{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T19:11:32Z","timestamp":1788635492146,"version":"build-2803163510"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Acute Viral Bronchiolitis is one of the leading causes of hospitalization in the first 12\u201324 months of life. International guidelines on the management of bronchiolitis broadly agree in recommending a minimal therapeutic approach, not recommending the use of bronchodilators. Guidelines, generally, consider bronchiolitis as a \u201cunique disease\u201d and this runs the risk of not administering therapy in some patients who could benefit from the use of bronchodilators, for instance, in those who will develop asthma later in their life and face first episode in the age of bronchiolitis. Today, there is growing evidence that bronchiolitis is not a single illness but can have different \u201cendotypes\u201d and \u201cphenotypes,\u201d based on age, personal or family history of atopy, etiology, and pathophysiological mechanism. There is evidence that some phenotypes of bronchiolitis are more strongly associated with asthma features and are linked to higher risk for asthma development. In these populations, possible use of bronchodilators might have a better impact. Age seems to be the main feature to suggest a good response to a bronchodilator-trial, because, among children &amp;gt; 6 months old with bronchiolitis, the presence of a subset of patients with virus-induced wheezing or the first episode of asthma is more likely. While waiting for new research to define the relationship between therapeutic options and different phenotypes, a bronchodilator-trial (using short-acting \u03b22 agonists with metered-dose inhalers and valved holding chambers) seems appropriate in every child with bronchiolitis and age &amp;gt; 6 months.<\/jats:p>","DOI":"10.3389\/fped.2022.865977","type":"journal-article","created":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T10:45:22Z","timestamp":1649933122000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Something Is Changing in Viral Infant Bronchiolitis Approach"],"prefix":"10.3389","volume":"10","author":[{"given":"Paolo","family":"Bottau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Liotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Laderchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Palpacelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Calamelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Colombo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Serra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Cazzato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/S0140-6736(16)30951-5","article-title":"Viral bronchiolitis","volume":"389","author":"Florin","year":"2017","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1056\/NEJMra1413456","article-title":"Viral bronchiolitis in children","volume":"374","author":"Meissner","year":"2016","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/1824-7288-40-65","article-title":"Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants","volume":"40","author":"Baraldi","year":"2014","journal-title":"Italian J Pediatr."},{"key":"B4","unstructured":"LondonNational Institute for Health and Care Excellence (NICE)National Institute for Health and Care Excellence: Guidelines.2021"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e1474","DOI":"10.1542\/peds.2014-2742","article-title":"Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis","volume":"134","author":"Ralston","year":"2014","journal-title":"Pediatrics."},{"key":"B6","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/jpc.14104","article-title":"Australasian bronchiolitis guideline","volume":"55","author":"O'Brien","year":"2019","journal-title":"J Paediatr Child Health."},{"key":"B7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.prrv.2019.04.003","article-title":"The impact of viral bronchiolitis phenotyping: Is it time to consider phenotype-specific responses to individualize pharmacological management?","volume":"34","author":"Rodr\u00edguez-Mart\u00ednez","year":"2020","journal-title":"Paediatr Respir Rev."},{"key":"B8","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1111\/all.13624","article-title":"Bronchiolitis needs a revisit: distinguishing between virus entities and their treatments","volume":"74","author":"Jartti","year":"2019","journal-title":"Allergy."