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Bronchiolitis, a respiratory illness, is the leading cause of hospitalization for infants. The authors examined whether environmental factors contributed to the severity of the bronchiolitis illness. They compiled environmental data (temperature, dew point, wind speed, precipitation, altitude, and barometric pressure) to augment clinical data from a 30-center prospective cohort study of emergency department patients with bronchiolitis. They analyzed these data using multivariable logistic regression. Higher altitude was modestly associated with increased retractions (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1-2.1; p < .001) and decreased air entry (OR = 2.0; 95% CI = 1.6-2.6; p < .001). Increasing wind speed had a minor association with more severe retractions (OR = 1.3; 95% CI = 1.1-1.7; p = .02). Higher dew points had a minor association with lower admission rates (OR = 0.9; 95% CI = 0.8-0.996; p = .04). Altitude and environmental climate variables appear to have modest associations with the severity of bronchiolitis in the emergency department. Further studies need to be conducted, however, on limiting exposure to these environmental variables or increasing humidity before making broad recommendations., Introduction Bronchiolitis is the leading cause of hospitalization for infants (Zorc & Hall, 2010). Bronchiolitis is an acute lower respiratory tract infection in young children most commonly caused by seasonal [...]

Purpose To redress the paucity of studies evaluating non-invasive respiratory support in bronchiolitis patients. Methods Following ethics committee approval, the clinical database of a tertiary 23-bed paediatric intensive care unit (PICU) was reviewed for bronchiolitis admissions from January 2000 to December 2009. Length of stay (LOS), ventilatory requirements and risk factors, including prematurity, respiratory syncytial virus (RSV) status, chronic lung, neuromuscular, immune and congenital heart disease, were analysed. Results Of 8,288 admissions, 520 (6.27 %) had bronchiolitis with 343 (65.9 %) having RSV. Median (±SD) age and LOS were 2.78 months and 2.68 (±4.32) days. One (0.2 %) patient died. Assisted ventilation was required for 399 (76.7 %) patients. A total of 114 (28.6 %) patients were intubated directly and 285 (71.4 %) had a trial of non-invasive ventilation (NIV). Significant increase in the use of NIV was seen (2.8 %/year) with decline in intubation rates (1.9 %/ year) (p = 0.002). Of NIV patients, 237 (83.2 %) needed only NIV and 48 (16.8 %) failed and therefore needed intubation. The median LOS was shorter in those who succeeded NIV (2.38 ± 2.43 days) compared to those with invasive ventilation (5.19 ± 6.34 days) and those who failed NIV (8.41 ± 3.44 days). Presence of a risk factor increased the chances of failing NIV from 6 to 10 %. Conclusion NIV was successful in the vast majority of patients, particularly in those without risk factors and halved the LOS in intensive care. Failure of NIV was associated with increased duration of invasive ventilation and PICU LOS. A prospective study comparing different techniques of NIV will be helpful in defining the risks of failure of NIV., Author(s): Subodh Suhas Ganu [sup.1], Anil Gautam [sup.1], Barry Wilkins [sup.1], Jonathan Egan [sup.1] Author Affiliations: (1) grid.413973.b, 000000009690854X, Paediatric Intensive Care Unit, Sydney Medical School, The Children's Hospital at [...]

The development of chronic allograft rejection is based on the hypothesis that cumulative, time-dependent tissue injury eventually leads to a fibrotic response. In this issue of the JCI, Babu and colleagues found that alloimmune-mediated microvascular loss precedes tissue damage in murine orthotopic tracheal allografts (see the related article beginning on page 3774). The concept that injury to the endothelium may precede airway fibrosis suggests that interventions to maintain vascular integrity may be important, especially in the case of lung transplantation. Further, for all solid organ allografts, it is possible that the key to long-term allograft survival is physiological vascular repair at early times following transplantation., Clues to mechanisms underlying long-term allograft survival The major obstacle to the long-term survival of lung transplant recipients is the development of the bronchiolitis obliterans syndrome (BOS), which typically occurs [...]

Bronchiolitis obliterans syndrome (BOS), a process of fibro-obliterative occlusion of the small airways in the transplanted lung, is the most common cause of lung transplant failure. We tested the role [...]

