Hon Kam L, Leung Alexander K C, Wong Alex H C, Dudi Amrita, Leung Karen K Y
Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong.
Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada.
Curr Pediatr Rev. 2023;19(2):139-149. doi: 10.2174/1573396318666220810161945.
Viral bronchiolitis is a common condition and a leading cause of hospitalization in young children.
This article provides readers with an update on the evaluation, diagnosis, and treatment of viral bronchiolitis, primarily due to RSV.
A PubMed search was conducted in December 2021 in Clinical Queries using the key terms "acute bronchiolitis" OR "respiratory syncytial virus infection". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to children and English literature. The information retrieved from the above search was used in the compilation of this article.
Respiratory syncytial virus (RSV) is the most common viral bronchiolitis in young children. Other viruses such as human rhinovirus and coronavirus could be etiological agents. Diagnosis is based on clinical manifestation. Viral testing is useful only for cohort and quarantine purposes. Cochrane evidence-based reviews have been performed on most treatment modalities for RSV and viral bronchiolitis. Treatment for viral bronchiolitis is mainly symptomatic support. Beta-agonists are frequently used despite the lack of evidence that they reduce hospital admissions or length of stay. Nebulized racemic epinephrine, hypertonic saline and corticosteroids are generally not effective. Passive immunoprophylaxis with a monoclonal antibody against RSV, when given intramuscularly and monthly during winter, is effective in preventing severe RSV bronchiolitis in high-risk children who are born prematurely and in children under 2 years with chronic lung disease or hemodynamically significant congenital heart disease. Vaccines for RSV bronchiolitis are being developed. Children with viral bronchiolitis in early life are at increased risk of developing asthma later in childhood.
Viral bronchiolitis is common. No current pharmacologic treatment or novel therapy has been proven to improve outcomes compared to supportive treatment. Viral bronchiolitis in early life predisposes asthma development later in childhood.
病毒性细支气管炎是一种常见疾病，也是幼儿住院的主要原因。
本文主要针对呼吸道合胞病毒（RSV）引起的病毒性细支气管炎，为读者提供有关评估、诊断和治疗的最新信息。
2021年12月在PubMed临床查询中使用关键词“急性细支气管炎”或“呼吸道合胞病毒感染”进行检索。检索范围包括临床试验、随机对照试验、病例对照研究、队列研究、荟萃分析、观察性研究、临床指南、病例报告、病例系列和综述。检索仅限于儿童和英文文献。从上述检索中获取的信息用于本文的编撰。
呼吸道合胞病毒（RSV）是幼儿中最常见的病毒性细支气管炎病因。其他病毒如人鼻病毒和冠状病毒也可能是病原体。诊断基于临床表现。病毒检测仅用于队列研究和检疫目的。已针对RSV和病毒性细支气管炎的大多数治疗方式进行了Cochrane循证综述。病毒性细支气管炎的治疗主要是对症支持。尽管缺乏证据表明β受体激动剂可减少住院率或缩短住院时间，但仍经常使用。雾化消旋肾上腺素、高渗盐水和皮质类固醇通常无效。对于早产的高危儿童以及患有慢性肺病或有血流动力学意义的先天性心脏病的2岁以下儿童，在冬季每月肌肉注射一次抗RSV单克隆抗体进行被动免疫预防，可有效预防严重的RSV细支气管炎。针对RSV细支气管炎的疫苗正在研发中。生命早期患有病毒性细支气管炎的儿童在童年后期患哮喘的风险增加。
病毒性细支气管炎很常见。与支持性治疗相比，目前尚无药物治疗或新疗法被证明能改善预后。生命早期的病毒性细支气管炎易导致儿童后期发生哮喘。
