What is the pre-hospital treatment for pediatric bronchitis?

From the Guidelines

Prehospital treatment for pediatric bronchitis should focus on maintaining adequate oxygenation and relieving respiratory distress, with supplemental oxygen and albuterol via nebulizer being the primary interventions. When assessing a child with bronchitis, it is crucial to evaluate their respiratory status, including respiratory rate, work of breathing, and oxygen saturation 1. According to the clinical practice guideline for the diagnosis, management, and prevention of bronchiolitis, the main goals in the history and physical examination of infants presenting with wheeze or other lower respiratory tract symptoms are to differentiate infants with probable viral bronchiolitis from those with other disorders and to estimate disease severity 1.

Key considerations in prehospital treatment include:

• Providing supplemental oxygen via nasal cannula or face mask to maintain oxygen saturation above 92%
• Administering albuterol via nebulizer at a dose of 0.15 mg/kg (minimum 2.5 mg, maximum 5 mg) in 3 mL normal saline, which can be repeated every 20 minutes for up to three doses if needed
• Positioning the child upright to optimize breathing mechanics
• Ensuring adequate hydration by encouraging small sips of clear fluids if the child is alert and able to drink
• Monitoring vital signs continuously, particularly respiratory rate and effort

It is essential to note that routine virologic testing and chest radiography are not recommended for children with bronchiolitis, except in specific cases where respiratory effort is severe enough to warrant ICU admission or where signs of an airway complication are present 1. For severe cases with significant respiratory distress, consider adding ipratropium bromide 250-500 mcg via nebulizer for children over 12 months. These interventions help by relaxing bronchial smooth muscles, reducing inflammation, and improving airflow. Early intervention and rapid transport to definitive care are crucial if the child shows signs of respiratory failure.

From the FDA Drug Label

The safety and effectiveness of albuterol sulfate inhalation solution have been established in children 2 years of age or older Published reports of trials in asthmatic children aged 3 years or older have demonstrated significant improvement in either FEV1 or PEFR within 2 to 20 minutes following a single dose of albuterol inhalation solution An increase of 15% or more in baseline FEV1 has been observed in children aged 5 to 11 years up to 6 hours after treatment with doses of 0. 10 mg/kg or higher of albuterol inhalation solution.

Bronchitis treatment in pediatric patients can be managed with albuterol inhalation solution. The recommended dose for pediatric patients is based on efficacy and safety studies in children 5 to 17 years old. Albuterol has been shown to improve FEV1 and PEFR in children aged 3 years or older. However, the safety and effectiveness of albuterol sulfate inhalation solution in children below 2 years of age have not been established 2.

From the Research

Bronchitis Treatment Pre-Hospital for Pediatric Patients

• The management of acute bronchitis in children is a common issue in general practice, with confusion surrounding the clinical diagnosis, especially when distinguishing it from asthma 3.
• Viral pathogens, particularly respiratory syncytial virus and rhinoviruses, are cited as the leading agents in the development of serious episodes of acute bronchitis in children 3.
• The U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years 4.
• For pediatric patients with acute bronchiolitis, frequent evaluation of patient clinical status, including respiratory rate, work of breathing, oxygen saturation, and the ability to take oral fluids, are important in determining safe disposition 5.

Treatment Options

• Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia 4.
• Albuterol delivered by metered-dose inhaler may be effective in reducing the likelihood of coughing after 7 days of treatment in patients with acute bronchitis 6.
• High-flow nasal cannula therapy and combination therapies may also have a potential role in the management of acute bronchiolitis in pediatric patients 5.

Pre-Hospital Care

• There is limited information available on pre-hospital treatment for pediatric bronchitis, and most studies focus on in-hospital management and treatment 3, 7, 5.
• However, it is essential to note that pre-hospital care should focus on maintaining patient stability and providing supportive care until hospital arrival.