Bronchiolitis: pathophysiology, diagnosis, and therapeutic strategies in childhood

Abstract

Bronchiolitis is a common acute respiratory infection in infants, characterized by inflammation and obstruction of the bronchioles, with respiratory syncytial virus (RSV) being the main etiological agent. The disease can range from mild to severe forms and is one of the leading causes of hospitalization in young children. Diagnosis is clinical, and management is based on respiratory support and hydration, with limited efficacy of pharmacological interventions. This study aimed to review the pathophysiology, diagnostic criteria, and therapeutic strategies for bronchiolitis, evaluating the effectiveness of clinical and pharmacological approaches, as well as identifying gaps in the literature for future investigations. A systematic review was conducted using the PubMed, SciELO, Scopus, Virtual Health Library (VHL), and Google Scholar databases, including studies published between 2015 and 2024. Randomized clinical trials, systematic reviews, and meta-analyses were selected according to PRISMA criteria. The findings indicate that the pathophysiology of bronchiolitis involves an intense inflammatory response in the bronchioles, leading to edema, excessive mucus secretion, and bronchial obstruction. Diagnosis remains predominantly clinical, with complementary tests indicated only for atypical or severe cases. Treatment is based on respiratory support, hydration, and oxygen therapy when necessary, while bronchodilators, corticosteroids, and antibiotics have not shown significant benefits and are not routinely recommended. In conclusion, bronchiolitis is a self-limiting disease but can progress to severe cases, with clinical support being the primary therapeutic strategy. Given the limitations of pharmacological interventions, future studies should focus on identifying prognostic biomarkers and developing therapies to optimize disease management.