The Syndrome We Agreed to Call Bronchiolitis

Fernando P Polack, Renato T Stein, Adnan Custovic, Fernando P Polack, Renato T Stein, Adnan Custovic

Abstract

We are ignoring evidence suggesting that the diagnosis of bronchiolitis encompasses several diseases with distinct underlying mechanisms, considerable heterogeneity in treatment responses, and ultimately different therapeutic targets. Understanding this heterogeneity may be the only way to deliver appropriate, stratified treatments.

Keywords: bronchiolitis; endotypes; machine learning; respiratory syncytial virus.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

References

    1. Ralston SL, Lieberthal AS, Meissner HC, et al. . American Academy of Pediatrics Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134:e1474–502.
    1. Murray CS, Woodcock A, Langley SJ, Morris J, Custovic A; IFWIN Study Team Secondary prevention of asthma by the use of inhaled fluticasone propionate in Wheezy INfants (IFWIN): double-blind, randomised, controlled study. Lancet 2006; 368:754–62.
    1. Hubble D, Osborn GR. Acute bronchiolitis in children. Br Med J 1941; 1:107–126.1.
    1. Meissner HC. Viral bronchiolitis in children. N Engl J Med 2016; 374:62–72.
    1. Scheltema NM, Nibbelke EE, Pouw J, et al. . Respiratory syncytial virus prevention and asthma in healthy preterm infants: a randomised controlled trial. Lancet Respir Med 2018; 6:257–64.
    1. Achten NB, Wu P, Bont L, et al. . Interference between respiratory syncytial virus and human rhinovirus infection in infancy. J Infect Dis 2017; 215:1102–6.
    1. Caballero MT, Serra ME, Acosta PL, et al. . TLR4 genotype and environmental LPS mediate RSV bronchiolitis through Th2 polarization. J Clin Invest 2015; 125:571–82.
    1. Bockova J, O’Brien KL, Oski J, et al. . Respiratory syncytial virus infection in Navajo and White Mountain Apache children. Pediatrics 2002; 110:e20.
    1. O’Brien KL, Chandran A, Weatherholtz R, et al. . Respiratory Syncytial Virus (RSV) Prevention Study Group Efficacy of motavizumab for the prevention of respiratory syncytial virus disease in healthy Native American infants: a phase 3 randomised double-blind placebo-controlled trial. Lancet Infect Dis 2015; 15:1398–408.
    1. Oksel C, Haider S, Fontanella S, Frainay C, Custovic A. Classification of pediatric asthma: from phenotype discovery to clinical practice. Front Pediatr 2018; 6:258.
    1. Dumas O, Mansbach JM, Jartti T, et al. . A clustering approach to identify severe bronchiolitis profiles in children. Thorax 2016; 71:712–8.
    1. Barlotta A, Pirillo P, Stocchero M, et al. . Metabolomic profiling of infants with recurrent wheezing after bronchiolitis [manuscript published online ahead of print 16 November 2018]. J Infect Dis 2018. doi:10.1093/infdis/jiy659.
    1. McNamara PS, Flanagan BF, Baldwin LM, Newland P, Hart CA, Smyth RL. Interleukin 9 production in the lungs of infants with severe respiratory syncytial virus bronchiolitis. Lancet 2004; 363:1031–7.
    1. Caballero MT, Hijano DR, Acosta PL, et al. . INFANT Respiratory Network Interleukin-13 associates with life-threatening rhinovirus infections in infants and young children. Pediatr Pulmonol 2018; 53:787–95.
    1. Rabe KF, Nair P, Brusselle G, et al. . Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma. N Engl J Med 2018; 378:2475–85.

Source: PubMed

3
Subscribe