},{"key":"B9","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1093\/infdis\/jiz082","article-title":"The syndrome we agreed to call bronchiolitis","volume":"220","author":"Polack","year":"2019","journal-title":"J Infect Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1002\/ppul.25799","article-title":"Bronchiolitis phenotypes identified by latent class analysis may influence the occurrence of respiratory sequelae","volume":"57","author":"Petrarca","year":"2022","journal-title":"Pediatr Pulmonol"},{"key":"B11","first-page":"94","article-title":"Respiratory syncytial virus bronchiolitis in children","volume":"95","author":"Smith","year":"2017","journal-title":"Am Fam Physician."},{"key":"B12","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1001\/archpediatrics.2011.1669","article-title":"Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis","volume":"166","author":"Mansbach","year":"2012","journal-title":"Arch Pediatr Adolesc Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1097\/INF.0b013e31829b7e43","article-title":"Viral etiologies of infant bronchiolitis, croup and upper respiratory illness during 4 consecutive years","volume":"32","author":"Miller","year":"2013","journal-title":"Pediatr Infect Dis J."},{"key":"B14","doi-asserted-by":"publisher","first-page":"E1717","DOI":"10.3390\/ijms18081717","article-title":"Respiratory syncytial virus: the influence of serotype and genotype variability on clinical course of infection","volume":"18","author":"Vandini","year":"2017","journal-title":"Int J Mol Sci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1542\/pir.2018-0260","article-title":"Bronchiolitis","volume":"40","author":"Silver","year":"2019","journal-title":"Pediatr Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"466","DOI":"10.3389\/fimmu.2014.00466","article-title":"Immunity to RSV in early-life","volume":"5","author":"Lambert","year":"2014","journal-title":"Front Immunol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/j.jaci.2017.08.003","article-title":"Role of viral infections in the development and exacerbation of asthma in children","volume":"140","author":"Jartti","year":"2017","journal-title":"J Allergy Clin Immunol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1183\/09031936.00062714","article-title":"Infantile respiratory syncytial virus and human rhinovirus infections: respective role in inception and persistence of wheezing","volume":"45","author":"Rossi","year":"2015","journal-title":"Eur Respir J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1038\/mi.2017.120","article-title":"Respiratory syncytial virus activates epidermal growth factor receptor to suppress interferon regulatory factor 1-dependent interferon-lambda and antiviral defence in airway epithelium","volume":"11","author":"Kalinowski","year":"2018","journal-title":"Mucosal Immunol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1164\/rccm.201712-2567OC","article-title":"Reduced nasal viral load and IFN responses in infants with RSV bronchiolitis and respiratory failure","volume":"198","author":"Thwaites","year":"2018","journal-title":"Am J Respir Crit Care Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.ajpath.2011.03.003","article-title":"IL-17-induced pulmonary pathogenesis during respiratory viral infection and exacerbation of allergic disease","volume":"179","author":"Mukherjee","year":"2011","journal-title":"Am J Pathol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1807","DOI":"10.1016\/j.ajpath.2014.02.004","article-title":"IL-27R- mediated regulation of IL-17 controls the development of respira- tory syncytial virus-associated pathogenesis","volume":"184","author":"de Almeida Nagata","year":"2014","journal-title":"Am J Pathol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1093\/infdis\/jiy496","article-title":"How respiratory syncytial virus genotypes influence the clinical course in infants hospitalized for bronchiolitis","volume":"219","author":"Midulla","year":"2019","journal-title":"J Infect Dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"eabc1983","DOI":"10.1126\/scisignal.abc1983","article-title":"Respiratory syncytial virus induces b2-adrenergic receptor dysfunction in human airway smooth muscle cells","volume":"14","author":"Harford","year":"2021","journal-title":"Sci Signal."},{"key":"B25","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1111\/pai.12318","article-title":"The first wheezing episode: respiratory virus etiology, atopic characteristics, and illness severity","volume":"25","author":"Turunen","year":"2014","journal-title":"Pediatr Allergy Immunol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1136\/thoraxjnl-2016-208535","article-title":"A clustering approach to identify severe bronchiolitis profiles in children","volume":"71","author":"Dumas","year":"2016","journal-title":"Thorax."