Bronchiolitis in young children consequences. Bronchiolitis in children: a serious blow to a small body. Effective methods of treating bronchiolitis in children

Damage to the intrapulmonary airways up to the alveolar ducts leads to respiratory failure. In more than 60% of cases, this disease - acute bronchiolitis in children - is caused by viral infection. A kind of “plugs” appear inside the bronchi, respiratory failure develops, and gas exchange is disrupted. Children under 2 years of age usually get sick, which is due to imperfect local immunity. respiratory tract. Babies require hospital treatment and careful post-hospital care.

The frequency of obstructive bronchitis and bronchiolitis in the first year or two of life is explained by the weakness of local immunity. These diseases in children follow a similar “scenario”. Bronchial tree in children early age are distinguished by narrow lumens of small bronchi. Even with slight swelling of the mucous membrane, air permeability is almost halved.

Causes and factors contributing to the development of bronchiolitis:

• respiratory syncytial viruses, para-influenza, adenovirus;
• the baby's tendency to allergic reactions;
• early transition to artificial feeding;
• overweight in a child;
• food allergies.

In young children, due to swelling of the bronchial mucosa, airway obstruction quickly occurs. Gas exchange is disrupted, symptoms of respiratory failure and cor pulmonale are observed.

Viruses that have penetrated deep into the intrapulmonary airways provoke changes first in the small bronchi, then in the bronchioles and alveolar ducts. Bronchiolitis in young children is characterized by desquamation of epithelial cells, inflammation, swelling of the mucous membrane and even the connective tissue membrane. Small bronchi with a diameter of 1–1.5 mm and narrower bronchioles are filled with mucus along with dead epithelial cells. Clogging begins - obturation - partially or completely. Possible reduction of a lobe or the entire lung due to loss of air (atelectasis)

Symptoms and risk factors for acute bronchiolitis in children

2–3 days after the onset of acute respiratory viral infection, acute bronchiolitis may develop in children weakened by chronic diseases and premature infants. A particularly serious condition in infants is observed when adenovirus infection. An annoying dry cough occurs, quickly turning into a productive form. The child is breathing heavily, the wings of the nose are swollen. Shortness of breath increases, the baby turns pale, and his nasolabial triangle becomes blue.

A pediatrician, auscultating the baby's chest, notes numerous persistent wheezing on inhalation and dry wheezing on exhalation. Severe tachycardia is often observed. Also during the examination, the specialist pays attention to the expansion chest. A blood test for acute bronchiolitis shows changes similar to ARVI. An X-ray examination is performed to study the condition of the lung tissue, bronchi and diaphragm.

With bronchiolitis in a small child, the danger is the development of respiratory failure. Premature babies can die during an apnea attack.

Features of severe bronchiolitis:

• the oxygen content in the blood decreases (hypoxemia);
• carbon dioxide accumulates in the blood (hypercapnia);
• lobes of the lungs collapse (atelectasis);
• baby up to three months old.

Obstruction of the small bronchi and bronchioles usually persists for one to three days. Symptoms of obstruction gradually fade away by 7–10 days from the onset of the disease. With adenoviral and parainfluenza infections, the total duration of the disease is up to three weeks.

Symptoms and course of bronchiolitis obliterans in children

This is one of severe forms, which is characterized by a transition to chronic course. The etiology of bronchiolitis obliterans in children is most often associated with adenoviruses. There are also cases of influence on the development of severe forms of the disease into intolerance to cow's milk, pathogens of whooping cough, and influenza.

Symptoms of acute bronchiolitis obliterans:

• long-term preservation of the child’s body temperature in the febrile range;
• fine bubbling rales are heard on auscultation;
• difficulty breathing, respiratory failure;
• need for artificial ventilation.

Bronchiolitis obliterans is characterized by significant lesions at the level of small intrapulmonary air tubes. The lumen of the bronchioles, as well as arterioles (small arteries), closes. Sclerosis of a lobe or the entire lung may develop.

Features of treatment

The use of bronchodilators for bronchiolitis often does not help babies breathe better. One of the reasons for the lack of the expected therapeutic effect lies in the peculiarities of the action of such drugs. Bronchodilators expand the lumen of the bronchi by influencing their muscles. But in young children, the muscle fibers of small bronchi and bronchioles are poorly developed. Therefore, a significant role in the treatment of bronchiolitis is given to oxygen therapy, anti-inflammatory drugs, expectorants and mucolytics.

