From the Guidelines
The treatment for acute bronchiolitis primarily involves supportive care, with a focus on ensuring adequate hydration and nutrition, and providing supplemental oxygen if necessary, as the illness is self-limiting and typically resolves within 1-2 weeks. The management of acute bronchiolitis should prioritize supportive care measures, including:
- Ensuring adequate hydration and nutrition through oral, nasogastric, or intravenous routes as needed
- Nasal suctioning to clear secretions, especially before feeds
- Providing supplemental oxygen if oxygen saturation falls below 90-92%
- Most medications have limited effectiveness, and bronchodilators like albuterol are not routinely recommended unless there's a clear response
- Nebulized hypertonic saline (3%) may help in hospitalized infants, as it has been shown to improve symptoms and reduce hospital length of stay in settings where the average length of stay is more than 3 days 1
- Corticosteroids and antibiotics are not recommended unless there's a specific indication like bacterial co-infection, as they have not been shown to be effective in treating acute bronchiolitis and may even cause harm 1
- For severe cases requiring hospitalization, high-flow nasal cannula oxygen or continuous positive airway pressure (CPAP) may be used, and mechanical ventilation is rarely needed but available for respiratory failure. Prevention through good hand hygiene and avoiding exposure to sick contacts is also important, especially for high-risk infants.
From the Research
Treatment of Acute Bronchiolitis
The treatment for acute bronchiolitis is primarily supportive, focusing on maintaining fluid intake, minimal handling, and close observation 2. The following are key aspects of treatment:
- Maintaining oxygen saturation above 90% 3
- Hydration and nutrition through nasogastric or intravenous routes if needed 3
- Oxygen therapy and assisted feeding for hospitalized patients 2, 4
- High-flow nasal cannula for improved oxygen delivery 5
- Nebulized hypertonic saline for better airway cleaning and respiratory function 5
Pharmacological Therapies
Pharmacological therapies for acute bronchiolitis are contentious, with limited evidence supporting their use:
- Sympathomimetics, such as inhaled salbutamol (albuterol), have shown both positive and negative outcomes 2
- Nebulised racemic adrenaline (epinephrine) may be helpful in reducing respiratory distress, but further research is needed 2
- Bronchodilators, corticosteroids, and antibiotics are not recommended for routine use 3
- Ribavirin (tribavirin) may be considered for patients with underlying heart or lung disease, but its effectiveness and cost-effectiveness are debated 2, 4
Ventilatory Support
Continuous positive airway pressure (CPAP) may be beneficial for children with acute bronchiolitis, particularly those with severe disease:
- CPAP aims to widen the lungs' peripheral airways and prevent collapse of small airways during expiration 6
- Limited evidence suggests that CPAP may decrease respiratory rate and improve breathing, but its effect on other outcomes is uncertain 6
- Larger, adequately powered trials are needed to evaluate the effect of CPAP for children with acute bronchiolitis 6