DIAGNOSIS AND TREATMENT: MANAGEMENT OF ACUTE VIRAL BRONCHIOLITIS IN INFANCY

Abstract

ACUTE bronchiolitis (capillary bronchitis, obstructive emphysema) is one of the common afflictions of the lower respiratory passages of infants. Although infection has long been accepted as the primary inciting factor, investigators (with the exception of Sell who believes H. influenzae to be responsible) have not found bacterial pathogens in consistent association with the syndrome. By exclusion, it has been assumed that most cases are precipitated by a viral infection. During the past decade this view has been substantiated by the application of new techniques to the study of respiratory viruses. Surveys of winter and spring epidemics of bronchiolitis in several urban centers have demonstrated a very significant portion of the cases to be associated with respiratory virus infection, most commonly the respiratory syncytial virus (RS), but in a minor number of instances influenza B or the parainfluenza agents. To date, no rapid laboratory proof of viral etiology is available, nor have any of the antiviral substances been found to be effective in treatment. Consequently, the welfare of the individual infant depends upon his physician's acumen in arriving at a correct clinical diagnosis and in utilizing nonspecific measures to combat the disturbances of his respiratory physiology.

DIAGNOSIS

The first requisite of proper management is an accurate diagnosis. Table I lists other causes of infantile dyspnea which may cause confusion. Exclusion of these entities depends upon a careful history and physical examination, a chest roentgenogram, and a few well-chosen laboratory tests. The most frequent differential problem is the distinction among viral bronchiolitis, asthmatic bronchitis, and bacterial infection of the lower respiratory passages.