急性病毒性支气管炎的新模式:是时候改变我们的方法了吗?

IF 4.7 3区 医学 Q1 PEDIATRICS Paediatric Respiratory Reviews Pub Date : 2024-11-01 DOI:10.1016/j.prrv.2024.10.004
Jose A Castro-Rodriguez, Patricio Astudillo, Sandeep Puranik, Mark A Brown, Adnan Custovic, Erick Forno
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引用次数: 0

摘要

病毒性支气管炎是导致住院治疗的最常见的儿科急性呼吸道感染,在全球范围内造成了巨大的医疗负担。在许多关于特定疗法的临床试验未能证明其疗效后,现行指南建议采取支持性治疗。然而,近十年来的多项研究表明,支气管炎可能并不是一种单一的疾病,而是由基于患者特征、病因、病理生理机制和临床表现的不同 "内型 "和 "表型 "组成的伞状疾病。在这篇内容广泛的综述中,我们总结了目前的证据,即几种不同类型的支气管炎("支气管炎")并存,对呼吸系统健康和哮喘发病风险造成不同的短期和长期后果。呼吸道合胞病毒和鼻病毒这两种最常见的病毒病原体的疾病病理生物学、免疫反应和临床特征可能有所不同。最近的随机试验表明,某些亚组儿童可能从使用全身性皮质类固醇激素和/或支气管扩张剂中获益。这些研究结果还表明,一些儿童可能会从针对病毒性支气管炎的个体化治疗方法中获益,而不是遵循广泛的建议,对所有患者统一采用支持性治疗方法。
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New paradigms in acute viral bronchiolitis: Is it time to change our approach?

Viral bronchiolitis is the most common pediatric acute respiratory infection leading to hospitalization, and it causes a significant healthcare burden worldwide. Current guidelines recommend supportive management after many clinical trials on specific therapies failed to demonstrate benefits. However, several studies in the past decade have revealed that bronchiolitis may not be a homogeneous disease, but instead may constitute an umbrella comprised of different "endotypes" and "phenotypes" based on patient characteristics, etiology, pathophysiological mechanisms, and clinical presentation. In this extensive review, we summarize the current evidence that several different types of bronchiolitis ("bronchiolitides") coexist, with different short- and long-term consequences on respiratory health and the risk of asthma development. Disease pathobiology, immune response, and clinical characteristics may differ between the two most prevalent viral agents, respiratory syncytial virus and rhinovirus. Recent randomized trials have shown that some subgroups of children may benefit from the use of systemic corticosteroids and/or bronchodilators. These findings also suggest that some children may benefit from individualized therapeutical approaches for viral bronchiolitis rather than following broad recommendations for treating all patients uniformly using only supportive management.

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来源期刊
Paediatric Respiratory Reviews
Paediatric Respiratory Reviews 医学-呼吸系统
CiteScore
12.50
自引率
0.00%
发文量
40
审稿时长
23 days
期刊介绍: Paediatric Respiratory Reviews offers authors the opportunity to submit their own editorials, educational reviews and short communications on topics relevant to paediatric respiratory medicine. These peer reviewed contributions will complement the commissioned reviews which will continue to form an integral part of the journal. Subjects covered include: • Epidemiology • Immunology and cell biology • Physiology • Occupational disorders • The role of allergens and pollutants A particular emphasis is given to the recommendation of "best practice" for primary care physicians and paediatricians. Paediatric Respiratory Reviews is aimed at general paediatricians but it should also be read by specialist paediatric physicians and nurses, respiratory physicians and general practitioners. It is a journal for those who are busy and do not have time to read systematically through literature, but who need to stay up to date in the field of paediatric respiratory and sleep medicine.
期刊最新文献
Exercise capacity and the psychosocial effect in preterm born infants - Should we do more? A review of imaging in the diagnosis and management of complicated paediatric pneumonia. Surfactant administration and cerebral oxygenation and perfusion in preterm neonates - A systematic review of literature. A Review Of Host-Specific Diagnostic And Surrogate Biomarkers In Children With Pulmonary Tuberculosis. New paradigms in acute viral bronchiolitis: Is it time to change our approach?
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