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All rights reserved.CA@F7@FE CA@F7@FEI@FDA6G5F;A@ ......................................................................................................................................................................... 4#76;5;@7 D75A??7@63F;A@E........................................................................................................................................................ 4&3F;7@F-57@FD76 53D7......................................................................................................................................................... 5!7K BD;AD;F;7E 8AD ;?B>7?7@F3F;A@............................................................................................................................... 61 (75A??7@63F;A@E ......................................................................................................................................................... 91.1 AEE7EE?7@F 3@6 6;39@AE;E..................................................................................................................................................... 91.2 -:7@ FA D787D ............................................................................................................................................................................ 101.3 -:7@ FA 36?;F .......................................................................................................................................................................... 121.4 #3@397?7@F A8 4DA@5:;A>;F;E............................................................................................................................................... 131.5 -:7@ FA 6;E5:3D97 ................................................................................................................................................................... 141.6 !7K E387FK ;@8AD?3F;A@ 8AD >AA=;@9 38F7D 3 5:;>6 3F :A?7 ......................................................................................... 152 (7E73D5: D75A??7@63F;A@E ...................................................................................................................................... 172.1 %JK97@ E3FGD3F;A@ ?73EGD7?7@F ;@ BD;?3DK 53D7 ...................................................................................................... 172.2 &376;3FD;5 73D>K I3D@;@9 E5AD7 (&E-)) 3E BD76;5FADE A8 67F7D;AD3F;A@.............................................................. 172.3 CA?4;@76 4DA@5:A6;>3FAD 3@6 5ADF;5AEF7DA;6 F:7D3BK 8AD 4DA@5:;A>;F;E .......................................................... 172.4 H;9:-SAI :G?;6;R76 AJK97@ 3@6 AJK97@ ...................................................................................................................... 182.5 $3E3> EG5F;A@ .............................................................................................................................................................................. 183 %F:7D ;@8AD?3F;A@.......................................................................................................................................................... 193.1 )5AB7 3@6 :AI F:;E 9G;67>;@7 I3E 67H7>AB76................................................................................................................ 193.2 (7>3F76 $ICE 9G;63@57........................................................................................................................................................... 194 *:7 GG;67>;@7 D7H7>AB?7@F GDAGB, $3F;A@3> CA>>34AD3F;@9 C7@FD7 3@6 $ICE BDA;@7 D7H7>AB?7@F GDAGB........................................................................................................................................... 214.2 $3F;A@3> CA>>34AD3F;@9 C7@FD7 8AD -A?7@'E 3@6 C:;>6D7@'E H73>F: .................................................................. 224.3 $ICE BDA3D3F;A@E A8 ;@F7D7EFE ....................................................................................................................................................... 23C:3@97E 38F7D BG4>;53F;A@............................................................................................................................................... 27A4AGF F:;E 9G;67>;@7 .......................................................................................................................................................... 