Quality points deducted for control interventions not consistent throughout in 1 trial, results based on interim analysis in 1 trial, unclear definition of “at risk” in 1 trial, and incomplete reporting of results. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: bronchodilators (oral, inhaled salbutamol, inhaled adrenaline [epinephrine]), chest physiotherapy, corticosteroids, montelukast, nursing interventions (cohort segregation, hand washing, gowns, masks, gloves, and goggles), respiratory syncytial virus immunoglobulins, pooled immunoglobulins, or palivizumab (monoclonal antibody), ribavirin, or surfactants. Key Points Bronchiolitis is a virally-induced acute bronchiolar inflammation that is associated with signs and symptoms of airway obstruction. It is the most common lower respiratory tract infection in infants. It is a common reason for attendance in the emergency department and for admission to hospital. Bronchiolitis is associated with increased morbidity and mortality in high-risk children (those with congenital heart disease, chronic lung disease, history of premature birth, hypoxia, immune deficiency and age less than 6 weeks) In high-risk children, prophylaxis with either respiratory syncytial virus immunoglobulin or the monoclonal antibody, palivizumab, reduces hospital admissions compared with placebo. It seems that nursing interventions such as cohort segregation, hand washing and wearing gowns, masks, gloves and goggles successfully prevent spreading of the disease in hospital. We do not know how effective most current interventions are in treating bronchiolitis. Although we dont know whether inhaled or oral bronchodilators such as inhaled adrenaline or inhaled or oral salbutamol are effective in treating bronchiolitis, they do seem WR99210 to improve overall clinical scores in the short term. We don’t know whether ribavirin, respiratory syncytial virus immunoglobulin, pooled immunoglobulins or palivizumab,chest physiotherapy, montelukast or surfactants work better than placebo or no treatment in reducing mortality, duration of hospital stay, or respiratory deterioration, although most of the studies could have been too small to detect any clinically important differences. Corticosteroids do not appear to be a useful treatment for bronchiolitis. About this condition Definition Bronchiolitis is a virally-induced acute bronchiolar WR99210 inflammation that is associated with signs and symptoms of airway obstruction. Diagnosis: The diagnosis of bronchiolitis, as well as the assessment of its severity, is based on clinical findings (history and physical WR99210 examination). Bronchiolitis is characterised by a cluster of clinical manifestations in children less than 2 years of age, beginning with an upper respiratory prodrome, followed by increased respiratory effort and wheezing. Suggestive findings include rhinorrhoea, cough, wheezing, tachypnoea, and increased respiratory distress manifested as grunting, nasal flaring, and chest indrawing. There is no good evidence supporting the value of diagnostic tests (chest radiographs, acute-phase reactants, viral tests) in infants with suspected bronchiolitis. RSV-test results rarely influence management decisions. Virologic tests, however, may be useful when cohorting of infants is feasible. Given these issues, it is not surprising to find wide variation in how bronchiolitis is diagnosed and treated in different settings. Incidence/ Prevalence Bronchiolitis is the most common lower respiratory tract infection in infants, occurring in a seasonal pattern, with highest incidence in the winter in temperate climates, and in the rainy season in warmer countries. Bronchiolitis is a common reason for attendance WR99210 and admission to hospital. It accounted for around 3% (1.9 million) of emergency department visits in children below two years of age between 1992 and 2000 in the USA.The respiratory syncytial virus (RSV)-bronchiolitis hospitalisation rate in the USA infant population in 2000-2001 was 24.2 per 1000 births. In a retrospective cohort study carried out in the USA in 1989-1993, one third of RSV-associated hospitalisations were in infants less than three months old. Admission rates are even higher among infants and young children with bronchopulmonary dysplasia (BPD), congenital heart disease (CHD), prematurity, and other conditions such as chronic pulmonary diseases and immunodeficiency. Aetiology/ Risk factors Respiratory syncytial virus is responsible for bronchiolitis in 70% of cases. This figure reaches 80-100% in the winter months. Reinfections are common and can occur throughout life. Other causal agents include human metapneumovirus, influenza, parainfluenza, and adenovirus. Prognosis Morbidity and mortality: Disease severity is related to the size of the infant, and to the proximity and frequency of contact with infective infants. It is estimated that 66 to 127 bronchiolitis-associated deaths occurred annually between 1979 and 1997 among US children aged under five years. Estimated annual RSV-attributed deaths in the UK were 8.4 per 100,000 in infants aged 1 to 12 months, Rabbit Polyclonal to CRMP-2 (phospho-Ser522) and 0.9 per 100,000 population per year for children 1 to 4 years, between 1989.