistence of symptoms of
bronchiolitis (cough, runny nose, aspiration of secretions, wheeze, short of breath). In the
second one, they were asked about recurrence of wheezing. The primary outcome measures
were the number of days of persistent symptoms, comparing children discharged at home with
those admitted. A difference of three days was considered clinically significant.
RESULTS
The first follow-up telephone interview was completed in 214 cases, 115 children discharged
(53.7%), 99 admitted (46.3%). The mean age and severity score in infants admitted and those
discharged was 3.9 ± 4.3 vs 7.1 ± 3.9, p<0.01 and 2.63 ± 1.46 vs 1.10 ± 1.06, p<0.01
respectively. One hundred and fifty eight patients (74.17%) showed a positive result of the
respiratory syncytial virus (RSV) rapid test in nasopharyngeal specimens without differences
between the study groups. There were no differences between children admitted than those
discharged in duration of cough and runny nose (11.8 ± 7.3 vs 11.5 ± 5.9, ns; 14.1 ± 8.3 vs 12.7
± 5.7, ns, respectively). However, parents of patients discharged at home remarked a superior
duration of wheezing and short of breath (8.8 ± 5 vs 5.2 ± 4.9, p<0.01; 12 ± 6.2 vs 7.8 ± 6.6,
p<0.01, respectively). Admitted children needed nasal suctioning a greater number of days
(15.5 ± 8.9 vs 13 ± 6.1, p<0.05).
To date, the second telephone interview has been completed in 72%. Global wheezing
recurrence was 31.4%, with no differences between the two groups (32% ± 4.7 vs 30% ± 4.6)
and similar duration of recurrence episodes (6.7 ± 4.3 days vs 7.3 ± 5.4 days).
CONCLUSION
Bronchiolitis severity seems to be neither related with a longer duration of symptoms four
weeks after PED presentation nor a higher rate of recurrence of wheezing twelve weeks later.
Short term follow-up must be recommended regardless initial severity.