From the Guidelines
Bronchiolitis treatment is primarily supportive care focused on maintaining hydration and oxygen levels. For most children with mild to moderate disease, home management includes nasal suctioning with saline drops, adequate fluid intake, and monitoring for worsening symptoms. Hospital care may be needed for infants with respiratory distress, oxygen saturation below 90%, or feeding difficulties. Supplemental oxygen is provided when saturation falls below 90-92%. Intravenous or nasogastric fluids may be necessary if the child cannot maintain adequate oral intake.
Key Considerations
- Medications like bronchodilators (albuterol), epinephrine, corticosteroids, and antibiotics are generally not recommended as they have not shown consistent benefit 1.
- Corticosteroid medications should not be used routinely in the management of bronchiolitis due to a preponderance of risk over benefit 1.
- Antibacterial medications should be used only in children with bronchiolitis who have specific indications of the coexistence of a bacterial infection 1.
- Hypertonic saline nebulization (3%) may help in hospitalized infants, particularly in settings where the average length of stay is more than 3 days 1.
Prevention Strategies
- Prevention strategies include handwashing, avoiding exposure to sick contacts, and breastfeeding.
- High-risk infants (premature, with heart/lung conditions) may receive palivizumab (Synagis) prophylaxis during RSV season. Treatment focuses on supportive care because bronchiolitis is typically viral and self-limiting, with most children improving within 1-2 weeks as their immune systems clear the infection.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Overview
- The treatment of bronchiolitis is mainly supportive 2, 3, 4
- Oxygen saturation should be maintained above 90% 2
- Hydration and nutrition should be maintained by nasogastric or intravenous routes, if needed 2
Pharmacological Interventions
- Prophylaxis with palivizumab may be considered for infants at high risk 2, 5, 6
- Palivizumab reduces hospitalisation due to RSV infection 6
- Palivizumab probably results in little to no difference in mortality or adverse events 6
- Therapies such as bronchodilators, epinephrine, nebulized hypertonic saline, corticosteroids, antibiotics, and chest physiotherapy are not recommended 2
Supportive Care
- Assisted feeding and hydration, minimal handling, nasal suctioning, and oxygen therapy are recommended 3
- High-flow nasal cannula can improve oxygen delivery 3
- Nebulized hypertonic saline can help with airway cleaning and improve respiratory function 3