From the Guidelines
The treatment for bronchiolitis is primarily supportive care focused on maintaining hydration, ensuring adequate oxygenation, and relieving symptoms. For most infants with mild to moderate bronchiolitis, home management includes nasal suctioning with a bulb syringe before feeds, adequate fluid intake to prevent dehydration, and fever control with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for infants older than 6 months. Hospital admission is necessary for infants with severe respiratory distress, oxygen saturation below 90%, dehydration, or inability to feed. In the hospital setting, supplemental oxygen is provided to maintain saturation above 90%, and intravenous fluids may be given if the infant cannot feed adequately.
Key Considerations
- Medications like bronchodilators (albuterol), corticosteroids, and antibiotics are generally not recommended as they have not shown significant benefit in bronchiolitis, which is caused by viral infections (commonly RSV) 1.
- Hypertonic saline nebulization (3%) may help in hospitalized infants by improving mucus clearance, particularly in settings where the average length of stay is more than 3 days 1.
- Most cases of bronchiolitis resolve within 1-2 weeks, though cough may persist for several weeks.
- Parents should seek immediate medical attention if their child develops severe respiratory distress, becomes lethargic, or shows signs of dehydration.
Management Approach
- The preponderance of the evidence suggests that 3% saline is safe and effective at improving symptoms of mild to moderate bronchiolitis after 24 hours of use and reducing hospital LOS in settings in which the average LOS is more than 3 days 1.
- However, it has not been shown to be effective at reducing hospitalization in emergency settings or in areas where the length of usage is brief.
- The use of corticosteroid medications is not recommended routinely in the management of bronchiolitis due to a lack of sufficient evidence to support their use and potential risks 1.
From the FDA Drug Label
The safety and efficacy of Synagis have not been established for treatment of RSV disease [see Warnings and Precautions (5.4)]. Synagis is used to help prevent RSV disease. It is not known if SYNAGIS is safe and effective to treat the symptoms of RSV in a child who already has RSV.
The FDA drug label does not provide information on the treatment of bronchiolitis. The label states that Synagis is used for prevention of serious lower respiratory tract disease caused by RSV, but it does not establish its safety and efficacy for treatment of RSV disease 2 2.
From the Research
Treatment Overview
- The treatment for bronchiolitis is largely supportive, with a focus on managing symptoms and preventing complications 3, 4, 5, 6.
- Oxygen therapy is commonly used to maintain oxygen saturation above 90% 4, 5.
- Hydration and nutrition are also crucial, and may be maintained through nasogastric or intravenous routes if necessary 4.
Medications
- There is no proven effective therapy for bronchiolitis other than oxygen for hypoxic children 3.
- Inhaled bronchodilators, adrenaline, and ipratropium bromide are not recommended for routine use 3, 4, 5, 6.
- Corticosteroids, antibiotics, and chest physiotherapy are also not recommended for routine use 3, 4, 5, 6.
- Palivizumab, a monoclonal antibody, may be used as prophylaxis for high-risk infants, such as premature infants or those with chronic lung disease 3, 5.
Prevention
- Prevention of respiratory syncytial virus (RSV) disease remains a challenge, and may involve prophylaxis with palivizumab for high-risk infants 3, 4.
- Education of parents and healthcare workers about diagnostic and management strategies is important, including the fact that bronchiolitis is caused by a virus and is usually self-limiting 3.
- Standard precautions, such as hand hygiene and surface cleaning, can help prevent the spread of RSV 4.