Features of various bronchodilators:

1. Contains salbutamol and fenoterol various drugs- low-toxic, effective and long-lasting.
2. The drug "Atrovent" based on ipratropium bromide is recommended for the prevention of attacks.
3. Theophylline - has a relaxing effect on the smooth muscles of the bronchi and other organs.
4. Euphilin is an effective antispasmodic mixture of theophylline with ethylenediamine (used instead of theophylline).

For bronchiolitis in children, oxygen therapy is prescribed using humidified oxygen (40% concentration). A procedure called “oxygen tent” is carried out three times a day or every two hours for one week. If the oxygen tent is ineffective, assisted artificial pulmonary ventilation (AVL) is performed. If cyanosis and increased content carbon dioxide persist, then the small patient is transferred to mechanical ventilation.

Only inpatient treatment provides quick fix respiratory failure in a child.

Procedures for bronchiolitis:

• removal of sputum by electric suction;
• postural drainage of the lower respiratory tract;
• inhalation of alkaline solutions;
• vibration massage.

Severe shortness of breath causes dehydration in the child. Therefore they give drinking plenty of fluids, rehydron solution, IV medications are prescribed. In addition to administering fluids to replenish the loss of water and salts, antibiotics and glucocorticoid drugs are also indicated. Antibacterial agents from the group of cephalosporins prevent the development of pneumonia, which often develops against the background of respiratory failure.

Prognosis for bronchiolitis in a child

Effective therapy for the disease helps eliminate bronchial obstruction and improve external respiration. Unfortunately, even in this case, irritation of the mucous membrane of the lower airways persists for a long time. Hyperactivity of the bronchi and bronchioles negatively affects the body's oxygen supply. Every second child after an illness is more susceptible to broncho-obstructive syndrome.

Increases the likelihood of developing severe bronchiolitis in children chronic diseases lungs and heart, weak immunity and taking certain medications. Scientists are also exploring the connection between bronchiolitis and asthma. The cause-and-effect relationship is still questionable, but it has been established that children who have had bronchiolitis are more susceptible to developing asthma in later life.

Prevention of bronchiolitis in a child

Respiratory syncytial virus infection is the cause of more than 50% of all cases of bronchiolitis. This type of virus is most active in winter and in early spring. With bronchiolitis, a runny nose occurs first, cough mild fever. These symptoms last only a day or two, followed by worsening symptoms. Shortness of breath gradually develops, the heartbeat quickens, breathing becomes frequent and shallow. The child sleeps poorly, loses appetite, becomes lethargic and irritable.

Parents should be more careful at the first signs of a cold in children, because with bronchiolitis the first symptoms are the same.

Are common preventive actions in family:

1. removing “dust collectors” from the children’s room - carpets, soft toys that cannot be washed;
2. providing a sick family member with separate dishes and towels;
3. frequent ventilation of rooms, air humidification;
4. regular wet cleaning of the house or apartment;
5. rinsing the nose with saline solution.

The child must be protected from tobacco smoke, strong odors, and strong allergens. It is also important to dress children according to the weather and prevent hypothermia.

Viruses are transmitted through direct contact and spread by airborne droplets. When coughing or laughing, tiny drops of saliva and mucus from the nasal passages of an infected person enter the air and settle on clothes, furniture, and children's toys. People inhale myriads of pathogens through the air and bring them into their mouths due to poor hygiene. child in kindergarten more susceptible to infection because he is in contact with many children from different social classes.

The main directions for the prevention of bronchiolitis:

1. maximum exclusion of contacts with viral infection;
2. taking antiviral drugs;
3. healthy diet;
4. vitamin therapy;
5. personal hygiene;
6. hardening.

There is no vaccine against bronchiolitis yet, but children who receive the flu vaccine are less likely to get the disease. The autumn-winter period accounts for over 80% of acute respiratory diseases, so vaccination begins in September. The greatest protection against influenza is provided by third-generation drugs for children over 6 months of age, for example, Grippol or Agrippal. Among natural antiviral agents, the most popular are garlic, onion, and eucalyptus.

Bronchiolitis most often affects children under one year of age. The peak incidence is from two to six months. The reason lies in the unstable immune system infants. If the virus enters the baby’s body, it penetrates into the “farthest corners”, for example, into the bronchioles. In 90% of cases, this type of bronchitis occurs as a complication of ARVI or influenza. Often with bronchiolitis, secondary bacterial infection at the site of inflammation. Perhaps bronchiolitis in children occurs as a reaction to irritants - cold or chemically polluted air, strong odors, household allergens. This causal relationship is disputed by some experts and is under study.

