Interventions to Prevent Long-Term Consequences of Bronchiolitis

Many epidemiologic studies have demonstrated a clear association between viral bronchiolitis early in life and subsequent development of persistent wheezing. Despite that a number of studies have been conducted to reduce post-bronchiolitis wheeze, we do not have consistent evidence of an effective strategy. Two different therapeutic approaches have been evaluated: a) anti-inflammatory and/or immunomodulatory agents; and b) specific anti-viral agents. Corticosteroids have been evaluated by different routes and doses in children with RSV bronchiolitis with disappointing results. Recent data, however, suggest a potential benefit of corticosteroids in reducing the long-term wheezing associated with rhinovirus bronchiolitis. Studies evaluating the anti leukotriene receptor antagonist -montelukast— have showed inconsistent results. Finally, studies in premature infants using agents that specifically target RSV, more specifically anti-RSV antibodies (palivizumab), have provided encouraging results indicating the need to design larger studies in broader patient populations.