OBJECTIVE. Our goal was to determine whether maternal asthma and maternal smoking during pregnancy are associated with the incidence and severity of clinically significant bronchiolitis in term, otherwise healthy infants without the confounding factors of small lung size or underlying cardiac or pulmonary disease. PATIENTS AND METHODS. We conducted a population-based retrospective cohort study of term, non-low birth weight infants enrolled in the Tennessee Medicaid Program from 1995 to 2003. The cohort of infants was followed through the first year of life to determine the incidence and severity of bronchiolitis as determined by health care visits and prolonged hospitalization. RESULTS. A total of 101 245 infants were included. Overall, 20% of infants had [greater than or equal to] 1 health care visit for bronchiolitis. Compared with infants with neither factor, the risk of bronchiolitis was increased in infants with maternal smoking only, maternal asthma only, or both. Infants with maternal asthma only or with both maternal smoking and asthma had the highest risks for emergency department visits and hospitalizations. Infants with a mother with asthma had the highest risk of a hospitalization >3 days, followed by infants with both maternal asthma and smoking, and maternal smoking only. CONCLUSIONS. Maternal asthma and maternal smoking during pregnancy are independently associated with the development of bronchiolitis in term, non-low birth weight infants without preexisting cardiac or pulmonary disease. The risk of bronchiolitis among infants with mothers who both have asthma and smoke during pregnancy is ~50% greater than that of infants with neither risk factor. Efforts to decrease the illness associated with these 2 risk factors will lead to decreased morbidity from bronchiolitis, the leading cause of hospitalization for severe lower respiratory tract infections during infancy. Key Words bronchiolitis, risk factors, infant, smoking, asthma, BRONCHIOLITIS, CAUSED BY viruses such as respiratory syncytial virus (RSV) and rhinovirus, is the leading cause of lower respiratory tract infections in infants. (1-4) Bronchiolitis results in significant morbidity in [...]

Objective. To determine the incidence of preventable adverse events (AEs) and near misses (NMs) among infants hospitalized for bronchiolitis at a pediatric tertiary care hospital and the impact of these errors on hospital length of stay (LOS). Methods. We studied 143 infants with bronchiolitis, ages 0 to 12 months, admitted from December 2002 to April 2003. Using prospective chart review and staff reports, we captured medical errors and AEs. Each event was classified as a (1) preventable AE, (2) nonpreventable AE, (3) intercepted NM, (4) nonintercepted NM, or (5) error with little or no potential for harm. Results. Of 143 patients, 15 (10%) suffered an AE or NM. The incidence of preventable AEs was 10 per 100 admissions. We found a higher incidence of preventable AEs and NMs among critically ill patients (CIPs) compared with non-CIPs (68 vs 5 per 100 admissions, respectively), making the absolute risk of an AE or NM 14 times more likely in CIPs. Mean LOS was significantly longer for CIPs with at least 1 AE (9.1 + 8.8 days) than for CIPs without AEs (2.9 [+ or -] 1.5 days). Mean LOS was not significantly different between non-CIPs who did (3.8 [+ or -] 2.6 days) and did not (4.2 [+ or -] 5.0 days) experience an AE. Conclusions. Preventable AEs occur frequently among patients admitted for bronchiolitis, especially those who are critically ill. CIPs who suffer AEs during their hospitalization have longer hospital LOSs. Future studies should investigate error-prevention strategies with a focus on those patients with severe disease. Pediatrics 2005;116:603-608; adverse events, bronchiolitis, medical errors., ABBREVIATIONS. AE, adverse event; NM, near miss; LOS, length of stay; CIP, critically ill patient. Pediatric inpatients frequently suffer medical errors, which may cause severe harm. Although the numbers are [...]

People who work at microwave popcorn factories may develop a lung disease called bronchiolitis obliterans if they work in areas that contain high amounts of butter flavoring in the air. These areas include the area where popcorn flavorings are mixed and the area where the popcorn is packaged.

Byline: Louis Bont (1), Jan L. Kimpen (1) Keywords: Respiratory syncytial virus Artificial respiration Review Pathogenesis Immunity Abstract: Respiratory syncytial virus (RSV) bronchiolitis resulting in respiratory insufficiency is frequently encountered during the winter season in paediatric intensive care units. This review evaluates potential determinants described in severe RSV bronchiolitis with special attention to the role of immaturity of immune responses during infancy. Pre-existent cardiac or pulmonary compromises have been documented as clinical risk factors for severe RSV bronchiolitis. In addition to this group of infants with pre-morbidity, a large proportion of mechanically ventilated RSV bronchiolitis patients are previously healthy full-term infants or premature neonates without predisposing risk factors. In general, infants at this early age have maturation-related deficient cellular immunity. Several studies show an association between decreased cellular immunity and severe RSV bronchiolitis, indeed suggesting that a maturation-related defect of the cellular immune system facilitates severe RSV. In addition, low virus-specific antibody titres prior to RSV bronchiolitis have been shown to be a risk factor for severe RSV bronchiolitis. A low level of cellular and humoral immunity would explain that higher viral titres are found in infants with most severe illness. In conclusion, immaturity of the physiological functions in healthy pre-term infants and neonates, in particular the immune system, appears to be an important factor in the pathogenesis of RSV bronchiolitis resulting in mechanical ventilation. Author Affiliation: (1) Wilhelmina Children's Hospital, University Medical Center, POB 85090, 3508 AB Utrecht, The Netherlands Article History: Received Date: 07/03/2001 Accepted Date: 28/01/2002 Article note: Electronic Publication