28Bronchiolitis in children (NG9) NICE 2015. 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Page 2 of 30)FD7@9F: A8 D75A??7@63F;A@E.................................................................................................................................................... 28%F:7D H7DE;A@E A8 F:;E 9G;67>;@7................................................................................................................................................. 29I?B>7?7@F3F;A@ ................................................................................................................................................................................ 29/AGD D7EBA@E;4;>;FK........................................................................................................................................................................... 30CABKD;9:F............................................................................................................................................................................................. 30Bronchiolitis in children (NG9) NICE 2015. 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All rights reserved. Page 4 of 30&&3F;7@F-57@FD76 53D7 3F;7@F-57@FD76 53D7*:;E 9G;67>;@7 A887DE 47EF BD35F;57 36H;57 A@ F:7 53D7 A8 5:;>6D7@ I;F: 4DA@5:;A>;F;E.&3F;7@FE 3@6 :73>F:53D7 BDA87EE;A@3>E :3H7 D;9:FE 3@6 D7EBA@E;4;>;F;7E 3E E7F AGF ;@ F:7 $H)CA@EF;FGF;A@ 8AD E@9>3@6 P 3>> $ICE 9G;63@57 ;E ID;FF7@ FA D7S75F F:7E7. *D73F?7@F 3@6 53D7 E:AG>6F3=7 ;@FA 355AG@F ;@6;H;6G3> @776E 3@6 BD787D7@57E. &3F;7@FE E:AG>6 :3H7 F:7 ABBADFG@;FK FA ?3=7;@8AD?76 675;E;A@E 34AGF F:7;D 53D7 3@6 FD73F?7@F, ;@ B3DF@7DE:;B I;F: F:7;D :73>F:53D7BDA87EE;A@3>E. I8 F:7 B3F;7@F ;E G@67D 16, F:7;D 83?;>K AD 53D7DE E:AG>6 3>EA 47 9;H7@ ;@8AD?3F;A@ 3@6EGBBADF FA :7>B F:7 5:;>6 AD KAG@9 B7DEA@ FA ?3=7 675;E;A@E 34AGF F:7;D FD73F?7@F. H73>F:53D7BDA87EE;A@3>E E:AG>6 8A>>AI F:7 D7B3DF?7@F A8 H73>F:'E 36H;57 A@ 5A@E7@F (AD, ;@ -3>7E, 36H;57 A@5A@E7@F 8DA? F:7 -7>E: GAH7D@?7@F). 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Page 5 of 30!!77K BD;AD;F;7E 8AD ;?B>7?7@F3F;A@ K BD;AD;F;7E 8AD ;?B>7?7@F3F;A@*:7 8A>>AI;@9 D75A??7@63F;A@E :3H7 477@ ;67@F;R76 3E BD;AD;F;7E 8AD ;?B>7?7@F3F;A@. *:7 8G>> >;EFA8 D75A??7@63F;A@E ;E ;@ E75F;A@ 1.D;39@AE7 4DA@5:;A>;F;E ;8 F:7 5:;>6 :3E 3 5ADKL3> BDA6DA?7 >3EF;@9 1 FA 3 63KE, 8A>>AI76 4K:B7DE;EF7@F 5AG9: 3@6 3@67;F:7D F35:KB@A73 AD 5:7EF D757EE;A@ (AD 4AF:) 3@6 3@67;F:7D I:77L7 AD 5D35=>7E A@ 5:7EF 3GE5G>F3F;A@ (AD 4AF:).-:7@ 6;39@AE;@9 4DA@5:;A>;F;E, F3=7 ;@FA 355AG@F F:3F KAG@9 ;@83@FE I;F: F:;E 6;E73E7 (;@B3DF;5G>3D F:AE7 G@67D 6 I77=E A8 397) ?3K BD7E7@F I;F: 3B@A73 I;F:AGF AF:7D 5>;@;53> E;9@E.I??76;3F7>K D787D 5:;>6D7@ I;F: 4DA@5:;A>;F;E 8AD 7?7D97@5K :AEB;F3> 53D7 (GEG3>>K 4K 9993?4G>3@57) ;8 F:7K :3H7 3@K A8 F:7 8A>>AI;@9:3B@A73 (A4E7DH76 AD D7BADF76)5:;>6 >AA=E E7D;AGE>K G@I7>> FA 3 :73>F:53D7 BDA87EE;A@3>E7H7D7 D7EB;D3FADK 6;EFD7EE, 8AD 7J3?B>7 9DG@F;@9, ?3D=76 5:7EF D757EE;A@, AD 3D7EB;D3FADK D3F7 A8 AH7D 70 4D73F:E/?;@GF757@FD3> 5K3@AE;EB7DE;EF7@F AJK97@ E3FGD3F;A@ A8 >7EE F:3@ 92% I:7@ 4D73F:;@9 3;D.CA@E;67D D787DD;@9 5:;>6D7@ I;F: 4DA@5:;A>;F;E FA :AEB;F3> ;8 F:7K :3H7 3@K A8 F:7 8A>>AI;@9:3 D7EB;D3FADK D3F7 A8 AH7D 60 4D73F:E/?;@GF76;8R5G>FK I;F: 4D73EF8776;@9 AD ;@367CG3F7 AD3> SG;6 ;@F3=7 (50P75% A8 GEG3> HA>G?7,F3=;@9 355AG@F A8 D;E= 835FADE 1E77 D75A??7@63F;A@ 1.3.32 3@6 GE;@9 5>;@;53> ;@;53> 67:K6D3F;A@.-:7@ 3EE7EE;@9 3 5:;>6 ;@ 3 E75A@63DK 53D7 E7FF;@9, 36?;F F:7? 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Page 6 of 30B7DE;EF7@F AJK97@ E3FGD3F;A@ A8 >7EE F:3@ 92% I:7@ 4D73F:;@9 3;D;@367CG3F7 AD3> SG;6 ;@F3=7 (50P75% A8 GEG3> HA>G?7, F3=;@9 355AG@F A8 D;E= 835FADE 1E77D75A??7@63F;A@ 1.3.32 3@6 GE;@9 5>;@;53> 7 9DG@F;@9, ?3D=76 5:7EF D757EE;A@, AD3 D7EB;D3FADK D3F7 A8 AH7D 70 4D73F:E/?;@GF7.DA @AF DAGF;@7>K B7D8AD? 3 5:7EF .-D3K ;@ 5:;>6D7@ I;F: 4DA@5:;A>;F;E, 4753GE7 5:3@97E A@ .-D3K?3K ?;?;5 B@7G?A@;3 3@6 E:AG>6 @AF 47 GE76 FA 67F7D?;@7 F:7 @776 8AD 3@F;4;AF;5E.DA @AF GE7 3@K A8 F:7 8A>>AI;@9 FA FD73F 4DA@5:;A>;F;E ;@ 5:;>6D7@:3@F;4;AF;5E:KB7DFA@;5 E3>;@736D7@3>;@7 (@74G>;E76)E3>4GF3?A>?A@F7>G=3EF;BD3FDAB;G? 4DA?;67EKEF7?;5 AD ;@:3>76 5ADF;5AEF7DA;6E3 5A?4;@3F;A@ A8 EKEF7?;5 5ADF;5AEF7DA;6E 3@6 @74G>;E76 36D7@3>;@7.G;H7 AJK97@ EGBB>7?7@F3F;A@ FA 5:;>6D7@ I;F: 4DA@5:;A>;F;E ;8 F:7;D AJK97@ E3FGD3F;A@ ;EB7DE;EF7@F>K >7EE F:3@ 92%.G;H7 SG;6E 4K @3EA93EFD;5 AD ADA93EFD;5 FG47 ;@ 5:;>6D7@ I;F: 4DA@5:;A>;F;E ;8 F:7K 53@@AF F3=77@AG9: SG;6 4K ?AGF:.