Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 177-179 (doi:10.1542/peds.2007-3323)
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COMMENTARY

Bronchiolitis: Lingering Questions About Its Definition and the Potential Role of Vitamin D

Jonathan M. Mansbach, MDa and Carlos A. Camargo, Jr, MD, DrPHb

a Department of Medicine, Children's Hospital Boston
b Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Abbreviations: RSV, respiratory syncytial virus

The first 20% of the full text of this article appears below.

BRONCHIOLITIS IS THE leading cause of hospitalization for infants younger than 1 year,1 and the associated hospitalization costs are more than $500 million per year in the United States.2 In this issue of Pediatrics, Carroll et al3 describe the increasing disease burden of bronchiolitis from 1996 to 2003 in healthy, term infants enrolled in the Tennessee Medicaid program. Over these 7 years, children with the International Classification of Diseases, Ninth Revision (ICD-9) codes 466.1 (bronchiolitis and bronchitis) or 480.1 (pneumonia caused by respiratory syncytial virus [RSV]) had an increasing number of visits at all levels of care: outpatient office visits, emergency department visits, and hospitalizations, including 23-hour observations. These data raise important questions not only about the definition of bronchiolitis but also about the reason for the increasing number of medical visits for bronchiolitis.

The clinical picture of bronchiolitis was provided by the American Academy of Pediatrics in its 2006 position statement, which states that children with bronchiolitis typically have "rhinitis, tachypnea, wheezing, cough, crackles, use of accessory muscles, and/or nasal flaring."4 This recognizable constellation of signs and symptoms makes bronchiolitis seem like a straightforward clinical diagnosis that then leads to assignment of the International Classification of Diseases, Ninth Revision codes used by Carroll et al.3 However, astute clinicians continue to debate when young children with an acute lower respiratory tract infection and wheezing should be diagnosed as having bronchiolitis, reactive airways disease, or even asthma.

In addition to this basic diagnostic challenge, there is a microbiologic issue. Bronchiolitis is caused . . . [Full Text of this Article]

Address correspondence to Jonathan M. Mansbach, MD, Children's Hospital Boston, Main Clinical Building 9 South, 9157, Boston, MA 02115. E-mail: jonathan.mansbach@childrens.harvard.edu