What is the treatment for bronchiolitis?

Treatment of Bronchiolitis

Bronchiolitis treatment should focus on supportive care, including hydration assessment, oxygen supplementation when needed, and avoidance of unnecessary interventions such as bronchodilators and corticosteroids. 1

Diagnosis and Assessment

• Bronchiolitis is a clinical diagnosis that does not require routine laboratory tests or radiologic studies 2, 1
• Risk factors for severe disease should be assessed, including age less than 12 weeks, history of prematurity, underlying cardiopulmonary disease, or immunodeficiency 2, 1

Recommended Supportive Care

Hydration and Nutrition

• Assess hydration status and ability to take fluids orally 2, 1
• When respiratory rate exceeds 60-70 breaths per minute, feeding may be compromised, particularly with copious nasal secretions 2
• Consider intravenous or nasogastric hydration for infants with respiratory distress that compromises safe feeding 2, 1
• Be aware of potential fluid retention related to antidiuretic hormone production in patients with bronchiolitis 2

Oxygen Therapy

• Provide supplemental oxygen if SpO₂ falls persistently below 90% in previously healthy infants 2, 1
• Maintain SpO₂ at or above 90% with adequate supplemental oxygen 2, 1
• Discontinue oxygen when SpO₂ is ≥90%, the infant is feeding well, and has minimal respiratory distress 2, 1
• Close monitoring during oxygen weaning is required for infants with hemodynamically significant heart or lung disease and premature infants 2, 1

Non-Recommended Interventions

• Bronchodilators should not be used routinely in bronchiolitis management 2, 1, 3

  • A carefully monitored trial may be considered, but should only be continued with documented positive clinical response 2

• Corticosteroids should not be used routinely 2, 1, 3

• Antibiotics should only be used when there are specific indications of coexisting bacterial infection 2, 1, 4

  • When bacterial infection is present, treat as you would in the absence of bronchiolitis 2

• Chest physiotherapy should not be used routinely 2, 1

• Ribavirin should not be used routinely 2

Prevention

Palivizumab Prophylaxis

• Consider palivizumab prophylaxis for high-risk infants 1, 4:

  • Premature infants (≤35 weeks gestational age) who are 6 months or younger at the beginning of RSV season 4
  • Children with bronchopulmonary dysplasia requiring medical treatment within previous 6 months and who are 24 months or younger at the beginning of RSV season 4
  • Children with hemodynamically significant congenital heart disease who are 24 months or younger at the beginning of RSV season 4

• Administer in 5 monthly doses (15 mg/kg per dose intramuscularly), typically starting in November or December 2, 4

Common Pitfalls to Avoid

• Overuse of diagnostic tests (chest X-rays, viral testing, laboratory evaluation) that do not change management 1, 3
• Continued use of bronchodilators despite lack of documented benefit 3, 5
• Inappropriate use of antibiotics without evidence of bacterial coinfection 2, 1
• Neglecting to closely monitor high-risk infants during oxygen weaning 2
• Failure to recognize when an infant with respiratory distress requires intravenous hydration rather than continued oral feeding attempts 2, 1