&DAH;67 =7K E387FK ;@8AD?3F;A@ 8AD B3D7@FE FA F3=7 3I3K 8AD D787D7@57 8AD 5:;>6D7@ I:A I;>> 47>AA=76 38F7D 3F :A?7. *:;E E:AG>6 5AH7D::AI FA D75A9@;E7 67H7>AB;@9 'D76 S39' EK?BFA?E:IADE7@;@9 IAD= A8 4D73F:;@9 (8AD 7J3?B>7 9DG@F;@9, @3E3> S3D;@9, ?3D=76 5:7EFD757EE;A@)SG;6 ;@F3=7 ;E 50P75% A8 @AD?3> AD @A I7F @3BBK 8AD 12 :AGDEBronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 7 of 303B@A73 AD 5K3@AE;E7J:3GEF;A@ (8AD 7J3?B>7, @AF D7EBA@6;@9 @AD?3>>K FA EA5;3> 5G7E, I3=7E A@>K I;F:BDA>A@976 EF;?G>3F;A@)F:3F B7AB>7 E:AG>6 @AF E?A=7 ;@ F:7 5:;>6'E :A?7 4753GE7 ;F ;@5D73E7E F:7 D;E= A8 ?AD7E7H7D7 EK?BFA?E ;@ 4DA@5:;A>;F;E:AI FA 97F ;??76;3F7 :7>B 8DA? 3@ 3BBDABD;3F7 BDA87EE;A@3> ;8 3@K D76 S39 EK?BFA?E67H7>AB3DD3@97?7@FE 8AD 8A>>AI-GB ;8 @757EE3DK.Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 8 of 3011 (75A??7@63F;A@E (75A??7@63F;A@E*:7 8A>>AI;@9 9G;63@57 ;E 43E76 A@ F:7 47EF 3H3;>34>7 7H;67@57. *:7 8G>> 9G;67>;@7 9;H7E 67F3;>E A8F:7 ?7F:A6E 3@6 F:7 7H;67@57 GE76 FA 67H7>AB F:7 9G;63@57.*:7 IAD6;@9 GE76 ;@ F:7 D75A??7@63F;A@E ;@ F:;E 9G;67>;@7 (8AD 7J3?B>7, IAD6E EG5: 3E 'A887D'3@6 '5A@E;67D') 67@AF7E F:7 57DF3;@FK I;F: I:;5: F:7 D75A??7@63F;A@ ;E ?367 (F:7 EFD7@9F: A8F:7 D75A??7@63F;A@). )77 34AGF F:;E 9G;67>;@7 8AD 67F3;>E.1.1 A..!..)!*/ a* %a#*+.%.1.1.1 -:7@ 6;39@AE;@9 4DA@5:;A>;F;E, F3=7 ;@FA 355AG@F F:3F ;F A55GDE ;@ 5:;>6D7@ G@67D2 K73DE A8 397 3@6 ?AEF 5A??A@>K ;@ F:7 RDEF K73D A8 >;87, B73=;@9 47FI77@ 33@6 6 ?A@F:E.1.1.2 -:7@ 6;39@AE;@9 4DA@5:;A>;F;E, F3=7 ;@FA 355AG@F F:3F EK?BFA?E GEG3>>K B73=47FI77@ 3 3@6 5 63KE, 3@6 F:3F 5AG9: D7EA>H7E ;@ 90% A8 ;@83@FE I;F:;@ 3 I77=E.1.1.3 D;39@AE7 4DA@5:;A>;F;E ;8 F:7 5:;>6 :3E 3 5ADKL3> BDA6DA?7 >3EF;@9 1 FA 3 63KE,8A>>AI76 4K:B7DE;EF7@F 5AG9: 3@6 3@67;F:7D F35:KB@A73 AD 5:7EF D757EE;A@ (AD 4AF:) 3@6 3@67;F:7D I:77L7 AD 5D35=>7E A@ 5:7EF 3GE5G>F3F;A@ (AD 4AF:).1.1.4 -:7@ 6;39@AE;@9 4DA@5:;A>;F;E, F3=7 ;@FA 355AG@F F:3F F:7 8A>>AI;@9 EK?BFA?E3D7 5A??A@ ;@ 5:;>6D7@ I;F: F:;E 6;E73E7:87H7D (;@ 3DAG@6 30% A8 53E7E, GEG3>>K A8 >7EE F:3@ 39OC)BAAD 8776;@9 (FKB;53>>K 38F7D 3 FA 5 63KE A8 ;>>@7EE).1.1.5 -:7@ 6;39@AE;@9 4DA@5:;A>;F;E, F3=7 ;@FA 355AG@F F:3F KAG@9 ;@83@FE I;F: F:;E6;E73E7 (;@ B3DF;5G>3D F:AE7 G@67D 6 I77=E A8 397) ?3K BD7E7@F I;F: 3B@A73I;F:AGF AF:7D 5>;@;53> E;9@E.1.1.6 CA@E;67D 3 6;39@AE;E A8 B@7G?A@;3 ;8 F:7 5:;>6 :3E:Bronchiolitis in children (NG9) NICE 2015. 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Page 9 of 30:;9: 87H7D (AH7D 39OC) 3@6/ADB7DE;EF7@F>K 8A53> 5D35=>7E.1.1.7 *:;@= 34AGF 3 6;39@AE;E A8 H;D3>-;@6G576 I:77L7 AD 73D>K-A@E7F 3EF:?3 D3F:7DF:3@ 4DA@5:;A>;F;E ;@ A>67D ;@83@FE 3@6 KAG@9 5:;>6D7@ ;8 F:7K :3H7:B7DE;EF7@F I:77L7 I;F:AGF 5D35=>7E ADD75GDD7@F 7B;EA6;5 I:77L7 AD3 B7DEA@3> AD 83?;>K :;EFADK A8 3FABK.*3=7 ;@FA 355AG@F F:3F F:7E7 5A@6;F;A@E 3D7 G@GEG3> ;@ 5:;>6D7@ G@67D 1 K73D A8 397.1.1.8 #73EGD7 AJK97@ E3FGD3F;A@ ;@ 7H7DK 5:;>6 BD7E7@F;@9 I;F: EGEB75F764DA@5:;A>;F;E, ;@5>G6;@9 F:AE7 BD7E7@F;@9 FA BD;?3DK 53D7 ;8 BG>E7 AJ;?7FDK ;E3H3;>34>7.1.1.9 E@EGD7 :73>F:53D7 BDA87EE;A@3>E B7D8AD?;@9 BG>E7 AJ;?7FDK 3D7 3BBDABD;3F7>KFD3;@76 ;@ ;FE GE7 EB75;R53>>K ;@ ;@83@FE 3@6 KAG@9 5:;>6D7@.1.1.10 )GEB75F ;?B7@6;@9 D7EB;D3FADK 83;>GD7, 3@6 F3=7 3BBDABD;3F7 35F;A@ 3E F:7E75:;>6D7@ ?3K @776 ;@F7@E;H7 53D7 (E77 D75A??7@63F;A@E 1.2.1 3@6 1.4.5), ;8 3@KA8 F:7 8A>>AI;@9 3D7 BD7E7@F:E;9@E A8 7J:3GEF;A@, 8AD 7J3?B>7 >;EF>7EE@7EE AD 675D73E76 D7EB;D3FADK 788ADFD75GDD7@F 3B@A7383;>GD7 FA ?3;@F3;@ 367CG3F7 AJK97@ E3FGD3F;A@ 67EB;F7 AJK97@ EGBB>7?7@F3F;A@.1.2 W$!* /+ -!"!-1.2.1 I??76;3F7>K D787D 5:;>6D7@ I;F: 4DA@5:;A>;F;E 8AD 7?7D97@5K :AEB;F3> 53D7(GEG3>>K 4K 999 3?4G>3@57) ;8 F:7K :3H7 3@K A8 F:7 8A>>AI;@9:3B@A73 (A4E7DH76 AD D7BADF76)5:;>6 >AA=E E7D;AGE>K G@I7>> FA 3 :73>F:53D7 BDA87EE;A@3>Bronchiolitis in children (NG9) NICE 2015. 