[Update on the management of acute viral bronchiolitis: proposed guidelines of Grand Ouest University Hospitals]

BACKGROUND AND OBJECTIVES

While our European and North American colleagues have recently updated their recommendations, the 2000 Consensus Conference remains the main guideline on management of acute viral bronchiolitis in France. We aimed to establish an updated inter-regional protocol on management of acute viral bronchiolitis in infants.

METHOD

Pediatricians, pediatric pulmonologists, and emergency physicians of the Grand Ouest University Hospitals (France) gathered to analyze the recent data from the literature.

RESULTS

Criteria to distinguish childhood asthma from acute viral bronchiolitis were established, then prescriptions of diagnostic tests, antibiotics, and chest physiotherapy were defined and reserved for very limited situations. Similarly, the modalities of oxygen therapy prescription and nutritional support were proposed. Finally, other therapeutics such as nebulized hypertonic saline seem promising, but their place in the treatment of acute bronchiolitis in infants remains unclear.

CONCLUSION

This work has provided new proposals for management of acute viral bronchiolitis and helped standardize practices within the Grand Ouest University Hospitals. This local organization could lay the keystone for working toward guidelines initiated by learned societies at the national level.

[Management of bronchiolitis in general practice and determinants of treatment being discordant with guidelines of the HAS]

INTRODUCTION

The Haute autorité de santé released clinical practice guidelines in 2000 to assist in the management of bronchiolitis. These guidelines emphasized supportive care with nasal suctioning and encouraged chest physiotherapy. The aim of this study was to examine the adherence to the french guidelines for the management of bronchiolitis by general practitioners.

PATIENTS AND METHODS

The study included infants less than 24 months of age with bronchiolitis, consulting a general practitioner in Vendée or in Loire-Atlantique, from November 2011 to April 2012 and whose parents accepted to participate to the study. The primary endpoint was the concordance of therapeutic practice with the french guidelines (administrated treatments, refer to pediatric emergencies). Data were collected through questionaires completed by general practitioners.

RESULTS

Of the 1236 questionnaires distributed, 134 were completed and 118 therapeutic practice were analyzed. A total of 52.5% of therapeutic practice were concordant with guidelines and 57.5% in case of first bronchiolitis. 50% of infants with a hospitalization criteria according to the guidelines, have not been, which probably shows the interest of new guidelines, with highlighting of hospitalization criteria.

Cathepsin L and cystatin B gene expression discriminates immune coelomic cells in the leech Theromyzon tessulatum

Previous studies evidenced that cystatin B-like gene is specifically expressed and induced in large circulating coelomic cells following bacterial challenge in the leech Theromyzon tessulatum. In order to understand the role of that cysteine proteinase inhibitor during immune response, we investigated the existence of members of cathepsin family. We cloned a cathepsin L-like gene and studied its tissue distribution. Immunohistochemical studies using anti-cathepsin L and anti-cystatin B antibodies and ultrastructural results demonstrated the presence of three distinct coelomic cell populations: (1) the chloragocytes, which were initially defined as large coelomocytes, (2) the granular amoebocytes and (3) small coelomic cells. Among those cells, while chloragocytes contain cystatin B and cathepsin L, granular amoebocytes contain only cathepsin L and the third cell population contains neither cathepsin nor inhibitor. Finally, results evidenced that cathepsin L immunopositive granular amoebocytes are chemoattracted to the site of injury and phagocyte bacteria.