Findings From Long-Term Follow-up in Children Hospitalized for Bronchiolitis in Pisa: Is It Time for a Standardized Protocol?

Background: Children with bronchiolitis in early life are at increased risk of wheezing and asthma in the following years, though its exact role in these respiratory sequelae remains unclear. Objectives: This study aimed to determine the long-term outcomes of children previously hospitalized with bronchiolitis and to evaluate the need for a standardized follow-up in the following years. Methods: Among 346 patients hospitalized for bronchiolitis at the Pediatrics Unit of the University Hospital of Pisa between 2010 and 2019, 234 were reached by phone and 102 agreed to participate to our follow-up protocol. We excluded patients with missing records or who disagreed to participate to our study. Patients were assessed by an anamnestic questionnaire, clinical examination, spirometry test and bronchodilator reversibility test when needed. Data on treatment approaches during hospitalization were recorded and analyzed considering that the Italian guidelines for the management of bronchiolitis were published in 2014. Results: In the study cohort, 102 patients were included (57 males, mean age 8.5 years), the mean age at hospitalization was 3.6 months and disease severity was mild, moderate, and severe in 44%, 49%, and 7% of cases, respectively. As for long-term sequelae, 54% developed wheezing (mean onset at 1.6 years), 12% were diagnosed with asthma, and 19% reported exertional dyspnea. Risk factors for respiratory sequelae included tobacco smoke exposure, family history of asthma, and personal history of allergy (p < 0.05). No associations were found with gender, prematurity, pathogens, age at evaluation, or BMI. Of 88 patients undergoing spirometry, six showed pathological FEV1, and 16 had a positive bronchodilator test. Patients treated after the publication of the 2014 Italian Guidelines received more HFNC and nebulized hypertonic saline but fewer corticosteroids. Wheezing incidence was higher after 2014 (63% vs. 42%), while asthma rates were unchanged. Conclusions: Over half of patients hospitalized for bronchiolitis in the first year of life developed wheezing and/or asthma during follow-up. These findings support long-term follow-up for early detection and management of respiratory sequelae to prevent further complications.