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Page 10 of 30E7H7D7 D7EB;D3FADK 6;EFD7EE, 8AD 7J3?B>7 9DG@F;@9, ?3D=76 5:7EF D757EE;A@, AD 3D7EB;D3FADK D3F7 A8 AH7D 70 4D73F:E/?;@GF757@FD3> 5K3@AE;EB7DE;EF7@F AJK97@ E3FGD3F;A@ A8 >7EE F:3@ 92% I:7@ 4D73F:;@9 3;D.1.2.2 CA@E;67D D787DD;@9 5:;>6D7@ I;F: 4DA@5:;A>;F;E FA :AEB;F3> ;8 F:7K :3H7 3@K A8 F:78A>>AI;@9:3 D7EB;D3FADK D3F7 A8 AH7D 60 4D73F:E/?;@GF76;8R5G>FK I;F: 4D73EF8776;@9 AD ;@367CG3F7 AD3> SG;6 ;@F3=7 (50P75% A8 GEG3> HA>G?7,F3=;@9 355AG@F A8 D;E= 835FADE 1E77 D75A??7@63F;A@ 1.3.32 3@6 GE;@9 5>;@;53>;@;53> 67:K6D3F;A@.1.2.3 -:7@ 675;6;@9 I:7F:7D FA D787D 3 5:;>6 I;F: 4DA@5:;A>;F;E FA E75A@63DK 53D7,F3=7 355AG@F A8 F:7 8A>>AI;@9 D;E= 835FADE 8AD ?AD7 E7H7D7 4DA@5:;A>;F;E:5:DA@;5 >G@9 6;E73E7 (;@5>G6;@9 4DA@5:ABG>?A@3DK 6KEB>3E;3):37?A6K@3?;53>>K E;9@;R53@F 5A@97@;F3> :73DF 6;E73E7397 ;@ KAG@9 ;@83@FE (G@67D 3 ?A@F:E)BD7?3FGD7 4;DF:, B3DF;5G>3D>K G@67D 32 I77=E@7GDA?GE5G>3D 6;EAD67DE;??G@A67R5;7@5K.1.2.4 -:7@ 675;6;@9 I:7F:7D FA D787D 3 5:;>6 FA E75A@63DK 53D7, F3=7 ;@FA 355AG@F835FADE F:3F ?;9:F 38875F 3 53D7D'E 34;>;FK FA >AA= 38F7D 3 5:;>6 I;F: 4DA@5:;A>;F;E,8AD 7J3?B>7:EA5;3> 5;D5G?EF3@57EF:7 E=;>> 3@6 5A@R67@57 A8 F:7 53D7D ;@ >AA=;@9 38F7D 3 5:;>6 I;F: 4DA@5:;A>;F;E 3F :A?75A@R67@57 ;@ 47;@9 34>7 FA EBAF D76 S39 EK?BFA?E (E77 D75A??7@63F;A@ 1.6.1)Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 11 of 306;EF3@57 FA :73>F:53D7 ;@ 53E7 A8 67F7D;AD3F;A@.1.3 W$!* /+ a)%/1.3.1 #73EGD7 AJK97@ E3FGD3F;A@ GE;@9 BG>E7 AJ;?7FDK ;@ 7H7DK 5:;>6 BD7E7@F;@9 FAE75A@63DK 53D7 I;F: 5>;@;53> 7H;67@57 A8 4DA@5:;A>;F;E.1.3.2 -:7@ 3EE7EE;@9 3 5:;>6 ;@ 3 E75A@63DK 53D7 E7FF;@9, 36?;F F:7? 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Page 12 of 306;EF3@57 FA :73>F:53D7 ;@ 53E7 A8 67F7D;AD3F;A@.1.3.5 C>;@;53>>K 3EE7EE F:7 :K6D3F;A@ EF3FGE A8 5:;>6D7@ I;F: 4DA@5:;A>;F;E.1.3.6 DA @AF DAGF;@7>K B7D8AD? 4>AA6 F7EFE ;@ F:7 3EE7EE?7@F A8 3 5:;>6 I;F:4DA@5:;A>;F;E.1.3.7 DA @AF DAGF;@7>K B7D8AD? 3 5:7EF .-D3K ;@ 5:;>6D7@ I;F: 4DA@5:;A>;F;E, 4753GE75:3@97E A@ .-D3K ?3K ?;?;5 B@7G?A@;3 3@6 E:AG>6 @AF 47 GE76 FA 67F7D?;@7F:7 @776 8AD 3@F;4;AF;5E.1.3.8 CA@E;67D B7D8AD?;@9 3 5:7EF .-D3K ;8 ;@F7@E;H7 53D7 ;E 47;@9 BDABAE76 8AD 3 5:;>6.1.3.9 &DAH;67 B3D7@FE AD 53D7DE I;F: =7K E387FK ;@8AD?3F;A@ (E77 D75A??7@63F;A@1.6.1) ;8 F:7 5:;>6 ;E @AF 36?;FF76.1.4 Ma*a#!)!*/ +" b-+*c$%+(%/%.1.4.1 DA @AF B7D8AD? 5:7EF B:KE;AF:7D3BK A@ 5:;>6D7@ I;F: 4DA@5:;A>;F;E I:A 6A @AF:3H7 D7>7H3@F 5A?AD4;6;F;7E (8AD 7J3?B>7 EB;@3> ?GE5G>3D 3FDAB:K, E7H7D7FD35:7A?3>35;3).1.4.2 CA@E;67D D7CG7EF;@9 3 5:7EF B:KE;AF:7D3BK 3EE7EE?7@F ;@ 5:;>6D7@ I:A :3H7D7>7H3@F 5A?AD4;6;F;7E (8AD 7J3?B>7 EB;@3> ?GE5G>3D 3FDAB:K, E7H7D7FD35:7A?3>35;3) I:7@ F:7D7 ?3K 47 366;F;A@3> 6;8R5G>FK 5>73D;@9 E75D7F;A@E.1.4.3 DA @AF GE7 3@K A8 F:7 8A>>AI;@9 FA FD73F 4DA@5:;A>;F;E ;@ 5:;>6D7@:3@F;4;AF;5E:KB7DFA@;5 E3>;@736D7@3>;@7 (@74G>;E76)E3>4GF3?A>?A@F7>G=3EF;BD3FDAB;G? 4DA?;67EKEF7?;5 AD ;@:3>76 5ADF;5AEF7DA;6EBronchiolitis in children (NG9) NICE 2015. 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Page 14 of 30;E F3=;@9 367CG3F7 AD3> SG;6E:3E ?3;@F3;@76 AJK97@ E3FGD3F;A@ AH7D 92% ;@ 3;D 8AD 4 :AGDE, ;@5>G6;@9 3 B7D;A6 A8E>77B.1.5.2 -:7@ 675;6;@9 I:7F:7D FA 6;E5:3D97 3 5:;>6, F3=7 ;@FA 355AG@F 835FADE F:3F?;9:F 38875F 3 53D7D'E 34;>;FK FA >AA= 38F7D 3 5:;>6 I;F: 4DA@5:;A>;F;E, 8AD 7J3?B>7:EA5;3> 5;D5G?EF3@57EF:7 E=;>> 3@6 5A@R67@57 A8 F:7 53D7D ;@ >AA=;@9 38F7D 3 5:;>6 I;F: 4DA@5:;A>;F;E 3F :A?75A@R67@57 ;@ 47;@9 34>7 FA EBAF D76 S39 EK?BFA?E (E77 D75A??7@63F;A@ 1.6.1)6;EF3@57 FA :73>F:53D7 ;@ 53E7 A8 67F7D;AD3F;A@.1.5.3 &DAH;67 B3D7@FE AD 53D7DE I;F: =7K E387FK ;@8AD?3F;A@ (E77 D75A??7@63F;A@1.6.1) I:7@ F:7 5:;>6 ;E 6;E5:3D976.1.6 K!4 .a"!/4 %*"+-)a/%+* "+- (++'%*# a"/!- a c$%( a/ $+)!1.6.1 &DAH;67 =7K E387FK ;@8AD?3F;A@ 8AD B3D7@FE 3@6 53D7DE FA F3=7 3I3K 8ADD787D7@57 8AD 5:;>6D7@ I:A I;>> 47 >AA=76 38F7D 3F :A?7. *:;E E:AG>6 5AH7D::AI FA D75A9@;E7 67H7>AB;@9 'D76 S39' EK?BFA?E:IADE7@;@9 IAD= A8 4D73F:;@9 (8AD 7J3?B>7 9DG@F;@9, @3E3> S3D;@9, ?3D=76 5:7EFD757EE;A@)SG;6 ;@F3=7 ;E 50P75% A8 @AD?3> AD @A I7F @3BBK 8AD 12 :AGDE3B@A73 AD 5K3@AE;E7J:3GEF;A@ (8AD 7J3?B>7, @AF D7EBA@6;@9 @AD?3>>K FA EA5;3> 5G7E, I3=7E A@>KI;F: BDA>A@976 EF;?G>3F;A@).F:3F B7AB>7 E:AG>6 @AF E?A=7 ;@ F:7 5:;>6'E :A?7 4753GE7 ;F ;@5D73E7E F:7 D;E= A8 ?AD7E7H7D7 EK?BFA?E ;@ 4DA@5:;A>;F;E:AI FA 97F ;??76;3F7 :7>B 8DA? 3@ 3BBDABD;3F7 BDA87EE;A@3> ;8 3@K D76 S39 EK?BFA?E67H7>AB3DD3@97?7@FE 8AD 8A>>AI-GB ;8 @757EE3DK.Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 15 of 30112$ICE 9G;63@57 A@ ;@FD3H7@AGE SG;6E F:7D3BK ;@ 5:;>6D7@ ;E ;@ 67H7>AB?7@F 3@6 ;E 6G7 FA 47BG4>;E:76 ;@ %5FA47D 2015.Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 16 of 3022 (7E73D5: D75A??7@63F;A@E (7E73D5: D75A??7@63F;A@E*:7 GG;67>;@7 D7H7>AB?7@F GDAGB :3E ?367 F:7 8A>>AI;@9 D75A??7@63F;A@E 8AD D7E73D5:, 43E76A@ ;FE D7H;7I A8 7H;67@57, FA ;?BDAH7 $ICE 9G;63@57 3@6 B3F;7@F 53D7 ;@ F:7 8GFGD7. *:7 GG;67>;@7D7H7>AB?7@F GDAGB'E 8G>> E7F A8 D7E73D5: D75A??7@63F;A@E ;E 67F3;>76 ;@ F:7 8G>> 9G;67>;@7. )77 F:79G;67>;@7E ?3@G3> E75F;A@ 9.5 8AD 9G;63@57 A@ 8AD?G>3F;@9 3@6 E7>75F;@9 :;9:-BD;AD;FK D7E73D5:D75A??7@63F;A@E 8AD ;@5>GE;A@ ;@ F:7 $ICE 9G;67>;@7.2.1 O34#!* .a/0-a/%+* )!a.0-!)!*/ %* ,-%)a-4 ca-!-:3F ;E F:7 5>;@;53> 3@6 5AEF 78875F;H7@7EE A8 AJK97@ E3FGD3F;A@ ()B%2) ?73EGD7?7@F ;@ BD;?3DK53D7 ;@ 5:;>6D7@ I;F: 4DA@5:;A>;F;E?-: -:K F:;E ;E ;?BADF3@F K F:;E ;E ;?BADF3@F*:7D7 3D7 @A EFG6;7E FA ;@8AD? F:7 GE7 A8 )B%2?73EGD7?7@F ;@ BD;?3DK 53D7. )B%2;E GE76 DAGF;@7>K;@ E75A@63DK 53D7 FA :7>B 675;67 A@ F:7 @776 8AD 36?;EE;A@ FA :AEB;F3>. *:7 5>;@;53> 3@6 5AEF78875F;H7@7EE A8 )B%2?73EGD7?7@F ;@ BD;?3DK 53D7 ;E 3>EA ;?BADF3@F. )B%2;E @AF DAGF;@7>K?73EGD76 ;@ ;@83@FE 3@6 KAG@9 5:;>6D7@ I;F: 4DA@5:;A>;F;E ;@ BD;?3DK 53D7. *:7 H3>G7 A8 )B%2?73EGD7?7@F FA :7>B ;67@F;8K F:AE7 I:A @776 36?;EE;A@ FA :AEB;F3> E:AG>6 47 3EE7EE76. &AEE;4>7AGF5A?7E ?;9:F 47 87I7D AD ?AD7 ;@83@FE 47;@9 D787DD76 FA :AEB;F3>, AD 36?;FF76.2.2 Pa!%a/-%c !a-(4 2a-*%*# .c+-! (PEWS) a. ,-!%c/+-. +" !/!-%+-a/%+*I@ 5:;>6D7@ I;F: 4DA@5:;A>;F;E 53@ B376;3FD;5 73D>K I3D@;@9 E5AD7 (&E-)) BD76;5F 67F7D;AD3F;A@?-: -:K F:;E ;E ;?BADF3@F K F:;E ;E ;?BADF3@FI@ 5:;>6D7@ I;F: 4DA@5:;A>;F;E F:7D7 ;E 5>;@;53> G@57DF3;@FK 34AGF F:7 BD76;5F;A@ A8 67F7D;AD3F;A@.*:7D7 3D7 3 @G?47D A8 5>;@;53> E5AD7E 8AD 4DA@5:;A>;F;E F:3F ;@5>G67 A4K ;@ I;67EBD736 GE7 ;@ 5>;@;53> BD35F;57. I@5D73E;@9>K,&E-) 3D7 47;@9 7?B>AK76 97@7D;53>>K ;@ B376;3FD;5 BD35F;57 ;@ F:7 +!. *:7 78875F;H7@7EE A8 &E-)E5AD7E ;@ BD76;5F;@9 67F7D;AD3F;A@ 8AD ;@83@FE I;F: 4DA@5:;A>;F;E @776E FA 47 3EE7EE76.2.3 C+)b%*! b-+*c$+%(a/+- a* c+-/%c+./!-+% /$!-a,4 "+- b-+*c$%+(%/%.-:3F ;E F:7 78R535K A8 5A?4;@76 4DA@5:A6;>3FAD 3@6 5ADF;5AEF7DA;6 F:7D3BK?Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 17 of 30-: -:K F:;E ;E ;?BADF3@F K F:;E ;E ;?BADF3@F*:7D7 3D7 @A 78875F;H7 F:7D3B;7E 8AD F:7 FD73F?7@F A8 4DA@5:;A>;F;E. %@7 EFG6K D7BADF76 F:3F ;@83@FEBDAH;676 I;F: 4AF: @74G>;E76 36D7@3>;@7 3@6 EKEF7?;5 EF7DA;6E :36 ;?BDAH76 5>;@;53> AGF5A?7E.*:;E I3E 3 EG49DAGB 3@3>KE;E, EA I3E @AF 3@F;5;B3F76 ;@ F:7 FD;3> 67E;9@ 3@6 5A@E7CG7@F>K F:73@3>KE;E I3E @AF 367CG3F7>K BAI7D76 FA 3@EI7D F:;E CG7EF;A@. A ?G>F;57@FD7 D3@6A?;E765A@FDA>>76 FD;3> ((C*) F:3F 3EE7EE7E F:7 5>;@;53> 3@6 5AEF 78875F;H7@7EE A8 5A?4;@76 36D7@3>;@7 3@65ADF;5AEF7DA;6E FD73F?7@F 8AD 4DA@5:;A>;F;E ;E @77676.2.4 H%#$-6+2 $0)%%5! +34#!* a* +34#!*-:3F ;E F:7 5>;@;53> 3@6 5AEF 78875F;H7@7EE A8 :;9:-SAI :G?;6;R76 AJK97@ H7DEGE EF3@63D6EGBB>7?7@F3> AJK97@?-: -:K F:;E ;E ;?BADF3@F K F:;E ;E ;?BADF3@F&DAH;6;@9 AJK97@ (FKB;53>>K 4K @3E3> 53@@G>3) ;E EF3@63D6 53D7 8AD 4DA@5:;A>;F;E. $7I>K-67H7>AB76?76;53> 67H;57E 53@ @AI 67>;H7D :;9:-SAI :G?;6;R76 AJK97@ F:3F ;E F:AG9:F FA BDAH;67 ?AD75A?8ADF34>7 3@6 78875F;H7 67>;H7DK A8 93E7E I:;>7 D7F3;@;@9 3;DI3K :G?;6;FK. *:7 GE7 A8 F:;E ?76;53>67H;57 ;E 475A?;@9 I;67EBD736 I;F:AGF 67?A@EFD3F;A@ A8 366;F;A@3> 78R535K. A ?G>F;57@FD7 (C*5A?B3D;@9 :;9:-SAI :G?;6;R76 AJK97@ 3@6 EF3@63D6 EGBB>7?7@F3> AJK97@ IAG>6 47 A8 47@7RF, 3EIAG>6 ;@5>G6;@9 I73@;@9 EFD3F79;7E 8AD :;9:-SAI :G?;6;R76 AJK97@.2.5 Na.a( .0c/%+*-:3F ;E F:7 5>;@;53> 3@6 5AEF 78875F;H7@7EE A8 EG5F;A@ FA D7?AH7 E75D7F;A@E 8DA? F:7 GBB7DD7EB;D3FADK FD35F 5A?B3D76 I;F: ?;@;?3> :3@6>;@9?-: -:K F:;E ;E ;?BADF3@F K F:;E ;E ;?BADF3@F)G5F;A@ ;E 3 5A??A@>K GE76 F:7D3BK ;@ 4DA@5:;A>;F;E. I@83@FE 3D7 A4>;93F7 @3E3> 4D73F:7DE, EAD7?AH3> A8 E75D7F;A@E ;E F:AG9:F FA D7>;7H7 D7EB;D3FADK 6;EFD7EE. HAI7H7D, EG5F;A@ ;E 6;EFD7EE;@9 FA;@83@FE 3@6 B3D7@FE. #7F:A6E H3DK 3@6 F:7D7 ;E @A 7H;67@57 A@ I:;5: 3BBDA35:, ;8 3@K, ;E ?AEF78875F;H7. I@ EA?7 FD;3>E ;F 3BB73DE F:3F ?;@;?3> :3@6>;@9 ;E ?AD7 78875F;H7 F:3@ F:7D3B;7E. A?G>F;57@FD7 (C* 5A?B3D;@9 F:7 5>;@;53> 3@6 5AEF 78875F;H7@7EE A8 EG5F;A@ (3>EA 5AH7D;@9 6;887D7@FEG5F;A@ EFD3F79;7E, 8AD 7J3?B>7 EGB7DR5;3> H7DEGE 677B) I;F: ?;@;?3> :3@6>;@9 ;E @77676.Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 18 of 3033 %F:7D ;@8AD?3F;A@ %F:7D ;@8AD?3F;A@3.1 Sc+,! a* $+2 /$%. #0%!(%*! 2a. !1!(+,!$ICE 9G;67>;@7E 3D7 67H7>AB76 ;@ 355AD63@57 I;F: 3 E5AB7 F:3F 67R@7E I:3F F:7 9G;67>;@7 I;>> 3@6I;>> @AF 5AH7D.HAI F:;E 9G;67>;@7 I3E 67 HAI F:;E 9G;67>;@7 I3E 67HH7>AB76 7>AB76$ICE 5A??;EE;A@76 F:7 $3F;A@3> CA>>34AD3F;@9 C7@FD7 8AD -A?7@'E 3@6 C:;>6D7@'E H73>F: FA67H7>AB F:;E 9G;67>;@7. *:7 C7@FD7 7EF34>;E:76 3 GG;67>;@7 D7H7>AB?7@F GDAGB (E77 E75F;A@ 4),I:;5: D7H;7I76 F:7 7H;67@57 3@6 67H7>AB76 F:7 D75A??7@63F;A@E.