Batna Journal of Medical Sciences
Volume 13, Numéro 6, Pages 444-451
2026-07-01
Rsv Bronchiolitis In Infants: From Pathomechanical Obstruction To Clinical Stewardship And Next-generation Prophylaxis"
Authors : El Mezouar Chahrazed . Djelti Farah . Dali-sahi Majda . Bourak Ikram . Benguella-benmansour Meriem . Berrahoui Samira . Kachakouch Youcef . Dib Joanna . Harek Yahia . Dennouni Medjati Nouria .
Abstract
Respiratory Syncytial Virus (RSV) is the leading cause of bronchiolitis-related hospitalizations in infants, heavily burdening pediatric critical care during seasonal peaks. Despite established guidelines, a persistent gap remains between evidence-based recommendations and frontline prescribing practices. This review highlights that bronchiolar obstruction in RSV bronchiolitis is intrinsically mechanical. It arises from cytopathic necrosis of the ciliated epithelium, intraluminal cellular debris, altered mucus rheology driven by neutrophil extracellular traps (NETs), and submucosal edema, rather than reversible bronchospasm responsive to bronchodilators. The clinical consequences of this mechanical obstruction—dynamic hyperinflation, auto-positive end-expiratory pressure (auto-PEEP), ventilation-perfusion mismatch, and resorption atelectasis—are explained through the lens of respiratory mechanics. Furthermore, a phenotype-stratified approach is proposed to distinguish the classical RSV neutrophilic endotype from the Rhinovirus-associated type-2 inflammatory endotype, which carries a higher risk of recurrent wheezing and childhood asthma. Therapeutic interventions are critically appraised: the de-implementation of ineffective pharmacological treatments (bronchodilators, systemic corticosteroids, empirical antibiotics, and chest physiotherapy) is strongly advocated. Instead, supportive care, primarily high-flow nasal cannula therapy and targeted hydration to optimize mucus rheology, remains the cornerstone of management. For prevention, nirsevimab—a long-acting monoclonal antibody targeting the pre-fusion RSV F glycoprotein at antigenic site Ø—represents a major advance in population-level passive immunoprophylaxis. Finally, a physiology-based clinical algorithm integrating severity triage, ventilatory support, and immunoprophylaxis is proposed to guide contemporary management.
Keywords
RSV bronchiolitis ; nirsevimab ; high-flow nasal cannula ; de-implementation ; respiratory mechanics ; endotype ; passive immunoprophylaxis
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