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Copyright (c) 2025 Abdullah Mastour Alamar Alamar, Amwaj Qassem alqahtani, Abduljalil salah Alahmadi, Ahmed Mohammed Masrhi, Mohammad Omar Mohammad Sultan, Ali Mohammed Ali Qaysi, Kheder Moussa Yahia Gabarri, Tariq Ahmed Hamoud Al Khairat, Hana Saeed Faqih
This work is licensed under a Creative Commons Attribution 4.0 International License.
Integrated Approach to Pediatric bronchiolitis Control: Role of Respiratory Professionals, Nursing Care, Imaging Support, Primary Care, Pharmacotherapy, and Public Health Surveillance
Corresponding Author(s) : Abdullah Mastour Alamar
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Pediatric bronchiolitis is among the most common respiratory illnesses affecting infants, primarily caused by respiratory syncytial virus (RSV), with significant clinical and economic burden during seasonal surges.
Aim: To summarize the etiology, epidemiology, clinical features, management strategies, preventive interventions, and complications associated with pediatric bronchiolitis.
Methods: A comprehensive review of clinical, epidemiological, and pathophysiological information extracted from recent literature detailing viral causes, risk factors, clinical progression, diagnostic practices, and treatment approaches.
Results: Bronchiolitis primarily affects infants aged two to six months and is influenced by host, environmental, and social risk factors such as prematurity, congenital heart disease, tobacco smoke exposure, and overcrowding. Diagnosis remains clinical, while management focuses on hydration, oxygen therapy, secretion clearance, and symptom monitoring. Preventive measures—including maternal RSV vaccination and infant monoclonal antibody administration—significantly reduce hospitalization and severe disease burden.
Conclusion: Bronchiolitis is typically self limiting but may progress rapidly in high risk infants. Early recognition, supportive care, and expanded preventive strategies remain essential to reducing morbidity.
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- Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, Madhi SA, Omer SB, Simões EAF, Campbell H, Pariente AB, Bardach D, Bassat Q, Casalegno JS, Chakhunashvili G, Crawford N, Danilenko D, Do LAH, Echavarria M, Gentile A, Gordon A, Heikkinen T, Huang QS, Jullien S, Krishnan A, Lopez EL, Markić J, Mira-Iglesias A, Moore HC, Moyes J, Mwananyanda L, Nokes DJ, Noordeen F, Obodai E, Palani N, Romero C, Salimi V, Satav A, Seo E, Shchomak Z, Singleton R, Stolyarov K, Stoszek SK, von Gottberg A, Wurzel D, Yoshida LM, Yung CF, Zar HJ, Respiratory Virus Global Epidemiology Network. Nair H., RESCEU investigators. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022 May 28;399(10340):2047-2064.
- Remien KA, Amarin JZ, Horvat CM, Nofziger RA, Page-Goertz CK, Besunder JB, Potts BK, Forbes ML, Halasa N, Pelletier JH. Admissions for Bronchiolitis at Children's Hospitals Before and During the COVID-19 Pandemic. JAMA Netw Open. 2023 Oct 02;6(10):e2339884.
- Dalziel SR, Haskell L, O'Brien S, Borland ML, Plint AC, Babl FE, Oakley E. Bronchiolitis. Lancet. 2022 Jul 30;400(10349):392-406.
- Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017 Jan 14;389(10065):211-224.
- Yusuf S, Piedimonte G, Auais A, Demmler G, Krishnan S, Van Caeseele P, Singleton R, Broor S, Parveen S, Avendano L, Parra J, Chavez-Bueno S, Murguía De Sierra T, Simoes EA, Shaha S, Welliver R. The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus. Epidemiol Infect. 2007 Oct;135(7):1077-90.
- Teoh Z, Conrey S, McNeal M, Burrell A, Burke RM, Mattison CP, McMorrow M, Thornburg N, Payne DC, Morrow AL, Staat MA. Factors Associated With Prolonged Respiratory Virus Detection From Polymerase Chain Reaction of Nasal Specimens Collected Longitudinally in Healthy Children in a US Birth Cohort. J Pediatric Infect Dis Soc. 2024 Mar 19;13(3):189-195.
