BRONCHIOLITIS - ORIGINS AND OPTIMAL MANAGEMENT

There is currently no prospect of an end to the annual epidemics of ac ute bronchiolitis, which cause considerable morbidity in previously he althy infants and are a major threat to the well-being of infants with underlying cardiac, respiratory or immunological disease. The respira tory syncytial virus remains the major cause of this condition, and pr ospects of developing a vaccine remain bleak while our understanding o f the viral-host interaction remain incomplete. Treatment of patients with this condition has remained essentially unchanged for more than 3 0 years. Correction of hypoxia with oxygen, minimal handling to reduce the risk of exhaustion and careful noninvasive monitoring for complic ations such as apnoea and respiratory failure are the mainstays of man agement. Mortality in at-risk groups has fallen substantially during t he past 10 years. This appears to be due to improved supportive and in tensive care. The role of the antiviral agent ribavirin in the improve d outcome, if any, is unclear. Other novel therapies have been tried, but none have been shown to significantly alter the natural history of the condition. The only effective preventive intervention currently a vailable is strict adherence to measures designed to prevent nosocomia l infection. This condition is likely to remain a continuing challenge to paediatricians for the foreseeable future.