Beatriz Morillo
Bronchiolitis - Prognosis
Most of children recover in spite of the lack of etiologic treatment. A peak in the severity of the symptoms is expected after 48-72 hours of the onset, and the resolution is variable within a median of 12 days. Having said that, some residual manifestations, such as mild cough, can take some weeks to disappear.
The case fatality rate is <1%, with death attributable to apnoea, respiratory arrest, or severe dehydration. Other complications are uncommon.
The immunity developed against RSV is not permanent so reinfections can occur.
Severe bronchiolitis early in life is associated with an increased risk of asthma; however, whether the viral infection is contributing to the development of asthma or whether there is a predisposition to suffer both of them remains elusive in spite of the investigations.

There are investigations for the development of a safe and effective vaccine against RSV, but, to date, the research has not been entirely successful. Therefore, the best tool for prevention is decreasing the exposure to and transmission of the respiratory viruses known to cause acute bronchiolitis. Most of them are spread by contact with secretions, while adenovirus and influenza are transmitted also by droplets.
Hand disinfection is the most effective measure to control the spread of the infection. All people should disinfect hands before and after direct contact with patients, after contact with inanimate objects in the direct vicinity of the patient, and after removing gloves, using preferentially an alcohol-based rubs for hand decontamination or soap and water.
Exclusive breastfeeding should be encouraged for at least 6 months to decrease the morbidity of respiratory infections.
Smoking increases the risk of severe bronchiolitis. Caregivers should be counselled about exposing the patient to environmental tobacco smoke and smoking cessation.
Palivizumab is a humanized mouse IgG1 monoclonal antibody directed against a conserved epitope on the surface fusion protein of RS. It is recommended to reduce the severity and incidence in selected children such as infants with hemodynamically significant heart disease or chronic lung disease of prematurity in the first year of life, given as maximum of 5 monthly doses (15 mg/kg/dose) during the RSV season. For other conditions (i.e. immunodeficiency, neuromuscular disorders, cystic fibrosis) it could be considered.

Bronchiolitis Bronchiolitis 02/13/2016
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