Bronchiolitis. What's in the name?

TLDR

Bronchiolitis historically denotes specific histologic changes, yet in practice it is applied based on clinical findings such as wheezing, resulting in variable diagnostic criteria and confusion between a histopathologic entity and a clinical syndrome. The study aims to expose the controversies surrounding the term bronchiolitis, trace their origins, and propose principles to clarify its use. The authors suggest resolution strategies in selected areas to reconcile the term’s histologic and clinical meanings.

Abstract

The etymology of bronchiolitis suggests specific histologic findings, and formal recognition of this meaning has been given (American College of Chest Physicians—American Thoracic Society Joint Committee, 1975). Yet, in practice, this label is applied on the basis of clinical findings alone, and diagnostic criteria vary widely. Cardinal among these findings is wheezing, which is a clinical sign associated not with unique, but with various histologic changes. Use of one term to describe both a specific histopathologic entity and a loosely defined clinical syndrome invites obfuscation. In the case of bronchiolitis, it may contribute to the controversy that surrounds this syndrome. I attempt to highlight controversies in the use of this term, to identify their origins, and to suggest principles on which they may be resolved. In selected areas, a resolution is suggested. According to one observer (McIntosh 1 ): Clinicians who care for small children all know what [bronchiolitis] means: an