Characteristic signs

If a baby gets sick with ARVI, but there is no improvement, the child may develop acute bronchiolitis. What are the symptoms of bronchiolitis in children?

• Appetite is disrupted: the baby eats little or refuses to eat at all.
• Pallor and cyanosis skin.
• Against the background of refusal of food and water, there may be signs of dehydration: rare urination, dry mouth, sunken fontanel on the top of the head, crying without tears, rapid pulse.
• Moodiness, agitation, poor sleep.
• Body temperature rises slightly, signs of intoxication are not as pronounced as with pneumonia.
• Dry paroxysmal cough, with little sputum.
• Difficulty breathing: moaning, grunting sounds; you can observe swelling of the wings of the nose, a strong retraction of the chest; severe shortness of breath, shallow breathing.
• There are cases of apnea - stopping breathing.
• In severe forms, the respiratory rate exceeds 70 times per minute.
• During listening, the pediatrician diagnoses ringing moist rales.
• A blood test shows low white blood cells and ESR.

The main symptom of bronchiolitis is respiratory failure, which in severe forms can lead to suffocation. This is a signal that qualified and immediate medical assistance. There is often confusion in diagnoses, because the clinical picture of bronchiolitis is similar to asthmatic bronchitis or pneumonia with obstructive syndrome.

How to help your child before the doctor arrives

It is important to create conditions that will not aggravate the baby’s condition.

• Humid and cool air. The air temperature should not exceed 20 °C, humidity - from 50 to 70%. These child care requirements cannot be neglected. Dry and hot air contributes to the drying out of mucous membranes, heavy sweating, which means rapid loss of moisture.
• Drink plenty of fluids. Frequent breastfeeding is recommended. You can give your child water, dried fruit compote, or any age-appropriate drinks. If there are signs of dehydration, you need to use pharmaceutical rehydration powders for solutions: “Hydrolit”, “Regidron”, “Oralit” and others. They are used to seal the baby from a syringe (without a needle) in fractional portions. You can prepare a solution at home: for 1 liter of water - 1 teaspoon of salt and soda, 2 tablespoons of sugar.

• physiotherapy for the chest;
• hot inhalations to avoid laryngospasm;
• the use of any medications, including bronchodilators, without a doctor’s prescription.

The risk of dehydration in babies under one year of age is extremely high. Sudden weight loss and disruption of the water-salt balance in the baby’s body can lead to serious and sometimes irreversible consequences: kidney and heart failure, brain, immune, of cardio-vascular system. Therefore, it is so important to prevent dehydration and recognize its symptoms in time.

Treatment

Treatment for bronchiolitis takes a long time: from 1 to 1.5 months. Treatment of infants with severe forms of the disease is carried out in inpatient conditions. What therapy is provided?

• Rehydration therapy. Rehydration is the replenishment of the body with glucose-salt solutions. It is carried out orally and intravenously in cases of emergency care.
• Measures for respiratory failure. Oxygen masks are used, and inhalations with medications are used to relieve asthma attacks. In severe forms, artificial ventilation may be performed.
• Antiviral drugs. Bronchiolitis in most cases is viral in nature, so antiviral drugs are prescribed, often interferon-based.
• Antibiotics. Prescribed if bronchiolitis is accompanied by a bacterial infection - most often streptococcal and pneumococcal. For the correction and effectiveness of therapy, bacterial culture from the throat is prescribed to determine the sensitivity of bacteria to various types antibiotics. More often used antibacterial drugs wide range actions: “Amoxiclav”, “Macropen”, “Sumamed”, “Augmentin”, “Amosin” and others.
• Antihistamines. They help relieve swelling in the bronchi and make breathing easier. New generation drugs are prescribed that do not give a sedative effect.

What can be the consequences after an illness? Shortness of breath and whistling when breathing may persist for a long time, but the child’s condition will be satisfactory. Also, children who have suffered acute bronchiolitis can be registered at a dispensary, since they are at risk for developing bronchial asthma.