- Checchia PA, Paes B, Bont L, Manzoni P, Simões EA, Fauroux B, Figueras-Aloy J, Carbonell-Estrany X. Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Infants with Congenital Heart Disease. Infect Dis Ther. 2017 Mar;6(1):37-56.
- Nenna R, Cutrera R, Frassanito A, Alessandroni C, Nicolai A, Cangiano G, Petrarca L, Arima S, Caggiano S, Ullmann N, Papoff P, Bonci E, Moretti C, Midulla F. Modifiable risk factors associated with bronchiolitis. Ther Adv Respir Dis. 2017 Oct;11(10):393-401.
- Riikonen R, Korppi M, Törmänen S, Koponen P, Nuolivirta K, Helminen M, He Q, Lauhkonen E. Risk factors for irreversible airway obstruction after infant bronchiolitis. Respir Med. 2021 Oct;187:106545.
- Choudhuri JA, Ogden LG, Ruttenber AJ, Thomas DS, Todd JK, Simoes EA. Effect of altitude on hospitalizations for respiratory syncytial virus infection. Pediatrics. 2006 Feb;117(2):349-56.
- Nicholson EG, Schlegel C, Garofalo RP, Mehta R, Scheffler M, Mei M, Piedra PA. Robust Cytokine and Chemokine Response in Nasopharyngeal Secretions: Association With Decreased Severity in Children With Physician Diagnosed Bronchiolitis. J Infect Dis. 2016 Aug 15;214(4):649-55.
- Johnson JE, Gonzales RA, Olson SJ, Wright PF, Graham BS. The histopathology of fatal untreated human respiratory syncytial virus infection. Mod Pathol. 2007 Jan;20(1):108-19.
- Sebina I, Phipps S. The Contribution of Neutrophils to the Pathogenesis of RSV Bronchiolitis. Viruses. 2020 Jul 27;12(8)
- Johansson C, Kirsebom FCM. Neutrophils in respiratory viral infections. Mucosal Immunol. 2021 Jul;14(4):815-827.
- Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev. 2014 Dec;35(12):519-30.
- Horvat CM, Pelletier J. A Trial of Albuterol Should Still Be Considered for Children With Severe Bronchiolitis. JAMA Pediatr. 2021 Nov 01;175(11):1182-1183.
- Jones JM, Fleming-Dutra KE, Prill MM, Roper LE, Brooks O, Sánchez PJ, Kotton CN, Mahon BE, Meyer S, Long SS, McMorrow ML. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Aug 25;72(34):920-925.
- Törmänen S, Lauhkonen E, Riikonen R, Koponen P, Huhtala H, Helminen M, Korppi M, Nuolivirta K. Risk factors for asthma after infant bronchiolitis. Allergy. 2018 Apr;73(4):916-922.
- Hon KL, Leung AKC, Wong AHC, Dudi A, Leung KKY. Respiratory Syncytial Virus is the Most Common Causative Agent of Viral Bronchiolitis in Young Children: An Updated Review. Curr Pediatr Rev. 2023;19(2):139-149.
- Ghazaly MMH, Abu Faddan NH, Raafat DM, Mohammed NA, Nadel S. Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome. Eur J Pediatr. 2021 Apr;180(4):1229-1234.
- Abreo A, Wu P, Donovan BM, Ding T, Gebretsadik T, Huang X, Stone CA, Turi KN, Hartert TV. Infant Respiratory Syncytial Virus Bronchiolitis and Subsequent Risk of Pneumonia, Otitis Media, and Antibiotic Utilization. Clin Infect Dis. 2020 Jun 24;71(1):211-214.
- Jerkic SP, Brinkmann F, Calder A, Casey A, Dishop M, Griese M, Kurland G, Niemitz M, Nyilas S, Schramm D, Schubert R, Tamm M, Zielen S, Rosewich M. Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report. Can Respir J. 2020;2020:5852827.
- Reichert H, Suh M, Jiang X, Movva N, Bylsma LC, Fryzek JP, Nelson CB. Mortality Associated With Respiratory Syncytial Virus, Bronchiolitis, and Influenza Among Infants in the United States: A Birth Cohort Study From 1999 to 2018. J Infect Dis. 2022 Aug 15;226(Suppl 2):S246-S254.
- Luo G, Stone BL, Nkoy FL, He S, Johnson MD. Predicting Appropriate Hospital Admission of Emergency Department Patients with Bronchiolitis: Secondary Analysis. JMIR Med Inform. 2019 Jan 22;7(1):e12591.
- Slain KN, Rotta AT, Martinez-Schlurmann N, Stormorken AG, Shein SL. Outcomes of Children With Critical Bronchiolitis Meeting at Risk for Pediatric Acute Respiratory Distress Syndrome Criteria. Pediatr Crit Care Med. 2019 Feb;20(2):e70-e76.
References
Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, Madhi SA, Omer SB, Simões EAF, Campbell H, Pariente AB, Bardach D, Bassat Q, Casalegno JS, Chakhunashvili G, Crawford N, Danilenko D, Do LAH, Echavarria M, Gentile A, Gordon A, Heikkinen T, Huang QS, Jullien S, Krishnan A, Lopez EL, Markić J, Mira-Iglesias A, Moore HC, Moyes J, Mwananyanda L, Nokes DJ, Noordeen F, Obodai E, Palani N, Romero C, Salimi V, Satav A, Seo E, Shchomak Z, Singleton R, Stolyarov K, Stoszek SK, von Gottberg A, Wurzel D, Yoshida LM, Yung CF, Zar HJ, Respiratory Virus Global Epidemiology Network. Nair H., RESCEU investigators. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022 May 28;399(10340):2047-2064.
Remien KA, Amarin JZ, Horvat CM, Nofziger RA, Page-Goertz CK, Besunder JB, Potts BK, Forbes ML, Halasa N, Pelletier JH. Admissions for Bronchiolitis at Children's Hospitals Before and During the COVID-19 Pandemic. JAMA Netw Open. 2023 Oct 02;6(10):e2339884.
Dalziel SR, Haskell L, O'Brien S, Borland ML, Plint AC, Babl FE, Oakley E. Bronchiolitis. Lancet. 2022 Jul 30;400(10349):392-406.
Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017 Jan 14;389(10065):211-224.
Yusuf S, Piedimonte G, Auais A, Demmler G, Krishnan S, Van Caeseele P, Singleton R, Broor S, Parveen S, Avendano L, Parra J, Chavez-Bueno S, Murguía De Sierra T, Simoes EA, Shaha S, Welliver R. The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus. Epidemiol Infect. 2007 Oct;135(7):1077-90.
Teoh Z, Conrey S, McNeal M, Burrell A, Burke RM, Mattison CP, McMorrow M, Thornburg N, Payne DC, Morrow AL, Staat MA. Factors Associated With Prolonged Respiratory Virus Detection From Polymerase Chain Reaction of Nasal Specimens Collected Longitudinally in Healthy Children in a US Birth Cohort. J Pediatric Infect Dis Soc. 2024 Mar 19;13(3):189-195.
Checchia PA, Paes B, Bont L, Manzoni P, Simões EA, Fauroux B, Figueras-Aloy J, Carbonell-Estrany X. Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Infants with Congenital Heart Disease. Infect Dis Ther. 2017 Mar;6(1):37-56.
Nenna R, Cutrera R, Frassanito A, Alessandroni C, Nicolai A, Cangiano G, Petrarca L, Arima S, Caggiano S, Ullmann N, Papoff P, Bonci E, Moretti C, Midulla F. Modifiable risk factors associated with bronchiolitis. Ther Adv Respir Dis. 2017 Oct;11(10):393-401.
Riikonen R, Korppi M, Törmänen S, Koponen P, Nuolivirta K, Helminen M, He Q, Lauhkonen E. Risk factors for irreversible airway obstruction after infant bronchiolitis. Respir Med. 2021 Oct;187:106545.