*:7 ?7F:A6E 3@6 BDA57EE7E 8AD 67H7>AB;@9 $ICE 5>;@;53> 9G;67>;@7E 3D7 67E5D;476 ;@ F:79G;67>;@7E ?3@G3>.3.2 R!(a/! NICE #0%a*c!D7F3;>E 3D7 5ADD75F 3F F:7 F;?7 A8 5A@EG>F3F;A@ A@ F:7 9G;67>;@7 ($AH7?47D 2014). FGDF:7D;@8AD?3F;A@ ;E 3H3;>34>7 A@ F:7 $ICE I74E;F7.&G4>;E:76 &G4>;E:76G!*!- G!*!-a( a(#76;5;@7E 36:7D7@57 $ICE 9G;67>;@7 CG76 (2009)C+*%/%+*-.,!c%5c C+*%/%+*-.,!c%5cF7H7D;E: ;>>@7EE ;@ 5:;>6D7@ (2013) $ICE 9G;67>;@7 CG160A@F;4;AF;5E 8AD 73D>K-A@E7F @7A@3F3> ;@875F;A@ (2012) $ICE 9G;67>;@7 CG149I@875F;A@ (2012) $ICE 9G;67>;@7 CG139&D7H7@F;A@ 3@6 5A@FDA> A8 :73>F:53D7-3EEA5;3F76 ;@875F;A@E (2011) $ICE 9G;67>;@7 &H36B35F7D;3> ?7@;@9;F;E 3@6 ?7@;@9A5A553> E7BF;537?;3 (2010) $ICE 9G;67>;@7 CG102(7EB;D3FADK FD35F ;@875F;A@E P 3@F;4;AF;5 BD7E5D;4;@9 (2008) $ICE 9G;67>;@7 CG69Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 19 of 30%?3>;LG?34 8AD E7H7D7 B7DE;EF7@F 3>>7D9;5 3EF:?3 (2007) $ICE F75:@A>A9K 3BBD3;E3> 9G;63@57133I@:3>76 5ADF;5AEF7DA;6E 8AD F:7 FD73F?7@F A8 5:DA@;5 3EF:?3 ;@ 5:;>6D7@ G@67D F:7 397 A812 K73DE (2007) $ICE F75:@A>A9K 3BBD3;E3> 9G;63@57 131GG;63@57 A@ F:7 GE7 A8 ;@:3>7D EKEF7?E (67H;57E) ;@ 5:;>6D7@ G@67D F:7 397 A8 5 K73DE I;F:5:DA@;5 3EF:?3 (2000) $ICE F75:@A>A9K 3BBD3;E3> 9G;63@57 10+@67D 67 +@67D 67HH7>AB?7@F 7>AB?7@F$ICE ;E 67H7>AB;@9 F:7 8A>>AI;@9 9G;63@57 (67F3;>E 3H3;>34>7 8DA? F:7 $ICE I74E;F7):AEF:?3. $ICE 9G;67>;@7. &G4>;53F;A@ 7JB75F76 G@7 2015.I@FD3H7@AGE SG;6 F:7D3BK ;@ 5:;>6D7@. $ICE 9G;67>;@7. &G4>;53F;A@ 7JB75F76 %5FA47D 2015.Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 20 of 3044 *:7 GG;67>;@7 D7 *:7 GG;67>;@7 D7HH7>AB?7@F GDAGB, $3F;A@3> CA>>34AD 7>AB?7@F GDAGB, $3F;A@3> CA>>34AD3F;@9 C7@FD7 3F;@9 C7@FD73@6 $ICE BDA &376;3FD;5;3@, (AK3> B7>83EF HAEB;F3> 8AD );5= C:;>6D7@!3F7 C:36I;5= !3F7 C:36I;5=&3F;7@F 3@6 53D7D ?7?47DG7A88D7 G7A88D7K A:@ CD;??;@E K A:@ CD;??;@EG7@7D3> &D35F;F;A@7D, ">3@FI;F #37 A8 G>3?AD93@)F7 )F7HH7 CG@@;@9:3? ( 7 CG@@;@9:3? 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H!a(/$00AE;3 B75=>7E AE;3 B75=>7EI@8AD?3F;A@ )5;7@F;EFA@@7 C3DFK A@@7 C3DFK&DA 2014);D; C:3D6 ;D; C:3D6)7@;AD (7E73D5: F7>>AI 3@6 GG;67>;@7 "736 (G@F;> AG9GEF 2014)";L B;5= ";L B;5=7D6;= 7D6;=77(7E73D5: AEE;EF3@F (G@F;> )7BF7?47D 2013),,3@7EE3 D7>936A $G@7E 3@7EE3 D7>936A $G@7E)7@;AD (7E73D5: F7>>AI 3@6 GG;67>;@7 "736 (8DA? AG9GEF 2014))F7B:7@ #GDB: )F7B:7@ #GDB:KKC>;@;53> D;D75FAD 8AD C:;>6D7@'E H73>F:!3F:7D;@7 CG>>7@ !3F:7D;@7 CG>>7@(7E73D5: F7>>AI P H73>F: E5A@A?;EF (G@F;> 3@G3DK 2015)&&3G> 35=>;@ 3G> 35=>;@)7@;AD (7E73D5: F7>>AI P H73>F: E5A@A?;EF (8DA? D757?47D 2014)$;F3D $;F3D3 &D 3 &D3E3@@3@ 3E3@@3@(7E73D5: F7>>AI (G@F;> %5FA47D 2014),,3>7@F;@3 (;55; 3>7@F;@3 (;55;(7E73D5: F7>>AI (8DA? 3@G3DK 2014)G7??3 #3D57@;G= G7??3 #3D57@;G=(7E73D5: AEE;EF3@F (G@F;> #3K 2014)CD;EF;@3 ,;E;@F;@ CD;EF;@3 ,;E;@F;@&DA ABD;> 2014)Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 22 of 304.3 NICE ,-+&!c/ /!a))3D )3D3: -;>>7FF 3: -;>>7FFGG;67>;@7 "736#3DF;@ A>>34 #3DF;@ A>>34KKC>;@;53> A6H;E7D%>;H %>;H7D B3;>7 7D B3;>7KKGG;67>;@7 CA??;EE;A@;@9 #3@397D (G@F;> F74DG3DK 2015))3D )3D3: )F7B:7@EA@ 3: )F7B:7@EA@GG;67>;@7 CA??;EE;A@;@9 #3@397D (8DA? F74DG3DK 2015)B7E?3 $3E: B7E?3 $3E:GG;67>;@7 CAAD6;@3FAD$;F3D $;F3D3 &D 3 &D3E3@@3@ 3E3@@3@*75:@;53> "736D3 D3H;6 G>K@@ H;6 G>K@@H73>F: E5A@A?;EFG3D7F: H3?3@ G3D7F: H3?3@)7@;AD #76;53> E6;FAD4.4 D!c(a-a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ronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 23 of 30*:A?3EBAGD=7&G4>;E:76 3 B3B7D A@ 4DA@5:;A>;F;E 1BAGD=7 *,):;7>6E # (2011) BDA@5:;A>;F;E. C>;@ EH;6 04(0308)2.&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7A:@CD;??;@E(757;H76 3@ :A@AD3D;G? 8AD 3@ 3DF;5>7 A@ 87H7D ;@5:;>6D7@.&7DEA@3>R@3@5;3>@A@-EB75;R5D75>3D73@6B3DF;5;B3F7)F7H7CG@@;@9:3?(C:3;D)A6H;EADK 4A3D6 3FF7@63@57 I;F: :A@AD3D;G? 8ADG;>736 3F I:;5: 3 BDA6G5F 8AD 5KEF;5 R4DAE;E I3E6;E5GEE76, 4GF 3>EA 3 4D;78 6;E5GEE;A@ A@ 3 @AH7>6DG9 FD73F?7@F 8AD (), 4DA@5:;A>;F;E.&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7)F7H7CG@@;@9:3?(C:3;D)C:;78 ;@H7EF;93FAD ;@ 3 BDA;F;E 3F 6;E5:3D97 8DA? :AEB;F3>.&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7)F7H7CG@@;@9:3?(C:3;D)&D;@5;B>7 I@H7EF;93FAD 8AD B:3E7 1 EFG6K A8 @AH7>6DG9 FD73F?7@F 8AD (), 4DA@5:;A>;F;E ;@ ;@83@FE.