Features of bronchiolitis obliterans

The term “obliteration” in medicine means the fusion and closure of a tubular or hollow organ due to proliferation connective tissue on the walls. Bronchiolitis obliterans in children - most often chronic form previous acute bronchiolitis. With this type of disease, a narrowing of the lumen of the small bronchi and bronchioles is observed. This interferes with pulmonary blood flow and over time can lead to the development pathological processes in the lungs, to pulmonary heart failure. What are the signs of chronic bronchiolitis obliterans?

• A dry, nonproductive cough with little sputum production often occurs.
• Shortness of breath after physical activity, but if the disease progresses, then shortness of breath occurs even in a calm state.
• Moist rales, wheezing.

These symptoms may appear long time- up to six months or more.

How is bronchiolitis obliterans treated in children?

• Drug therapy. Bronchodilator, mucolytic, and expectorant medications may be prescribed. If bacterial inflammation is detected, antibiotics are prescribed.
• Assistive therapy. The doctor recommends chest massage, breathing exercises, physical therapy, climatotherapy, speleotherapy, physiotherapy.

Bronchiolitis in young children is widespread. Along with pneumonia, this is the most common and dangerous complication after ARVI in children. Infants diagnosed with bronchiolitis are most often hospitalized. Lethal outcome is possible in premature infants, with congenital bronchopulmonary and cardiac defects, with severe dehydration and hypoxia. Timely health care in this diagnosis is extremely important.

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When a child is sick, parents always worry. Particular concern arises if the doctor makes a diagnosis that is not the most popular, for example, bronchiolitis. What is this disease and how does it manifest itself?

Causes of the disease

Experts consider respiratory syncytial virus to be the leading causative agent of acute bronchiolitis.

Bronchiolitis is an inflammation of the smallest branches of the bronchi - bronchioles. This disease most often affects children under 3 years of age. More than 60% of young patients are boys.

According to the nature of the disease, it can be:

• acute – lasts no more than 5 weeks,
• chronic – lasts for 3 months or longer.

The culprit of acute bronchiolitis in most cases is respiratory syncytial virus (RSV). Similarly, this infection likes to “walk” during the cold season - from October to April. However, unlike the common cold, RSV hits the lower respiratory tract rather than the upper respiratory tract.

Infection usually occurs by airborne droplets. This means that the virus is transferred from sick people to healthy people through sneezing and communication. Less commonly, the infection is transmitted through dirty hands, shared towels, and toys.

In a small number of children, other microorganisms become causative agents of the disease:

• influenza viruses,
• adenoviruses,
• parainfluenza,
• mycoplasma.

Chronic bronchiolitis can develop as a consequence of acute bronchiolitis, but usually it is an independent disease caused by prolonged inhalation of irritating gases. Very often this disease is found in children living in smoking families.

The rapid development of inflammation is promoted by:

• low baby weight,
• weakened immunity,
• age under 3 months,
• diseases of the cardiovascular system,
• congenital defects of the respiratory tract,
• visiting a nursery/kindergarten,
• smoking by parents in the presence of the baby.

Among newborns, children who are on artificial feeding. Their body is more susceptible to infections due to the fact that it does not receive antibodies from mother's milk.

Clinical picture

The initial symptoms of the disease are similar to a cold. Children develop a dry cough and fever. After a few days the condition worsens. The temperature continues to rise (up to 39 degrees), appetite decreases. But the main thing is that respiratory failure develops.

Inhaling air, the child wheezes, the wings of his nose swell and the nasolabial triangle turns blue. Shortness of breath and rapid heartbeat are added. Vomiting may occur after severe coughing attacks. It is most difficult for infants, because due to anatomical features chest they are unable to cough properly.

In severe cases:

• "bloating of the chest,
• sudden holding of breath (apnea),
• swelling.

Development can be a dangerous complication of the disease.

Diagnostics

To make a diagnosis, a doctor only needs to examine the child and listen to the parents’ complaints. To distinguish bronchiolitis from other pathologies (for example, pneumonia), the doctor may order a chest x-ray.

The causative agent of the disease is identified by general analysis blood. In viral infections, results show increased numbers of lymphocytes and monocytes. The neutrophil content is below normal. With bacterial infections, the number of leukocytes and neutrophils increases.

To detect respiratory syncytial virus, rapid diagnostic methods are used. Swabs from the nasal cavity are taken as material for analysis. They are applied to special test systems that react to the presence of RSV by changing color.

In case of severe shortness of breath, pulse oximetry is performed - a test that helps determine the degree of oxygen saturation in the blood. Values ​​below 95% indicate respiratory failure.