Byline: Eric A.F. Simoes (1), Anthony R. Hayward (2), Esther M. Ponnuraj (1), John P. Straumanis (3), Kurt R. Stenmark (3), Harry L. Wilson (4), P. George Babu (5) Keywords: Key words: bronchiolitis, pneumonia, animal models, respiratory syncytial virus, bronchoalveolar lavage, Bonnet monkeys Abstract: The Bonnet monkey model of respiratory syncytial virus (RSV) infection may be a useful nonhuman primate model for studying RSV disease in humans because Bonnet monkeys can predictably be infected to obtain an orderly sequence of morphologic, cytologic, virologic, serologic, and inflammatory changes related to time of infection. Young feral Bonnet monkeys, Macaca radiata, were infected endotracheally with 10.sup.6 plaque-forming units (pfu) of the Long strain of RSV. RSV was recovered from the animals' lungs at necropsy on days 3, 5, and 7 with the highest viral titer obtained on day 3 (1.1 and 5.2x10.sup.3 pfu/g of tissue in the upper and lower lobes, respectively). RSV antigen and F protein mRNA were detected 3--5 days after infection in alveolar macrophages and in the epithelium of bronchi, terminal bronchioles, and alveoli. Histologic analysis of RSV-infected lungs at necropsy revealed progressive bronchiolar mucosal and submucosal inflammation, periarterial mononuclear interstitial inflammation, and focal alveolitis, with a maximal response at 7 days after infection. Cell counts in bronchoalveolar lavage (BAL) increased with time with neutrophils and macrophages predominating on day 3 (6.47 and 5.85x10.sup.5/mm.sup.3, respectively) and lymphocytes predominating on day 9 (4.18x10.sup.5/mm.sup.3). Serum-neutralizing antibody appeared on day 5 and IgG antibody to RSV was detected on day 9. This sequence of morphologic, cytologic, virologic, serologic, and inflammatory change following RSV infection creates a useful model in the study of experimentally induced RSV disease with a potential for testing future vaccine-induced alterations in RSV disease response. Author Affiliation: (1) Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Colorado Health Sciences Center, Denver, CO 80262, USA , US (2) Department of Pediatrics, Division of Immunology, University of Colorado Health Sciences Center, Denver, CO 80262, USA , US (3) Department of Pediatrics, Developmental Lung Biology Laboratories, University of Colorado Health Sciences Center, Denver, CO 80262, USA , US (4) Department of Pathology, Providence Memorial Hospital, El Paso, TX 79902, USA , US (5) Department of Virology, Christian Medical College Hospital, Vellore, India 632004 , IN Article note: Received March 20, 1998 accepted September 7, 1998.

The association between vitamin D status and susceptibility to acute lower respiratory tract infection (ALRI) was studied in young Canadian children. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured in patients aged 1-25 months admitted to hospital with uncomplicated ALRI (primarily viral bronchiolitis) as well as in healthy, similarly aged patients without a history of hospitalization for ALRI (controls). Serum 25(OH)D concentrations were similar among cases and controls (77.0 versus 77.2 [nmoll.sup.-1]; P = 0.960), and there was no case-control difference in the prevalence of vitamin D insufficiency using two thresholds ( doi:10.1038/sj.ejcn.1602946; published online 31 October 2007 Keywords: vitamin D; bronchiolitis; respiratory tract infections; child; Canada, Introduction In addition to its role in bone metabolism, the active metabolite of vitamin D is a potent immunomodulator (Deluca and Cantorna, 2001). Rickets is more common in children with [...]

Although there is no doubt that secondhand environmental tobacco smoke exposure contributes to lower respiratory tract infection (LRTI) in infants and young children in developing countries (1) and industrialized nations, [...]

Diacetyl, a chemical compound used to impart a buttery flavor to foods like microwave popcorn, may become hazardous when it is heated and inhaled over a long period. In exposed [...]

People who work in microwave popcorn factories are at risk for developing a lung disease called bronchiolitis obliterans, especially if they work in the mixing room or the microwave popcorn packaging area. Some workers may have a mild form of the disease that does not cause symptoms. However, most lung diseases are chronic and progressive and usually get worse.

After diacetyl (2,3-butanedione) was shown to cause bronchiolitis obliterans in workers who inhaled high levels of this volatile butter flavoring at microwave popcorn processing plants, (1), (2), (3) some manufacturers [...]