Management and Prevention Strategies for Respiratory Syncytial Virus (RSV) Bronchiolitis in Infants and Young Children: A Review of Evidence-Based Practice Interventions

Allison C. Cooper; Nancy Cantey Banasiak; Patricia Jackson Allen

Disclosures

Pediatr Nurs. 2003;29(6) 

In This Article

Etiology and Pathophysiology

RSV is a member of the paramyxovirus family containing a single strand RNA and is related to the parainfluenza, mumps, and measles virus. The two major strains of RSV are A and B. The A strain is responsible for the majority of more severe forms of RSV bronchiolitis (Martinello, Chen, Weibel, & Kahn, 2002; Walsh, McConnochie, Long, & Hall, 1997). In a recent study by Martinello et al. (2002), the investigators found a subgroup of the A strain (GA3) was associated with more severe disease. The different strains of RSV often circulate at the same time, and season-to-season variation is found in the predominant strain (American Academy of Pediatrics [AAP], 2003; Martinello et al., 2002).

RSV invades the bronchiolar epithelial cells causing inflammation and edema. The membranes of the infected cells fuse with adjacent cells to form a large, multinucleated cell creating large masses of cells or "syncytia" (McIntosh, 2000; Wong et al., 2003). The bronchiole mucosa ultimately begins to swell, and the lumina fill with mucus and exudate. Inflammatory cells infiltrate the area resulting in the shedding of dead epithelial cells, which causes obstruction of small airway passages resulting in hyperinflation and areas of atelectasis (Linzer & Guthrie, 2003). Bronchiole passages normally dilate on inspiration, allowing for adequate air intake, but narrow on expiration. The inflammation and exudate caused by the RSV infection results in bronchiole obstruction during expiration, air trapping, poor exchange of gases, increased work of breathing, and a characteristic expiratory wheeze (Sandritter & Kraus, 1997; Wong et al., 2003).

A strong association has been suggested between severe RSV infection in infancy and long-term pulmonary sequela. Multiple studies have suggested that RSV infection during infancy is an important contributory factor to wheezing and additional lower respiratory tract problems in childhood (Eriksson, Bennet, & Nilsson, 2000; McBride, 1999; Openshaw & Hewitt, 2000; Sigurs, Bjarnason, Sigurbergsson, & Kjellman, 2000). In the study by Sigurs et al. (2000), the authors found a high association between hospitalized infants with bronchiolitis and the development of asthma. The study followed 140 children till age 7 1/2 years and found 30% of the children developed asthma verses 2% in the control subjects. A literature review by McBride (1999) on the association between RSV bronchiolitis and asthma found evidence to suggest either viral illness causes damage to the infant's lung or is an indicator of preexisting susceptibility to long-term respiratory abnormality later in life.

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