&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7)F7H7CG@@;@9:3?(C:3;D)AFF7@6E >G@5: ?77F;@9 EBA@EAD76 4KG>3JA)?;F:!>;@7 7H7DK 3 ?A@F:E.&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7)F7H7CG@@;@9:3?(C:3;D)CA@EG>F3@5K IAD= H;3 $H) "AF:;3@ 8ADB;AF75:@A>A9K 5A?B3@K 67H7>AB;@9 3 @AH7> 6DG9FD73F?7@F 8AD (), 4DA@5:;A>;F;E ;@ ;@83@FE.&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7G>;3@ "799 (7E73D5: ;@F7D7EF ;@ H;D3> 4DA@5:;A>;F;E. &7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7G>;3@ "799 AFF7@676 3 ?76;53> ?77F;@9 EBA@EAD76 4KG>3JA)?;F:!>;@7 3F I:;5: 3 BDA6G5F G@D7>3F76 FAF:7 5GDD7@F 9G;67>;@7 I3E 6;E5GEE76.G>3JA)?;F:!>;@7 BDAH;676 EG4E;EF7@57 (3 ?73>) 8ADF:7 3FF7@677E.&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 24 of 30G>;3@ "799 C:3;D76 ?77F;@9 A8 -7EE7J &376;3FD;5 (7EB;D3FADK)A5;7FK ;@ F74DG3DK 2014. *:;E I3E 3@ 76G53F;A@3>?77F;@9 EBA@EAD76 4K G>3JA)?;F:!>;@7 I:A3DD3@976 F:7 H7@G7 3@6 BDAH;676 EG4E;EF7@57 (3?73>) 8AD F:7 3FF7@677E. $A 3D73E D7>3F76 FA F:75GDD7@F 9G;67>;@7 I7D7 6;E5GEE76.&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7G>;3@ "799 AFF7@676 3 5KEF;5 R4DAE;E 76G53F;A@3> ?77F;@9(#3D5: 2015) AD93@;E76 4K FAD7EF "34AD3FAD;7EI:A BDAH;676 AH7D@;9:F 355A??A63F;A@ 3@6EG4E;EF7@57 (?73>E). $A 3D73E D7>3F76 FA F:75GDD7@F 9G;67>;@7 I7D7 6;E5GEE76.&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7G>;3@ "799 $ADF: A?7D;53@ CKEF;5 F;4DAE;E CA@87D7@57 2015P 9D3@F BDAH;676 4K CKEF;5 F;4DAE;E *DGEF, +! 8ADCA@87D7@57 (79;EFD3F;A@&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7G>;3@ "799 EJB7@E7E 8DA? A44AFF "34AD3FAD;7E FA EGBBADF3FF7@63@57 A8 3 ?77F;@9 A@ CKEF;5 F;4DAE;EAD93@;E76 4K 3 5:3D;FK (C:;>6 H73>F: I@F7D@3F;A@3>);@ BG>93D;3 ;@ 2013.$A@-B7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DFC>;@;53> 6A5FAD3F7 D7E73D5: 87>>AIE:;B 8G@676 4KF:7 $3F;A@3> I@EF;FGF7 8AD H73>F: (7E73D5: FA#73EGD;@9 C>;@;53> )7H7D;FK ;@ I@83@FE I;F:BDA@5:;A>;F;E.&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DF)B73=7D 3F 3 D7EB;D3FADK ?77F;@9 BD7E7@F;@96A5FAD3F7 D7E73D5: EFG6K&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DFCA-3BB>;53@F A@ 3 9D3@F (&C%(I) I;F: 3;?E FA;67@F;8K ;?BADF3@F AGF5A?7E 8AD B3D7@FE I;F:5:;>6D7@ I;F: 35GF7 D7EB;D3FADK ;@875F;A@E&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DFAFF7@676 3 BD7>;?;@3DK ?77F;@9 I;F:D7BD7E7@F3F;H7E A8 F;E:7D & &3K=7> FA 7JB>AD7 F:7BAEE;4;>;FK F:3F F:7K IAG>6 EGBB>K 7CG;B?7@F 3@65A@EG?34>7E 8AD 3 D7E73D5: EFG6K ;@H7EF;93F;@9 F:778R535K 3@6 E387FK A8 :;9: SAI AJK97@ 5A?B3D76I;F: EF3@63D6 53D7&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 25 of 30C>3D7 H3@#;7DF&G4>;E:76 3 B3B7D 1H3@ #;7DF C, A44AFF , ,7D:A788F, "3@7 ), C3DF7D B, #5$3?3D3 & (2014)D7H7>AB?7@F 3@6 ,3>;63F;A@ A8 F:7 ";H7DBAA>I@83@F BDA@5:;A>;F;E )7H7D;FK )5AD7: 3 D7E73D5:BDAFA5A>. AGD@3> A8 A6H3@576 $GDE;@92&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DF)G4?;FF76 3@ 3BB>;53F;A@ FA H*A 5A??;EE;A@ 53>>8AD 3 873E;4;>;FK EFG6K FA >AA= 3F F:7 ABF;?G?F:D7E:A>6E 8AD EF3DF;@9 @C&A& 3@6 :;9:-SAIAJK97@ ;@ ;@83@FE I;F: 4DA@5:;A>;F;E (M255,816.00)&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DFAFF7@676 3 9DAG@6 DAG@6 ?77F;@9 I:;5: :36 34D73=83EF EBA@EAD76 4K )B75FDG?F:73 (5DA;EE3@F3@6 5A8877)&7DEA@3>@A@-B75G@;3DKD75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DFCA-3BB>;53@F 8AD 8G@6;@9 FA (7E73D5: 8AD &3F;7@FB7@7RF A@ 3 4DA@5:;A>;F;E 873E;4;>;FK EFG6K&7DEA@3>R@3@5;3>EB75;R5D75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DF&DAH;676 7JB7DF 3DF;5>7 A@ 4DA@5:;A>;F;E:BDA@5:;A>;F;E $GDE;@9 )F3@63D6, 3@G3DK 7 2015,HA> 19 B 19.&7DEA@3>@A@-R@3@5;3>EB75;R5D75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DFABBDA35:76 (H;3 7?3;>) 8AD ;@8AD?3F;A@ A@ B3D7@FE'@776E' 4K 3 ?7?47D A8 3 B3D>;3?7@F3DK DAG@6F34>75A??;FF77 ?77F;@9 8AD 4DA@5:;A>;F;E 38F7DG@67DF3=;@9 ;@F7DH;7IE I;F: B3D7@FE A8 ;@83@FEI;F: 4DA@5:;A>;F;E 3E B3DF &:D&7DEA@3>@A@-R@3@5;3>EB75;R5D75>3D73@6B3DF;5;B3F7C>3D7 H3@#;7DF)G557EE8G>>K 3BB>;76 8AD 3 FD3H7> 4GDE3DK FA BD7E7@F3F (), 5A@87D7@57 ;@ )AGF: A8D;53 ($AH7?47D 14)FA BD7E7@F D7E73D5: A@ 4DA@5:;A>;F;E 4GF 5AG>6 @AF3FF7@6 P &:D EGB7DH;EAD 3FF7@676 3@6 BD7E7@F76F:7 D7E73D5:$A@-B7DEA@3>R@3@5;3>EB75;R5D75>3D73@6B3DF;5;B3F7D74D3'G3@FD;>>HA>6E E:3D7E ;@ FGFGD3 #76;53> B>5 PB:3D?357GF;53> 9DAGB F:3F 67H7>ABE BDA6G5FE 8ADF:7 5A@EG?7D :73>F:53D7 ?3D=7F&7DEA@3>B75G@;3DKD75>3D73@6B3DF;5;B3F7Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 26 of 30C:3@97E 38F7D BG4>;53F;A@ C:3@97E 38F7D BG4>;53F;A@G@7 2015 G@7 2015: ?;@AD 5ADD75F;A@E FA $CGC EF388 >;EF.Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 27 of 30A4AGF F:;E 9G;67>;@7 A4AGF F:;E 9G;67>;@7$ICE 5>;@;53> 9G;67>;@7E 3D7 D75A??7@63F;A@E 34AGF F:7 FD73F?7@F 3@6 53D7 A8 B7AB>7 I;F: EB75;R56;E73E7E 3@6 5A@6;F;A@E.$ICE 9G;67>;@7E 3D7 67H7>AB76 ;@ 355AD63@57 I;F: 3 E5AB7 F:3F 67R@7E I:3F F:7 9G;67>;@7 I;>> 3@6I;>> @AF 5AH7D.*:;E 9G;67>;@7 I3E 67H7>AB76 4K F:7 $3F;A@3> CA>>34AD3F;@9 C7@FD7 8AD -A?7@'E 3@6 C:;>6D7@'EH73>F: I:;5: ;E 43E76 3F F:7 (AK3> CA>>797 A8 %4EF7FD;5;3@E 3@6 GK@375A>A9;EFE. *:7 CA>>34AD3F;@9C7@FD7 IAD=76 I;F: 3 GG;67>;@7 D7H7>AB?7@F GDAGB, 5A?BD;E;@9 :73>F:53D7 BDA87EE;A@3>E(;@5>G6;@9 5A@EG>F3@FE, G&E 3@6 @GDE7E), B3F;7@FE 3@6 53D7DE, 3@6 F75:@;53> EF388, I:;5: D7H;7I76 F:77H;67@57 3@6 6D38F76 F:7 D75A??7@63F;A@E. *:7 D75A??7@63F;A@E I7D7 R@3>;E76 38F7D BG4>;55A@EG>F3F;A@.*:7 ?7F:A6E 3@6 BDA57EE7E 8AD 67H7>AB;@9 $ICE 5>;@;53> 9G;67>;@7E 3D7 67E5D;476 ;@ F:7 9G;67>;@7E?3@G3>.$ICE BDA6G57E 9G;63@57, EF3@63D6E 3@6 ;@8AD?3F;A@ A@ 5A??;EE;A@;@9 3@6 BDAH;6;@9 :;9:-CG3>;FK:73>F:53D7, EA5;3> 53D7, 3@6 BG4>;5 :73>F: E7DH;57E. -7 :3H7 39D77?7@FE FA BDAH;67 57DF3;@ $ICEE7DH;57E FA -3>7E, )5AF>3@6 3@6 $ADF:7D@ ID7>3@6. D75;E;A@E A@ :AI $ICE 9G;63@57 3@6 AF:7DBDA6G5FE 3BB>K ;@ F:AE7 5AG@FD;7E 3D7 ?367 4K ?;@;EF7DE ;@ F:7 -7>E: 9AH7D@?7@F, )5AFF;E:9AH7D@?7@F, 3@6 $ADF:7D@ ID7>3@6 EJ75GF;H7. $ICE 9G;63@57 AD AF:7D BDA6G5FE ?3K ;@5>G67D787D7@57E FA AD93@;E3F;A@E AD B7AB>7 D7EBA@E;4>7 8AD 5A??;EE;A@;@9 AD BDAH;6;@9 53D7 F:3F ?3K 47D7>7H3@F A@>K FA E@9>3@6.S/-!*#/$ +" -!c+))!*a/%+*.)A?7 D75A??7@63F;A@E 53@ 47 ?367 I;F: ?AD7 57DF3;@FK F:3@ AF:7DE. *:7 GG;67>;@7 D7H7>AB?7@FGDAGB ?3=7E 3 D75A??7@63F;A@ 43E76 A@ F:7 FD367-A88 47FI77@ F:7 47@7RFE 3@6 :3D?E A8 3@;@F7DH7@F;A@, F3=;@9 ;@FA 355AG@F F:7 CG3>;FK A8 F:7 G@67DB;@@;@9 7H;67@57. FAD EA?7 ;@F7DH7@F;A@E,F:7 GG;67>;@7 D7H7>AB?7@F GDAGB ;E 5A@R67@F F:3F, 9;H7@ F:7 ;@8AD?3F;A@ ;F :3E >AA=76 3F, ?AEFB3F;7@FE IAG>6 5:AAE7 F:7 ;@F7DH7@F;A@. *:7 IAD6;@9 GE76 ;@ F:7 D75A??7@63F;A@E ;@ F:;E 9G;67>;@767@AF7E F:7 57DF3;@FK I;F: I:;5: F:7 D75A??7@63F;A@ ;E ?367 (F:7 EFD7@9F: A8 F:7D75A??7@63F;A@).Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 28 of 30FAD 3>> D75A??7@63F;A@E, $ICE 7JB75FE F:3F F:7D7 ;E 6;E5GEE;A@ I;F: F:7 B3F;7@F 34AGF F:7 D;E=E 3@647@7RFE A8 F:7 ;@F7DH7@F;A@E, 3@6 F:7;D H3>G7E 3@6 BD787D7@57E. *:;E 6;E5GEE;A@ 3;?E FA :7>B F:7? 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IF ;E BG4>;E:76 4K F:7 $3F;A@3>CA>>34AD3F;@9 C7@FD7 8AD -A?7@'E 3@6 C:;>6D7@'E H73>F:.*:7 D75A??7@63F;A@E 8DA? F:;E 9G;67>;@7 :3H7 477@ ;@5ADBAD3F76 ;@FA 3 $ICE B3F:I3K.-7 :3H7 BDA6G576 ;@8AD?3F;A@ 8AD F:7 BG4>;5 34AGF F:;E 9G;67>;@7.I),(!)!*/a/%+*I?B>7?7@F3F;A@ FAA>E 3@6 D7EAGD57E FA :7>B KAG BGF F:7 9G;67>;@7 ;@FA BD35F;57 3D7 3>EA 3H3;>34>7.Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 29 of 30Y+0- -!.,+*.%b%(%/4*:;E 9G;63@57 D7BD7E7@FE F:7 H;7I A8 $ICE, I:;5: I3E 3DD;H76 3F 38F7D 53D78G> 5A@E;67D3F;A@ A8 F:77H;67@57 3H3;>34>7. H73>F:53D7 BDA87EE;A@3>E 3D7 7JB75F76 FA F3=7 ;F 8G>>K ;@FA 355AG@F I:7@7J7D5;E;@9 F:7;D 5>;@;53> D7EBA@E;4;>;FK A8 :73>F:53D7 BDA87EE;A@3>E FA ?3=7 675;E;A@E 3BBDABD;3F7 FA F:7 5;D5G?EF3@57E A8F:7 ;@6;H;6G3> B3F;7@F, ;@ 5A@EG>F3F;A@ I;F: F:7 B3F;7@F 3@6/AD 9G3D6;3@ AD 53D7D, 3@6 ;@8AD?76 4KF:7 EG??3D;7E A8 BDA6G5F 5:3D35F7D;EF;5E A8 3@K 6DG9E.I?B>7?7@F3F;A@ A8 F:;E 9G;63@57 ;E F:7 D7EBA@E;4;>;FK A8 >A53> 5A??;EE;A@7DE 3@6/AD BDAH;67DE.CA??;EE;A@7DE 3@6 BDAH;67DE 3D7 D7?;@676 F:3F ;F ;E F:7;D D7EBA@E;4;>;FK FA ;?B>7?7@F F:79G;63@57, ;@ F:7;D >A53> 5A@F7JF, ;@ >;9:F A8 F:7;D 6GF;7E FA :3H7 6G7 D793D6 FA F:7 @776 FA 7>;?;@3F7G@>3I8G> 6;E5D;?;@3F;A@, 36H3@57 7CG3>;FK A8 ABBADFG@;FK 3@6 8AEF7D 9AA6 D7>3F;A@E. $AF:;@9 ;@ F:;E9G;63@57 E:AG>6 47 ;@F7DBD7F76 ;@ 3 I3K F:3F IAG>6 47 ;@5A@E;EF7@F I;F: 5A?B>;3@57 I;F: F:AE76GF;7E.C+,4-%#$/N $3F;A@3> I@EF;FGF7 8AD H73>F: 3@6 C3D7 EJ57>>7@57 2015. A>> D;9:FE D7E7DH76. $ICE 5ABKD;9:F?3F7D;3> 53@ 47 6AI@>A3676 8AD BD;H3F7 D7E73D5: 3@6 EFG6K, 3@6 ?3K 47 D7BDA6G576 8AD 76G53F;A@3>3@6 @AF-8AD-BDARF BGDBAE7E. $A D7BDA6G5F;A@ 4K AD 8AD 5A??7D5;3> AD93@;E3F;A@E, AD 8AD5A??7D5;3> BGDBAE7E, ;E 3>>AI76 I;F:AGF F:7 ID;FF7@ B7D?;EE;A@ A8 $ICE.I)B$ 978-1-4731-1162-2Acc-!%/a/%+*Bronchiolitis in children (NG9) NICE 2015. All rights reserved. Page 30 of 30