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Background: Hypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim of this study was to determine the value of food intake during the previous 24h (bottle and spoon feeding), as a percentage of usual intake (24h FI), as a marker of hypoxia, and to compare its diagnostic value with that of usual clinical signs., Methods: In this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6 months, with bronchiolitis (rhinorrhea+dyspnea+cough+expiratory sounds). Infants with risk factors (history of prematurity, chronic heart or lung disorders), breast-fed infants, and infants having previously been treated for bronchial disorders were excluded. The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous oxygen saturation (SpO2) was recorded. Hypoxia was noted if SpO2 was below 95% and verified., Results: 24h FI greater or equal to 50% was associated with a 96% likelihood of SpO2 greater or equal to 95% [95% CI, 91-99%]. In univariate analysis, 24h FI less than 50% had the highest odds ratio (13.8) for SpO2 less than 95%, compared to other 24h FI values and other clinical signs, as well as providing one of the best compromises between specificity (90%) and sensitivity (60%) for identifying infants with hypoxia. In multivariate analysis with adjustment for age, SpO2 less than 95% was related to the presence of intercostal retractions (OR=9.1 [95% CI, 2.4-33.8%]) and 24h FI less than 50% (OR=10.9 [95% CI, 3.0-39.1%]). Hospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions., Conclusion: In practice, the measure of 24h FI may be useful in identifying hypoxia and deserves further study., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

The association of inflammatory involvement of the distal airways or bronchiolitis and systemic diseases is essentially observed in Sjögren's syndrome, rheumatoid arthritis and chronic inflammatory bowel disease. Bronchiolitis may be mainly cellular in nature, often involving lympho-monocytic cells, and sometimes associated with lymphoid follicles, as in Sjögren's syndrome. It may also, particularly in rheumatoid arthritis, be constrictive, with peribronchiolar fibrosis. This type is associated with a worse prognosis, with possible progression to chronic respiratory insufficiency. The diagnosis of bronchiolitis should be suspected in any atypical form of asthma, or recurrent "bronchitis", and it is essential to look for extrarespiratory symptoms and auto-antibodies to establish the diagnose of systemic disease. The CT appearances coupled with the evaluation of pulmonary function parameters usually lead to the diagnosis. In severe and/or rapidly progressive cases treatment-combining corticosteroids with immunosuppressive drugs may be prescribed, but often with disappointing results. In these cases, lung transplantation should be considered in young patients., (© 2012. Published by Elsevier Masson SAS.)

Clinical criteria used to define acute broncholitis in infants are not worldwide consensual diagnostic criteria. Respiratory failures as well as young age account for the severity of the disease. Laboratory analyses are useless in community medical practice. Infectious complications are due to secondary infection with usual respiratory pathogenic bacteria. In France the treatment mainly consists in physical therapy whose efficiency is currently being evaluated by randomized studies. Prevention of the disease relies on hygiene measures and in an integrated physician-physiotherapist collaboration.

Heliox is composed of oxygen and helium and its low specific gravity allows a modification of the gas flow within the airway. Breathing heliox favors a laminar flow and therefore decreases the work of breathing. Its usefulness in the child is established in croup or in post-extubation stridor. It can be considered if conventional treatment fails to improve the child's breathing pattern. Its major goal is to avoid invasive manoeuvers as much as possible.

COPD is a widespread disease in western countries affecting 10% of adults and linked to tobacco consumption in 90% of cases. This disorder is characterized by a reduced maximal expiratory flow which is irreversible and slowly progressive over the years. In those who are genetically prone to develop a COPD, chronic exposure to toxic fumes or particles generates a bronchiolitis and an emphysema which cause disturbances in ventilation mechanics and alveolar gaz exchange. This leads to symptoms of breathlessness, hypoxemia, pulmonary hypertension and, in end stage disease, cor pulmonale. The smoking cessation is the only way to prevent the occurrence of COPD.

Bronchiolitis includes a broad range of conditions with variable clinical, functional and morphological expression. Bronchiolar disease may be a primary or a secondary condition. Non-specific inflammatory changes are observed at the histology examination, involving respiratory and membranous bronchioles with or without extension to the alveoli. CT findings vary from subtle to quite marked abnormalities related to alveolar involvement, including small centrilobular lesions (nodular and branching linear opacities), ground-glass attenuation, and airspace consolidation. All are potentially reversible and treatable. Cicatrization processes may lead to constrictive bronchiolitis, an irreversible condition characterized by circumferential submucosal or periadventitial fibrosis causing an obstruction of the bronchiolar lumen. CT findings include decreased lung attenuation and expiratory air trapping within the areas of bronchiolar obstruction. The contrast with normally ventilated and perfused areas creates a mosaic perfusion pattern.