Choudhuri JA, Ogden LG, Ruttenber AJ, Thomas DS, Todd JK, Simoes EA. Effect of altitude on hospitalizations for respiratory syncytial virus infection. Pediatrics. 2006 Feb;117(2):349-56.
Nicholson EG, Schlegel C, Garofalo RP, Mehta R, Scheffler M, Mei M, Piedra PA. Robust Cytokine and Chemokine Response in Nasopharyngeal Secretions: Association With Decreased Severity in Children With Physician Diagnosed Bronchiolitis. J Infect Dis. 2016 Aug 15;214(4):649-55.
Johnson JE, Gonzales RA, Olson SJ, Wright PF, Graham BS. The histopathology of fatal untreated human respiratory syncytial virus infection. Mod Pathol. 2007 Jan;20(1):108-19.
Sebina I, Phipps S. The Contribution of Neutrophils to the Pathogenesis of RSV Bronchiolitis. Viruses. 2020 Jul 27;12(8)
Johansson C, Kirsebom FCM. Neutrophils in respiratory viral infections. Mucosal Immunol. 2021 Jul;14(4):815-827.
Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev. 2014 Dec;35(12):519-30.
Horvat CM, Pelletier J. A Trial of Albuterol Should Still Be Considered for Children With Severe Bronchiolitis. JAMA Pediatr. 2021 Nov 01;175(11):1182-1183.
Jones JM, Fleming-Dutra KE, Prill MM, Roper LE, Brooks O, Sánchez PJ, Kotton CN, Mahon BE, Meyer S, Long SS, McMorrow ML. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Aug 25;72(34):920-925.
Törmänen S, Lauhkonen E, Riikonen R, Koponen P, Huhtala H, Helminen M, Korppi M, Nuolivirta K. Risk factors for asthma after infant bronchiolitis. Allergy. 2018 Apr;73(4):916-922.
Hon KL, Leung AKC, Wong AHC, Dudi A, Leung KKY. Respiratory Syncytial Virus is the Most Common Causative Agent of Viral Bronchiolitis in Young Children: An Updated Review. Curr Pediatr Rev. 2023;19(2):139-149.
Ghazaly MMH, Abu Faddan NH, Raafat DM, Mohammed NA, Nadel S. Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome. Eur J Pediatr. 2021 Apr;180(4):1229-1234.
Abreo A, Wu P, Donovan BM, Ding T, Gebretsadik T, Huang X, Stone CA, Turi KN, Hartert TV. Infant Respiratory Syncytial Virus Bronchiolitis and Subsequent Risk of Pneumonia, Otitis Media, and Antibiotic Utilization. Clin Infect Dis. 2020 Jun 24;71(1):211-214.
Jerkic SP, Brinkmann F, Calder A, Casey A, Dishop M, Griese M, Kurland G, Niemitz M, Nyilas S, Schramm D, Schubert R, Tamm M, Zielen S, Rosewich M. Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report. Can Respir J. 2020;2020:5852827.
Reichert H, Suh M, Jiang X, Movva N, Bylsma LC, Fryzek JP, Nelson CB. Mortality Associated With Respiratory Syncytial Virus, Bronchiolitis, and Influenza Among Infants in the United States: A Birth Cohort Study From 1999 to 2018. J Infect Dis. 2022 Aug 15;226(Suppl 2):S246-S254.
Luo G, Stone BL, Nkoy FL, He S, Johnson MD. Predicting Appropriate Hospital Admission of Emergency Department Patients with Bronchiolitis: Secondary Analysis. JMIR Med Inform. 2019 Jan 22;7(1):e12591.
Slain KN, Rotta AT, Martinez-Schlurmann N, Stormorken AG, Shein SL. Outcomes of Children With Critical Bronchiolitis Meeting at Risk for Pediatric Acute Respiratory Distress Syndrome Criteria. Pediatr Crit Care Med. 2019 Feb;20(2):e70-e76.