},{"key":"B27","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1038\/ng.2830","article-title":"A genome-wide association study identifies CDHR3 as a susceptibility locus for early child- hood asthma with severe exacerbations","volume":"46","author":"B\u00f8nnelykke","year":"2014","journal-title":"Nat Genet."},{"key":"B28","doi-asserted-by":"publisher","first-page":"5353","DOI":"10.1128\/JVI.79.9.5353-5362.2005","article-title":"Effects of nonstructural proteins NS1 and NS2 of human respiratory syncytial virus on interferon regulatory factor 3, NF-\u03baB, and proinflammatory cytokines","volume":"79","author":"Spann","year":"2005","journal-title":"J Virol."},{"key":"B29","first-page":"A2865","article-title":"RSV bronchiolitis in infants hospitalized during the epidemic peak and non-peak months: different Th1\/Th2 response","volume":"197","author":"Nenna","year":"2018","journal-title":"Am J Respir Crit Care Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1001\/jamapediatrics.2015.1746","article-title":"Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized clinical trial","volume":"169","author":"McCulloh","year":"2015","journal-title":"JAMA Pediatr."},{"key":"B31","doi-asserted-by":"publisher","first-page":"f7027","DOI":"10.1136\/bmj.f7027","article-title":"Duration of symptoms of respiratory tract infections in children: systematic review","volume":"347","author":"Thompson","year":"2013","journal-title":"BMJ."},{"key":"B32","doi-asserted-by":"publisher","first-page":"278","DOI":"10.12968\/hmed.2019.80.5.278","article-title":"Bronchiolitis: an update on management and prophylaxis","volume":"80","author":"Karampatsas","year":"2019","journal-title":"Br J Hosp Med (Lond)."},{"key":"B33","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1097\/01.JAA.0000694944.22382.39","article-title":"Identifying and managing bronchiolitis","volume":"33","author":"Paluch","year":"2020","journal-title":"J Am Acad Phys Assist."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2016\/20331.8262","article-title":"Demographic, clinical and hematological profile of children with bronchiolitis: a comparative study between respiratory syncytial virus [RSV] and [Non RSV] groups","author":"Ramagopal","year":"2016","journal-title":"J Clin Diagn Res."},{"key":"B35","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.emc.2017.12.006","article-title":"Bronchiolitis: from practice guideline to clinical practice","volume":"36","author":"Kou","year":"2018","journal-title":"Emerg Med Clin North Am."},{"key":"B36","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.ajem.2009.08.020","article-title":"Predictors of respiratory failure among previously healthy children with respiratory syncytial virus infection","volume":"29","author":"Prodhan","year":"2011","journal-title":"Am J Emerg Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3389\/fped.2020.00121","article-title":"Phenotypical sub-setting of the first episode of severe viral respiratory infection based on clinical assessment and underlying airway disease: a pilot study","volume":"8","author":"Arroyo","year":"2020","journal-title":"Front Pediatr."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1016\/S0140-6736(15)00163-4","article-title":"Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial","volume":"386","author":"Cunningham","year":"2015","journal-title":"Lancet."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1056\/NEJMoa1714855","article-title":"A Randomized trial of high-flow oxygen therapy in infants with bronchiolitis","volume":"378","author":"Franklin","year":"2018","journal-title":"N Engl J Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1136\/archdischild-2018-315846","article-title":"High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis","volume":"104","author":"Lin","year":"2019","journal-title":"Arch Dis Child."},{"key":"B41","doi-asserted-by":"publisher","first-page":"e2020040816","DOI":"10.1542\/peds.2020-040816","article-title":"Comparative efficacy of bronchiolitis interventions in acute care: a network meta-analysis","volume":"147","author":"Elliott","year":"2021","journal-title":"Pediatrics."},{"key":"B42","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.prrv.2019.09.001","article-title":"Bronchodilators and steroids should not be given in viral bronchiolitis - CON","volume":"32","author":"Wall","year":"2019","journal-title":"Paediatr Respir Rev."},{"key":"B43","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.prrv.2019.09.002","article-title":"Bronchodilators and steroids should not be given in viral bronchiolitis - PRO","volume":"32","author":"Brown","year":"2019","journal-title":"Paediatr Respir Rev."