What are the treatments for bronchiolitis in children?

From the Guidelines

The treatment of bronchiolitis in children primarily focuses on supportive care rather than medications, with the mainstay of treatment including ensuring adequate hydration, nasal suctioning, and monitoring oxygen levels with supplemental oxygen provided if necessary 1. The goal of treatment is to support the child's immune system as it fights the infection and to manage symptoms until the airways heal.

• Ensuring adequate hydration through oral fluids or IV fluids if necessary is crucial to prevent dehydration.
• Nasal suctioning to clear secretions can help relieve congestion and improve breathing.
• Monitoring oxygen levels with supplemental oxygen provided if saturation falls below 90-92% is essential to prevent hypoxia. Most cases can be managed at home with careful monitoring, but hospitalization may be needed for infants with severe respiratory distress, dehydration, or oxygen requirements. Medications generally play a limited role in bronchiolitis treatment, with:
• Bronchodilators like albuterol not routinely recommended as they show minimal benefit 1.
• Corticosteroids, antibiotics, and nebulized hypertonic saline not demonstrating consistent benefits and not recommended for routine use 1.
• Antiviral medications like ribavirin rarely used due to limited efficacy, high cost, and potential toxicity. The reason for this supportive approach is that bronchiolitis is a self-limiting viral infection where inflammation and mucus production cause small airway obstruction, and most children recover naturally within 1-2 weeks as their immune systems fight the infection and the airways heal 1.

From the FDA Drug Label

SYNAGIS is a prescription medication that is used to help prevent a serious lung disease caused by Respiratory Syncytial Virus (RSV) in children: born prematurely (at or before 35 weeks) and who are 6 months of age or less at the beginning of RSV season, who have a chronic lung condition called bronchopulmonary dysplasia (BPD), that needed medical treatment within the last 6 months, and who are 24 months of age or less at the beginning of RSV season, born with certain types of heart disease and who are 24 months of age or less at the beginning of RSV season.

The treatment for bronchiolitis in children is prevention of RSV infection using palivizumab (Synagis) in high-risk groups, such as:

• Premature infants
• Children with bronchopulmonary dysplasia (BPD)
• Children with certain types of heart disease Palivizumab is given as a monthly injection during the RSV season to help prevent severe RSV disease. 2

From the Research

Treatments for Bronchiolitis in Children

• The primary approach to managing bronchiolitis is supportive care, focusing on relieving symptoms and supporting the child's respiratory and nutritional needs 3, 4, 5, 6, 7.
• Recommended supportive care measures include:
  • Intravenous or nasogastric hydration and nutritional support 3, 5, 6.
  • Supplemental oxygen therapy to maintain oxygen saturation above 90% 3, 5.
  • Respiratory support as needed 3, 5, 6.
• Pharmacological interventions that are not recommended for routine use in bronchiolitis include:
  • Bronchodilators, such as albuterol and nebulized epinephrine 3, 4, 5, 6.
  • Corticosteroids 3, 4, 5, 6.
  • Hypertonic saline nebulization 3, 4, 5.
  • Antibiotics, except in cases of suspected bacterial co-infection 3, 4, 6.
• Prophylaxis with palivizumab may be considered for high-risk infants, such as those with premature birth, chronic lung disease, or congenital heart disease 4, 5.