bronchiolitis

細気管支炎

　

WordNet

1. inflammation of the membranes lining the bronchioles

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/15 03:46:51」(JST)

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Not to be confused with bronchitis.

Bronchiolitis
An X-ray of a child with RSV showing the typical bilateral perihilar fullness of bronchiolitis.
Classification and external resources
Specialty	pulmonology
ICD-10	J21
ICD-9-CM	466.1
DiseasesDB	1701
MedlinePlus	000975
eMedicine	emerg/365
NCI	Bronchiolitis
Patient UK	Bronchiolitis
MeSH	D001988

Bronchiolitis is inflammation of the bronchioles, the smallest air passages of the lungs. It usually occurs in children less than two years of age with the majority being aged between three and six months. It presents with coughing, wheezing and shortness of breath which can cause some children difficulty in feeding. This inflammation is usually caused by respiratory syncytial virus (70% of cases) and is much more common in the winter months. Treatment is typically supportive with Oxygen, monitoring, fluid and nutrition perhaps by gastric tube or intravenously. There is insufficient evidence to support treatment with antibiotics, surfactant, chest physiotherapy or bronchodilators nebulized epinephrine or hypertonic saline. Bronchiolitis is common with up to one third of children being affected in their first year of life.

Signs and symptoms

In a typical case, an infant under two years of age develops cough, wheeze, and shortness of breath over one or two days. Crackles and/or wheeze are typical findings on listening to the chest with a stethoscope. The infant may be breathless for several days. After the acute illness, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheeze.

Some signs of severe disease include:

• poor feeding (less than half of usual fluid intake in preceding 24 hours)
• lethargy
• history of apnea
• respiratory rate >70/min
• presence of nasal flaring and/or grunting
• severe chest wall recession
• cyanosis

Causes

The term usually refers to acute viral bronchiolitis, a common disease in infancy. This is most commonly caused by respiratory syncytial virus (RSV, also known as human pneumovirus). Other viruses which may cause this illness include metapneumovirus, influenza, parainfluenza, coronavirus, adenovirus, and rhinovirus.

Studies have shown there is a link between voluntary caesarean birth and an increased prevalence of bronchiolitis. A recent study by Perth's Telethon Institute for Child Health Research has shown an 11% increase in hospital admissions for children delivered this way. Children born prematurely (less than 35 weeks), with a low birth weight or who suffer from congenital heart disease may have higher rates of bronchiolitis and are more likely to require hospital admission. There is evidence that breastfeeding provides some protection against bronchiolitis.

Diagnosis

The diagnosis is typically made by clinical examination. Chest X-ray is sometimes useful to exclude bacterial pneumonia, but not indicated in routine cases.

Testing for the specific viral cause can be done but has little effect on management and thus is not routinely recommended. RSV testing by direct immunofluorescence testing on nasopharyngeal aspirate had a sensitivity of 61% and specificity of 89%. Identification of those who are RSV-positive can help for: disease surveillance, grouping ("cohorting") people together in hospital wards to prevent cross infection, predicting whether the disease course has peaked yet, reducing the need for other diagnostic procedures (by providing confidence that a cause has been identified).

Infants with bronchiolitis between the age of two and three months have a second infection by bacteria (usually a urinary tract infection) less than 6% of the time. Preliminary studies have suggested that elevated procalcitonin levels may assist clinicians in determining the presence of bacterial coinfection, which could prevent unnecessary antibiotic use and costs.

Prevention

Prevention of bronchiolitis relies strongly on measures to reduce the spread of the viruses that cause respiratory infections (that is, handwashing, and avoiding exposure to those symptomatic with respiratory infections). In addition to good hygiene an improved immune system is a great tool for prevention. One way to improve the immune system is to feed the infant with breast milk, especially during the first month of life. Immunizations are available for premature infants who meet certain criteria (some cardiac and respiratory disorders) such as Palivizumab (a monoclonal antibody against RSV). Passive immunization therapy requires monthly injections every winter.

Management

Treatment and management of bronchiolitis is usually focused on the symptoms instead of the infection itself since the infection will run its course and complications are typically from the symptoms themselves. Without active treatment half of cases will go away in 13 days and 90% in three weeks.

Bronchodilators

Although inhaled epinephrine has been shown to decrease initial hospital admissions and overall length of stay compared to placebo in some studies, meta-analyses have found that it has no effect on the rate of one week post-emergency department visits or length of stay (although it does lead to shorter stay versus salbutamol). Nebulized and inhaled salbutamol (sold in the USA as Ventolin HFA) has been shown to decrease initial hospital admission rates in some studies, but no clear effect on length of stay in meta-analysis. The Society of Hospital Medicine recommends against routine use of these or other bronchodilators in children with bronchiolitis: "Published guidelines do not advocate the routine use of bronchodilators in patients with bronchiolitis. Comprehensive reviews of the literature have demonstrated that the use of bronchodilators in children admitted to the hospital with bronchiolitis has no effect on any important outcomes. There is limited demonstration of clear impact of bronchodilator therapy upon the course of disease. Additionally, providers should consider the potential impact of adverse events upon the patient."

Nebulized hypertonic saline

In one study Nebulized hypertonic saline (3%) appeared to be effective in improving clinical outcomes and shortening the duration of hospital stay. However, other multi-centre trials (SABRE 2014) and a Cochrane database systematic review showed no evidence for its use

Non-effective

Currently other medications do not yet have evidence to support their use. Ribavirin is an antiviral drug which does not appear to be effective for bronchiolitis. Antibiotics are often given in case of a bacterial infection complicating bronchiolitis, but have no effect on the underlying viral infection. Corticosteroids have no proven benefit in bronchiolitis treatment and are not advised. DNAse has not been found to be effective.

Epidemiology

90% of the people affected are between 1 and 9 months old. Bronchiolitis is the most common cause of hospitalization up to the first year of life. It is epidemic in winters.

References

External links

• Bronchiolitis. Patient information from NHS Choices
• Bronchiolitis in children – A national clinical guideline PDF (1.74 MB) from the Scottish Intercollegiate Guidelines Network
• Ralston, SL; Lieberthal, AS; Meissner, HC; Alverson, BK; Baley, JE; Gadomski, AM; Johnson, DW; Light, MJ; Maraqa, NF; Mendonca, EA; Phelan, KJ; Zorc, JJ; Stanko-Lopp, D; Brown, MA; Nathanson, I; Rosenblum, E; Sayles S, 3rd; Hernandez-Cancio, S (27 October 2014). "Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis.". Pediatrics 134 (5): e1474–502. doi:10.1542/peds.2014-2742. PMID 25349312. 

UpToDate Contents

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• 1. 幼児および小児における細気管支炎：治療、転帰および予防 bronchiolitis in infants and children treatment outcome and prevention
• 2. 幼児および小児における細気管支炎：臨床的特徴および診断 bronchiolitis in infants and children clinical features and diagnosis
• 3. 成人における細気管支炎 bronchiolitis in adults
• 4. 慢性肺移植拒絶反応：閉塞性細気管支炎 chronic lung transplant rejection bronchiolitis obliterans
• 5. 呼吸細気管支炎関連間質性肺疾患 respiratory bronchiolitis associated interstitial lung disease

English Journal

• Atypical presentation of human bocavirus: Severe respiratory tract infection complicated with encephalopathy.

• Akturk H1, Sık G2, Salman N1, Sutcu M1, Tatli B3, Akcay Ciblak M4, Bulent Erol O5, Hancerli Torun S1, Citak A2, Somer A1.
• Journal of medical virology.J Med Virol.2015 Nov;87(11):1831-8. doi: 10.1002/jmv.24263. Epub 2015 Jun 12.
• Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has also been associated with encephalitis recently by detection of the virus in cerebrospinal fluid (CSF) of patients presented with encephalitis. This retrospective study aimed to present clinical features
• PMID 25966820

• Maternal transfer of RSV immunity in cotton rats vaccinated during pregnancy.

• Blanco JC1, Pletneva LM2, Oue RO2, Patel MC3, Boukhvalova MS2.
• Vaccine.Vaccine.2015 Oct 5;33(41):5371-9. doi: 10.1016/j.vaccine.2015.08.071. Epub 2015 Aug 31.
• Respiratory Syncytial Virus (RSV) is the leading cause of pneumonia and bronchiolitis in infants, resulting in significant morbidity and mortality worldwide. There is currently no RSV vaccine. Although maternal serum antibodies against RSV are efficiently transferred through placenta protecting huma
• PMID 26335771

• Chronic lung allograft dysfunction: evolving practice.

• Vos R1, Verleden SE, Verleden GM.
• Current opinion in organ transplantation.Curr Opin Organ Transplant.2015 Oct;20(5):483-91. doi: 10.1097/MOT.0000000000000236.
• PURPOSE OF REVIEW: Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term covering different phenotypes of chronic allograft dysfunction, including obstructive CLAD (bronchiolitis obliterans syndrome), restrictive CLAD (restrictive allograft syndrome) and graft dysf
• PMID 26262458

Japanese Journal

• 症例 ANCA関連血管炎による閉塞性細気管支炎が疑われた1例

• 日本呼吸器学会誌 = Annals of the Japanese Respiratory Society 5(4), 217-221, 2016-07-10
• NAID 40020912871

• 症例 習慣的飲酒が発症要因と考えられた胃食道逆流症によるびまん性嚥下性細気管支炎の1例

• 日本呼吸器学会誌 = Annals of the Japanese Respiratory Society 5(4), 199-203, 2016-07-10
• NAID 40020912773

• 高齢者における慢性咳嗽 : 診断と治療 (特集 咳嗽の実地診療Up-to-date)

• 呼吸器内科 = Respiratory medicine 29(2), 150-154, 2016-02
• NAID 40020797018

Related Links

• Bronchiolitis in adults

Bronchiolitis is a general term used to describe a nonspecific inflammatory injury that primarily affects thesmall airways(eg, 2 mm or less in diameter without cartilage), often sparing a considerable portion of the interstitium.A number ...

• Bronchiolitis: MedlinePlus Medical Encyclopedia

Bronchiolitis usually affects children under the age of 2, with a peak age of 3 to 6 months. It is a common, and sometimes severe illness. Respiratory syncytial virus (RSV) is the most common cause. More than half of all infants are ...

Related Pictures

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★リンクテーブル★

リンク元	「細気管支炎」
拡張検索	「proliferative bronchiolitis」「acute bronchiolitis obliterans fibrosa」「diffuse panbronchiolitis」

「細気管支炎」

　　[★]

英

bronchiolitis

関

細気管支

「proliferative bronchiolitis」

　　[★]

増殖性細気管支炎

関

bronchiolitis obliterans

「acute bronchiolitis obliterans fibrosa」

　　[★] 急性閉塞性線維性細気管支炎

「diffuse panbronchiolitis」

　　[★] びまん性汎細気管支炎 DPB