Is bronchiolitis a common pathology in adults?
From an epidemiological point of view, it is quite rare. The frequency is significantly lower than what can be seen in children’s wards. Nevertheless, this pathology exists in adults and we currently have a few cases of it in my department. It is mainly of viral origin (influenza, adenovirus), but unlike infantile bronchiolitis, it is rarely caused by respiratory syncytial virus (RSV), against which adults are generally immunized.
It can also have a bacterial origin, among other things associated with intracellular bacteria, such as Mycoplasma pneumoniae, which are found in patients of all ages. I recently treated a man for bronchiolitis that was contaminated by bacteria that was in his jacuzzi.
Does this respiratory condition always have an infectious origin?
No, in my ward I am confronted with bronchiolitis due to accidental inhalations, or very high pollution peaks. It is, for example, a worker who inhales a toxic gas or smoke. I also know that firefighters, mobilized this summer to fight forest fires in the Gironde, suffered from it. Despite all precautions, such toxic dust inoculates the entire respiratory system.
They can also be associated with the intake of drugs that have a toxic effect on the lungs and that can cause damage in this very region of the bronchioles, between the large bronchi and the alveoli, where oxygen passes. I remember a transplant patient whose immunosuppressive therapy had caused severe bronchiolitis treated with high-dose cortisone.
But infectious or chronic (more common), bronchiolitis rarely causes hospitalization, much less than, for example, asthma. And in most cases the development is favorable. It can sometimes become proliferative, this is called a “BOOP” (editor’s note, obliterating bronchiolitis with organizing pneumopathy). It is more complicated because she becomes less sensitive to cortisone. But again, this is very rare.
Are medical groups preparing an RSV vaccine for people over 65? Does this seem appropriate to you?
When an elderly person is hospitalized for bronchiolitis, about fifteen viruses are looked for through a series of tests. But we often find influenza (it will also start), adenoviruses and very rarely RSV. Admittedly, I am not a geriatrician, but I see very little RSV in older adults in my ministry. And when that happens, patients suffer from another infection, often pneumococci. He is the killer. For once, vaccination against pneumococci in the frail elderly should, in my opinion, be a real public health goal.
Which clinical signs should warn?
In adults, the onset of bronchiolitis often goes unnoticed: it is rarely acute and very insidious. The patient may have a simple dry cough, some sputum, shortness of breath. At the first consultation, the attending physician often misses the point. The situation usually changes after eight days. It is only then that clinical signs allow the correct diagnosis. We are very far from the classic and brutal onset of infantile bronchiolitis (especially wheezing).
Sometimes even the chest CT is normal. And exploration of the breath shows no abnormality. Nevertheless, it is an authentic bronchiolitis. Many cases must be under the radar…