Castro-Rodriguez Jose A, Astudillo Patricio, Puranik Sandeep, Brown Mark A, Custovic Adnan, Forno Erick
Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Molecular Virology Laboratory, Millennium Institute of Immunology and Immunotherapy, Department of Pediatric Infection Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Paediatr Respir Rev. 2024 Nov 1. doi: 10.1016/j.prrv.2024.10.004.
Viral bronchiolitis is the most common pediatric acute respiratory infection leading to hospitalization, and it causes a significant healthcare burden worldwide. Current guidelines recommend supportive management after many clinical trials on specific therapies failed to demonstrate benefits. However, several studies in the past decade have revealed that bronchiolitis may not be a homogeneous disease, but instead may constitute an umbrella comprised of different "endotypes" and "phenotypes" based on patient characteristics, etiology, pathophysiological mechanisms, and clinical presentation. In this extensive review, we summarize the current evidence that several different types of bronchiolitis ("bronchiolitides") coexist, with different short- and long-term consequences on respiratory health and the risk of asthma development. Disease pathobiology, immune response, and clinical characteristics may differ between the two most prevalent viral agents, respiratory syncytial virus and rhinovirus. Recent randomized trials have shown that some subgroups of children may benefit from the use of systemic corticosteroids and/or bronchodilators. These findings also suggest that some children may benefit from individualized therapeutical approaches for viral bronchiolitis rather than following broad recommendations for treating all patients uniformly using only supportive management.
病毒性细支气管炎是导致住院的最常见的儿科急性呼吸道感染，在全球范围内造成了巨大的医疗负担。在许多针对特定疗法的临床试验未能证明其益处之后，当前指南推荐采用支持性治疗。然而，过去十年的多项研究表明，细支气管炎可能并非一种单一的疾病，而是可能基于患者特征、病因、病理生理机制和临床表现，构成一个由不同“内型”和“表型”组成的集合。在这篇全面的综述中，我们总结了目前的证据，即几种不同类型的细支气管炎（“细支气管炎症”）并存，对呼吸健康以及哮喘发生风险有着不同的短期和长期影响。在两种最常见的病毒病原体，即呼吸道合胞病毒和鼻病毒之间，疾病病理生物学、免疫反应和临床特征可能有所不同。最近的随机试验表明，一些儿童亚组可能受益于全身用糖皮质激素和/或支气管扩张剂的使用。这些发现还表明，一些儿童可能受益于针对病毒性细支气管炎的个体化治疗方法，而不是遵循仅采用支持性治疗统一治疗所有患者的宽泛建议。
