What is the treatment for respiratory bronchiolitis?

Treatment for Respiratory Bronchiolitis

The primary treatment for respiratory bronchiolitis is supportive care, including adequate hydration, nasal saline with gentle suctioning, and supplemental oxygen when oxygen saturation falls below 90%. 1

Supportive Care Measures

• Oxygen therapy: Administer when SpO₂ is <90% 1
• Hydration: Ensure adequate fluid intake; use intravenous or nasogastric routes if oral intake is compromised 1, 2
• Nasal suctioning: Clear secretions to improve breathing 1
• Minimal handling: Reduce unnecessary interventions that may stress the infant 3
• High-flow nasal cannula: Consider if respiratory distress worsens despite standard oxygen therapy 1, 3

Pharmacological Interventions

NOT Recommended for Routine Use:

• Bronchodilators: The American Academy of Pediatrics strongly recommends against routine use of bronchodilators in bronchiolitis 1, 4

  • Exception: May be considered in select cases with audible wheezing, but only with objective evaluation of response within 15-20 minutes 1

• Corticosteroids: Not recommended for routine management of bronchiolitis 1, 5, 2

• Antibiotics: Should be avoided unless there is specific evidence of bacterial co-infection 1, 2

• Nebulized hypertonic saline: Current evidence does not support routine use 5, though some earlier studies suggested potential benefit for airway cleaning 3

• Chest physiotherapy: Not recommended as a standard intervention 5, 2

Special Considerations for High-Risk Patients

For infants with underlying conditions such as:

• Prematurity
• Chronic lung disease/bronchopulmonary dysplasia
• Congenital heart disease
• Immunodeficiency

Consider:

• More intensive monitoring
• Lower threshold for hospitalization
• Possible consideration of ribavirin in severe cases (though evidence is limited) 6

Prevention Strategies

• RSV prophylaxis: Palivizumab (15 mg/kg IM) in 5 monthly doses starting before RSV season for eligible high-risk infants 1
• Encourage breastfeeding: Reduces risk of bronchiolitis 1
• Avoid tobacco smoke exposure: Significantly reduces risk 1
• Hand hygiene: Essential before and after patient contact 1

Discharge Criteria

Consider discharge when:

• Oxygen saturation is maintained ≥90% on room air
• Adequate oral intake is established
• Respiratory distress has significantly improved 1

Common Pitfalls to Avoid

1. Overuse of diagnostic tests: Routine chest radiographs and viral testing are not recommended 5, 2

2. Unnecessary medication use: Despite common practice, bronchodilators, corticosteroids, and antibiotics have not demonstrated consistent benefit and may cause harm 1, 5

3. Inadequate monitoring of high-risk infants: Children with risk factors (prematurity, cardiopulmonary disease, immunodeficiency) require closer observation 1, 2

4. Failure to recognize potential for long-term sequelae: RSV bronchiolitis is associated with increased risk of subsequent wheezing; patients should be monitored for this development 1

The management of bronchiolitis has shifted toward minimalist approaches in recent years, with guidelines emphasizing supportive care and discouraging routine use of medications that have not demonstrated clear benefit in controlled trials.