What is the treatment for bronchiolitis?

Treatment of Bronchiolitis

The treatment of bronchiolitis is primarily supportive care, focusing on hydration assessment, oxygen supplementation when needed, and avoiding unnecessary interventions such as bronchodilators, corticosteroids, and antibiotics. 1, 2

Supportive Care

• Hydration assessment is essential - clinicians should evaluate the infant's ability to feed and maintain adequate hydration 1, 2
• For infants with respiratory rates exceeding 60-70 breaths per minute or significant respiratory distress affecting feeding, intravenous fluids should be administered 1
• Clinicians should be aware of potential fluid retention related to antidiuretic hormone production in bronchiolitis patients and adjust fluid management accordingly 1

Oxygen Therapy

• Supplemental oxygen is indicated when oxyhemoglobin saturation (SpO₂) falls persistently below 90% in previously healthy infants 1, 2
• Oxygen therapy can be discontinued when SpO₂ is at or above 90%, the infant is feeding well, and has minimal respiratory distress 1
• Infants with history of hemodynamically significant heart or lung disease and premature infants require closer monitoring during oxygen weaning 1, 2

Non-Recommended Treatments

• Bronchodilators should not be used routinely in bronchiolitis management 1, 2, 3
  • A carefully monitored trial of bronchodilator may be considered, but should only be continued if there is a documented positive clinical response 1, 3
• Corticosteroids should not be used routinely in bronchiolitis treatment 1, 2, 4
• Chest physiotherapy should not be used routinely as it causes more harm than benefit 1
• Antibiotics should only be used when there are specific indications of coexisting bacterial infection 1, 2
  • When acute otitis media is present, it should be managed according to standard guidelines 1
• Ribavirin should not be used routinely in children with bronchiolitis 1, 5
  • FDA labeling indicates ribavirin should only be considered for severe RSV lower respiratory tract infections in hospitalized infants, particularly those with underlying conditions such as prematurity, immunosuppression, or cardiopulmonary disease 5

Advanced Respiratory Support

• For infants with more severe disease, continuous positive airway pressure (CPAP) may be considered, though evidence for its effectiveness is limited 6
• The effect of CPAP on reducing the need for mechanical ventilation remains uncertain, but it may help decrease respiratory rate 6

Monitoring

• Continuous measurement of SpO₂ is not routinely necessary as the child's clinical condition improves 1, 2
• For infants with mild respiratory distress and unaffected feeding, observation alone may be sufficient 1

Common Pitfalls to Avoid

• Overuse of diagnostic tests such as chest radiographs and viral testing, which are not routinely recommended 2, 3
• Continued use of bronchodilators without documented clinical improvement 1, 4
• Failure to recognize signs of respiratory distress that may compromise feeding and hydration 1
• Inadequate monitoring of high-risk infants (premature, those with cardiopulmonary disease) during oxygen weaning 1, 2

Bronchiolitis management should focus on supportive care while avoiding unnecessary interventions that have not demonstrated benefit in clinical outcomes and may potentially cause harm.