Therapy methods

The child is prescribed ultrasonic inhalations with saline solution, and in severe cases, with corticosteroids.

In case of bronchiolitis, the child must be hospitalized. Treatment tactics are aimed at maintaining normal breathing and preventing complications.

If RSV is detected, a specific drug is prescribed antiviral agent- Ribavirin. It blocks the reproduction of the pathogen and prevents further development diseases.

If a bacterial infection has been established, the child is prescribed antibiotics. Preference is given to drugs from the group of penicillins and cephalosporins (Ampicillin, Cefotaxime). Medicines are administered intramuscularly for 7–10 days.

If necessary, the doctor recommends sputum thinners (mucolytics - Ambroxol, Bromhexine). To facilitate the passage of mucus, it is also prescribed. In severe cases, inhalations with corticosteroids (Dexamethasone) are added, which have an anti-inflammatory effect.

In addition to medications, a mixture of oxygen and helium is given through a mask. This allows you to reduce the manifestations of respiratory failure and improve the patient’s well-being.

Since babies lose a lot of fluid due to rapid breathing, they are advised to drink plenty of fluids. Liquids are given 2 times more than the daily requirement. If the child refuses to drink, he is given saline through an IV.

For 5 years after bronchiolitis in children, the bronchi remain highly susceptible to the action of negative factors. Such babies are more susceptible to bronchitis and bronchial asthma, and therefore require long-term monitoring by a specialist.

Inflammatory obstruction of small-caliber bronchi (bronchioles), usually developing in young children against the background of a viral infection. Initial signs resemble acute respiratory viral infections, which are soon joined by the phenomena of bronchial obstruction ( expiratory dyspnea, spasmodic cough, tachypnea, crepitating or wheezing, cyanosis of the nasolabial triangle, etc.). Diagnosis of acute bronchiolitis is based on data from an X-ray examination of the chest organs and blood gas composition. The basis of treatment for acute bronchiolitis is adequate oxygenation, oral or parenteral hydration, and the use of interferon.

General information

Acute bronchiolitis (capillary bronchitis) is a diffuse inflammatory lesion of the terminal sections of the respiratory tract, occurring with symptoms of broncho-obstruction and respiratory failure. In most cases, the disease develops in children in the first two to three years of life against the background of an acute respiratory viral infection; the maximum peak incidence occurs at the age of 5-7 months.

Every year, 3-4% of young children suffer from acute bronchiolitis, of which 0.5-2% suffer from severe bronchiolitis; death is recorded in 1% of cases. A severe course of acute bronchiolitis is observed in children with aggravated background: premature babies, suffering from congenital lung anomalies and heart defects. The wide prevalence of the pathology and the high frequency of hospitalizations make the problem of acute bronchiolitis extremely relevant for practical pediatrics and pulmonology.

Causes

Up to 70-80% of all cases of acute bronchiolitis in children of the first year of life are etiologically associated with respiratory syncytial virus (RSV). Since MS infection occurs with annual seasonal epidemic outbreaks (in winter and early spring), more than half of young children experience MS infection, and the instability of post-infectious immunity causes frequent reinfection.

Other viral agents (adenoviruses, rhinoviruses, influenza and parainfluenza viruses, enteroviruses, coronaviruses, etc.) account for about 15% of cases of acute bronchiolitis. In recent years, there has been an increase in the role of human metapneumovirus in the development of broncho-obstructive syndrome in children. Early breastfeeding and the child receiving colostrum with high content IgA.

In children of the second year of life, the importance of viruses causing acute bronchiolitis changes: the RS virus gives way to enteroviruses and rhinoviruses. In preschool and school age Among the causative agents of bronchiolitis, mycoplasmas and rhinoviruses predominate, and PC viruses usually cause viral pneumonia and bronchitis. In addition to traditional etiological agents, acute bronchiolitis can also be caused by cytomegalovirus, chlamydia, measles viruses, chickenpox, mumps, herpes simplex. Among the older children age group In adults and adults, acute bronchiolitis affects people with immunodeficiency, those who have undergone organ and stem cell transplantation, and elderly patients.

