Treating respiratory syncytial virus — nothing works
It’s that time of year again in the PICU, time for a winter outbreak of respiratory syncytial virus (RSV). RSV is extremely common and highly infectious: its attack rate, meaning the chances of a susceptible person getting the infection if exposed to a case, is among the highest of any virus. Estimates are that as many as 125,000 infants each year are hospitalized with RSV, with many, many more infected less severely. The peak age for those children needing a hospital is between two and five months. It is so common that by early childhood virtually all of us have been infected at least once.
Much of the time RSV causes the symptoms of a cold — cough, runny nose, sometimes a low-grade fever. But in very young children, particularly infants, RSV can cause severe pneumonia or bronchiolitis. The latter disorder is an inflammation of the tiniest of the lung’s air tubes, or bronchioles. This inflammation blocks off the little tubes, making it difficult for air to get in, or most characteristically, to get the air out. Babies with severe RSV often need oxygen and some need mechanical ventilators to breathe for them as we wait out its course until it passes.
Every parent asks: can we do anything to treat this illness, make the symptoms better, make it go away faster? Sadly, the answer is no. I’ve been taking care of children with RSV for 30 years, and I’ve seen a long list of things tried — breathing treatments, anti-viral medicines, steroids, medicines intended to open up the small airways. None of them work. The research of the past few years is conclusive — all we can do is wait for the infection to pass, meanwhile supporting breathing as needed with oxygen, clearing the lungs of mucous, and sometimes a mechanical breathing machine in severe cases.