From the Guidelines
The management of bronchiolitis is primarily supportive care, focusing on maintaining hydration and oxygenation. For most infants with bronchiolitis, treatment involves ensuring adequate fluid intake through oral feeding or, if necessary, intravenous fluids 1. Supplemental oxygen should be provided when oxygen saturation falls below 90-92% 1. Nasal suctioning can help clear secretions and improve breathing, especially before feeds. Medications generally have limited effectiveness in bronchiolitis. Bronchodilators like albuterol are not routinely recommended as they show minimal benefit 1. Similarly, corticosteroids, antibiotics, and nebulized hypertonic saline have not demonstrated consistent efficacy and are not recommended for routine use 1. In severe cases requiring hospitalization, high-flow nasal cannula oxygen therapy may be used before considering more invasive respiratory support. Parents should be educated about the self-limiting nature of the illness (typically 1-2 weeks), signs of worsening that require medical attention (increased work of breathing, poor feeding, lethargy), and preventive measures like handwashing and avoiding exposure to cigarette smoke. The supportive approach is based on the viral etiology of bronchiolitis (commonly RSV) and the understanding that the inflammation and mucus production will resolve as the viral infection clears 1.
Some key points to consider in the management of bronchiolitis include:
- The use of pulse oximetry to monitor oxygen saturation and guide the need for supplemental oxygen 1
- The importance of assessing the child's overall clinical condition, including signs of respiratory distress and ability to feed 1
- The limited role of laboratory tests, such as complete blood counts and viral testing, in the diagnosis and management of bronchiolitis 1
- The potential for underlying conditions, such as congenital heart disease or immunodeficiency, to increase the risk of severe disease 1
- The need for parents to be educated about the signs of worsening illness and the importance of seeking medical attention if concerned 1.
Overall, the management of bronchiolitis should focus on providing supportive care and monitoring for signs of worsening illness, rather than relying on medications or other interventions that have limited efficacy.
From the Research
Management of Bronchiolitis
The management of bronchiolitis primarily involves supportive care, as there is no specific treatment for the condition. The following are key aspects of managing bronchiolitis:
- Supportive Care: This includes ensuring adequate hydration and oxygen supplementation 2, 3, 4.
- Oxygen Therapy: Maintaining oxygen saturation above 90% is recommended 4.
- Hydration and Nutrition: Nasogastric or intravenous routes may be used to maintain hydration and nutrition if needed 2, 4.
- Respiratory Support: High flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) may be used as respiratory support in certain cases 5, 6.
Pharmacological Therapies
The use of pharmacological therapies in bronchiolitis is generally not recommended, including:
- Bronchodilators: Such as albuterol and nebulized epinephrine 2, 4.
- Corticosteroids: Not recommended for infants and children with bronchiolitis 2, 4.
- Hypertonic Saline: Not recommended for routine use in bronchiolitis 2, 4.
- Antibiotics: Not recommended unless there is a secondary bacterial infection 4.
Diagnostic Tests
The routine use of certain diagnostic tests is not recommended, including: