it does not only affect infants

Professor François Vincent, pulmonologist at CHU Limoges.

Photo VF

Is bronchiolitis…

Professor François Vincent, pulmonologist at CHU Limoges.

Professor François Vincent, pulmonologist at CHU Limoges.

Photo VF

Is bronchiolitis a common pathology in adults?

From an epidemiological point of view, it is rather rare. The frequency is significantly lower than what can be seen in pediatric wards. Nevertheless, this pathology does exist 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 the respiratory syncytial virus (RSV) against which adults are generally immunized.

It can also have a bacterial origin, inter alia linked to intracellular germs, such as Mycoplasma pneumoniae, which is found in patients of all ages. I recently took care of bronchiolitis in a man contaminated by bacteria who was in his jacuzzi.

Does this respiratory condition always have an infectious origin?

No, in my department, 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 Gironde, suffered from it. Despite all the precautions, such toxic dust is grafted onto the entire respiratory system.

They can also be linked to the consumption of drugs which have a toxic effect on the lungs and which can cause damage in this particular region of the bronchioles, between the large bronchi and the alveoli where oxygen passes. I remember a transplant patient whose immunosuppressive treatment had caused severe bronchiolitis treated with high-dose cortisone.

However, infectious or chronic (more frequent), bronchiolitis rarely causes hospitalizations, much less than asthma for example. And in the majority of cases, the evolution is favorable. It can sometimes become proliferative, this is called a “BOOP” (Editor’s note, obliterating bronchiolitis with organized pneumopathy). It’s more complicated because she becomes less sensitive to cortisone. But, again, this is very rare.

Are pharmaceutical 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 searched through a battery of tests. But we often find the flu (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 service. And when it does, patients suffer from another infection, often pneumococcus. He’s the killer. For once, vaccination against pneumococcus in frail elderly people should be, in my opinion, a real public health objective.

What clinical signs should alert?

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. Often, at the first consultation, the attending physician 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 scan is normal. And exploration of the breath shows no abnormality. Yet it is an authentic bronchiolitis. A lot of cases have to go under the radar…

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