During the first day after entry respiratory viruses necrosis of the epithelium of bronchioles and alveocytes develops, mucus formation increases, active release of inflammatory mediators occurs, lymphocytic infiltration and swelling of the submucosal layer occurs. Obstruction of the airways in acute bronchiolitis is not caused by bronchospasm (as, for example, in obstructive bronchitis), but by swelling of the walls of the bronchioles, accumulation of mucus and cellular detritus in their lumen. Together with the small diameter of the bronchi in children, these changes lead to an increase in resistance to air movement, especially during exhalation, like a valve mechanism.

Pathognomonic signs of acute bronchiolitis are tachypnea (RR up to 60-80 beats per minute), tachycardia (heart rate 160-180 beats per minute), participation in breathing of auxiliary muscles, flaring of the wings of the nose, retraction of the intercostal spaces and hypochondrium, perioral cyanosis or cyanosis all skin. Premature babies or babies with birth trauma may experience episodes of sleep apnea. Due to the increased airiness of the lungs and the flattening of the dome of the diaphragm, the liver and spleen protrude 2-4 cm from under the costal arches. Intoxication, refusal to eat and vomiting lead to dehydration and disruption of water-electrolyte homeostasis.

Extrapulmonary complications may include otitis media, myocarditis, and extrasystole. The severity of the patient's condition with bronchiolitis is determined by the degree of acute respiratory failure. In weakened patients, respiratory distress syndrome may develop and death may occur.

Diagnostics

When diagnosing acute bronchiolitis, a pediatrician or pulmonologist takes into account the relationship of bronchial obstruction with a viral infection, characteristic clinical and physical data. A typical auscultatory picture of a “wet lung” includes multiple rales (fine-bubbly, crepitating), prolonged exhalation, and distant wheezing. Due to increased bloating lungs, a percussion sound with a boxy tint is determined.

To assess oxygenation parameters, pulse oximetry, a study of the gas composition of the blood, is performed. The X-ray picture in the lungs is characterized by signs of hyperpneumatization and peribronchial infiltration, increased pulmonary pattern, the presence of atelectasis, and flattening of the dome of the diaphragm. Of the laboratory tests, the most valuable is the rapid analysis for determining RSV in a nasopharyngeal smear using ELISA, RIF or PCR. Bronchoscopy data (diffuse catarrhal bronchitis, a significant amount of mucus) in acute bronchiolitis are not indicative. Spirography cannot be performed on young children.

Acute bronchiolitis must be differentiated from obstructive bronchitis, bronchial asthma, CHF, pneumonia (aspiration, viral, bacterial, mycoplasma), whooping cough, foreign bodies in the respiratory tract, pulmonary cystic fibrosis, gastroesophageal reflux.

Treatment of acute bronchiolitis

To date, no etiotropic treatment for acute bronchiolitis has been developed. Inhaled use of ribavirin is considered inappropriate due to lack of effectiveness and frequent hypersensitivity reactions. The use of bronchodilators, physiotherapy, and inhaled steroids is also not recommended. The basis of basic therapy for acute bronchiolitis is adequate oxygenation and hydration of the patient. Children younger age subject to hospitalization and isolation.

Humidified oxygen is supplied using a mask or oxygen tent. In case of repeated apnea, persistence of hypercapnia, or general serious condition, transfer to mechanical ventilation is indicated. Replenishment of fluid losses is ensured through frequent fractional drinking or infusion therapy (under the control of diuresis, electrolyte composition and blood CBS). To remove mucus from the respiratory tract, aspiration with an electric suction, vibration massage of the chest, postural drainage, salt inhalation with hypertonic solution or inhalation of epinephrine through a nebulizer.

Interferon preparations are used to eliminate viral infections. Glucocorticoids can be used in a short course to relieve bronchial obstruction. The clinical effectiveness of including the drug fenspiride, which has a pronounced anti-inflammatory effect, in the treatment regimen for acute bronchiolitis has been proven. Antibacterial agents should be prescribed only if bacterial complications are suspected.

Prognosis and prevention

In mild cases, acute bronchiolitis can resolve on its own, without special pathogenetic therapy. After 3-5 days, improvement occurs, although bronchial obstruction and cough may persist for up to 2-3 weeks or longer. In the next five years after acute bronchiolitis, children continue to have bronchial hyperreactivity and a high risk of developing bronchial asthma. Fatalities are registered mainly in persons with aggravated concomitant background.

A specific immunoglobulin, palivizumab, with anti-RSV activity has been developed as a means of passive immunoprophylaxis. The drug is intended for use during periods of increased MS infection in categories of children and adults at risk of developing severe forms of acute bronchiolitis.