Background: Acute infant bronchiolitis is a frequent seasonal disease which peaks in December. It often requires hospital care in Paris and in its surroundings. The exceptional bronchiolitis epidemic of December 1991 brought about a temporary saturation of hospital bed space at the Assistance Publique-Hôpitaux de Paris (AP-HP). Hereafter, in order to organize care more efficiently, an epidemiological observation network called ERBUS was set up., Methods: Thanks to daily reports of emergency pediatric admissions through the Minitel network, it has been possible to get real time information on the course of the past five epidemics in each of the 11 AP-HP hospitals with pediatric emergency units., Results: Globally the results point to a similar situation every year: approximately 60% boys, 35% babies under 6 months; the ratio of very young patients who are admitted to hospital is multiplied by 1.5 at the mid-point of and at the end of the epidemic compared with the beginning; 70% of the babies under 3 months are admitted to hospital. The ratio of patients who come and are admitted to hospital has been on the decrease every year since 1991: globally from 36.8% down to 28.6% in five years (from 75.1% down to 65.3% among babies under 3 months). The rhythm and intensity of the epidemic have risen sharply: in five years, the number of patients has increased by 119% and that of patients admitted to hospital by 69%, while the epidemic peaks are earlier and higher., Conclusion: These statistics have actually been used to allocate additional resources in AP-HP hospitals during the epidemics. To avoid the saturation of bed space in the future, ambulatory care of patients not admitted to hospital should be favored.

The management of infant bronchiolitis with bronchodilators and steroids is controversial. A literature review on this topic allows to determine the influence of these medications on the first episode of viral bronchiolitis. The effect of alpha and beta adrenergic drugs is undoubtful but it is not possible to anticipate a positive or negative response based on the age of the child nor on a family history of atopic disease. Systemic steroid therapy has no immediate effect but inhaled steroids may be tried during the recovery period to reduce short term morbidity.

Iatrogenic respiratory disorders include bronchic manifestations (asthma, bronchospasm, cough) and bronchiolar manifestations (constrictive or proliferative bronchiolitis). Many pharmacologic agents can induce a bronchospasm. The bronchospasm induced by acetylsalicylic acid and nonsteroidal anti-inflammatory agents, often severe, is mediated by the inhibition of the cyclooxygenase enzyme; it can be prevented by eviction of the drug or desensitization. Leukotriene receptor antagonists and 5-lipoxygenase inhibitors may also be useful. Beta-blockers including cardioselective beta-blockers, cholinergic agonists, inhaled agents, angiotensin-converting enzyme inhibitors (ACE), vindesine, histamine liberators, etc..., can also induce a bronchospasm. Most of the same agents can also induce an isolated cough, particularly beta-blockers, inhaled agents, and ACE, which cause 75% of the reported cases of iatrogenic cough. ACE-induced cough usually disappears within 1 to 4 days after withdrawal of the treatment, confirming the diagnosis; ACE-induced cough may be prevented by sodium cromoglycate. The risk of obliterans bronchiolitis with expiratory airflow impairment during rheumatoid arthritis is increased by D-penicillamine. Many drugs can be involved in the pathogenesis of bronchiolitis obliterans organizing pneumonia, which presents with various clinical and radiological aspects. The physician has to keep in mind that bronchospasm, cough, or bronchiolitis of unknown origin, may have a iatrogenic cause.

The term "obstructive bronchiolitis" used in this review covers different clinicopathological aspects. On the one hand, it refers to "small airways disease", where bronchiolar narrowings are widespread, secondary to post inflammatory fibrotic changes linked to tobacco smoke or fibrogenic dust inhalation. These obstructive changes at the level of small airways are responsible for a fixed airflow limitation. The specificity and sensibility of functional tests designed for early detection of such an obstruction (the frequency dependence of compliance, the nitrogen slope and the density dependence of the flow-volume curve) are still controversial. On the other hand, the entity covers a disease described at the beginning of the century under the name "bronchiolitis obliterans". It usually appears as a consequence of various causes: viral infection, toxins acting either inhalation or by systemic route, immunological mechanisms as in connective tissue diseases or in graft versus host reactions. A special emphasis is put on idiopathic bronchiolitis obliterans associated with organizing pneumonia. Some clinicopathologic correlations are of basic interest in relation to etiological factors: bronchiolitis obliterans due to viral infection in children involving mainly membranous bronchioles; by contrast, bronchiolitis obliterans related to other causes seems to extend further down from the terminal bronchioles to the respiratory bronchioles. Lymphoid bronchiolitis appears non specific and is mostly observed in association with systemic connective tissue diseases, such as rheumatoid arthritis.