},{"key":"B44","doi-asserted-by":"publisher","first-page":"e2021051345","DOI":"10.1542\/peds.2021-051345","article-title":"Patient, provider, and health care system characteristics associated with overuse in bronchiolitis","volume":"148","author":"Wolf","year":"2021","journal-title":"Pediatrics."},{"key":"B45","doi-asserted-by":"publisher","first-page":"CD001266","DOI":"10.1002\/14651858.CD001266.pub4","article-title":"Bronchodilators for bronchiolitis","volume":"2014","author":"Gadomski","year":"2014","journal-title":"Cochrane Database Syst Rev."},{"key":"B46","doi-asserted-by":"publisher","first-page":"144","DOI":"10.3389\/fped.2020.00144","article-title":"Age limit in bronchiolitis diagnosis: 6 or 12 months?","volume":"8","author":"Nenna","year":"2020","journal-title":"Front. Pediatr."},{"key":"B47","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s13052-020-00914-4","article-title":"Identification of bronchiolitis profiles in Italian children through the application of latent class analysis","volume":"46","author":"Ferrante","year":"2020","journal-title":"Italian J Pediatr."},{"key":"B48","doi-asserted-by":"publisher","first-page":"153","DOI":"10.15586\/aei.v49i1.12","article-title":"For which infants with viral bronchiolitis could it be deemed appropriate to use albuterol, at least on a therapeutic trial basis?","volume":"49","author":"Rodr\u00edguez-Mart\u00ednez","year":"2021","journal-title":"Allergol Immunopathol (Madr)."},{"key":"B49","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1002\/ppul.25114","article-title":"Cost-effectiveness analysis of phenotypic-guided versus guidelines-guided bronchodilator therapy in viral bronchiolitis","volume":"56","author":"Rodr\u00edguez-Mart\u00ednez","year":"2021","journal-title":"Pediatr Pulmonol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"3101","DOI":"10.1007\/s00431-021-04074-3","article-title":"Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature","volume":"180","author":"Csonka","year":"2021","journal-title":"Eur J Pediatr."},{"key":"B51","unstructured":"GlobalInitiative for Asthma,. Global Strategy for Asthma Management Prevention.\n          2021"},{"key":"B52","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.prrv.2016.12.006","article-title":"Systematic review of instruments aimed at evaluating the severity of bronchiolitis","volume":"25","author":"Rodriguez-Martinez","year":"2018","journal-title":"Paediatr Respir Rev."},{"key":"B53","doi-asserted-by":"publisher","first-page":"e810","DOI":"10.1542\/peds.2012-3746","article-title":"Oral dexamethasone for bronchiolitis: a randomized trial","volume":"132","author":"Alansari","year":"2013","journal-title":"Pediatrics."},{"key":"B54","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1111\/pai.12749","article-title":"Prednisolone for the first rhinovirus-induced wheezing and 4-year asthma risk: a randomized trial","volume":"28","author":"Koistinen","year":"2017","journal-title":"Pediatr Allergy Immunol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.jaci.2014.07.001","article-title":"Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode","volume":"135","author":"Jartti","year":"2015","journal-title":"J Allergy Clin Immunol."},{"key":"B56","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1111\/cea.13960","article-title":"Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus-induced wheezing episode","volume":"51","author":"Hurme","year":"2021","journal-title":"Clin Exp Allergy."},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.08.035.","article-title":"Severe bronchiolitis profiles and risk of asthma development in Finnish children","author":"Dumas","year":"2021","journal-title":"J Allergy Clin Immunol."},{"key":"B58","doi-asserted-by":"publisher","first-page":"475","DOI":"10.5811\/westjem.2018.3.35837","article-title":"Multicenter study of albuterol use among infants hospitalized with bronchiolitis","volume":"19","author":"Condella","year":"2018","journal-title":"West J Emerg Med."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.865977\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T10:45:28Z","timestamp":1649933128000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.865977\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,14]]},"references-count":58,"alternative-id":["10.3389\/fped.2022.865977"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.865977","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,14]]},"article-number":"865977"}}