Nino Gustavo, Rodríguez-Martínez Carlos E, Castro-Rodriguez Jose A
Division of Pediatric Pulmonary and Sleep Medicine, Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, DC, USA.
Dept of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
ERJ Open Res. 2020 Oct 13;6(4). doi: 10.1183/23120541.00135-2020. eCollection 2020 Oct.
Despite scientific evidence proving that inhaled β-adrenergic receptor (β-AR) agonists can reverse bronchoconstriction in all ages, current guidelines advocate against the use of β-AR bronchodilators in infants with viral bronchiolitis because clinical trials have not demonstrated an overall clinical benefit. However, there are many different types of viral bronchiolitis, with variations occurring at an individual and viral level. To discard a potentially helpful treatment from all children regardless of their clinical features may be unwarranted. Unfortunately, the clinical criteria to identify the infants that may benefit from bronchodilators from those who do not are not clear. Thus, we summarised the current understanding of the individual factors that may help clinicians determine the highest probability of response to β-AR bronchodilators during viral bronchiolitis, based on the individual immunobiology, viral pathogen, host factors and clinical presentation.
尽管有科学证据证明吸入性β-肾上腺素能受体（β-AR）激动剂可逆转所有年龄段的支气管收缩，但目前的指南仍不主张在患有病毒性细支气管炎的婴儿中使用β-AR支气管扩张剂，因为临床试验并未证明其具有整体临床益处。然而，病毒性细支气管炎有许多不同类型，在个体和病毒层面都存在差异。不顾所有儿童的临床特征而摒弃一种可能有益的治疗方法可能是不合理的。不幸的是，目前尚不清楚用于区分哪些婴儿可能从支气管扩张剂治疗中获益、哪些婴儿不能获益的临床标准。因此，我们基于个体免疫生物学、病毒病原体、宿主因素和临床表现，总结了目前对可能有助于临床医生确定病毒性细支气管炎期间对β-AR支气管扩张剂反应可能性最高的个体因素的理解。
