What is the management approach for adults presenting with symptoms of bronchiolitis?

Management of Bronchiolitis in Adults

Adult bronchiolitis requires cause-specific treatment fundamentally different from pediatric disease, with infectious bacterial cases requiring prolonged antibiotic therapy, while toxic/antigenic exposure or drug-related cases necessitate cessation of the offending agent plus corticosteroids for those with physiologic impairment. 1

Critical Distinction: Adults vs. Pediatrics

• Pediatric bronchiolitis guidelines (American Academy of Pediatrics) explicitly do not apply to adult management 1
• Adult bronchiolitis represents distinct pathophysiologic entities requiring targeted pharmacologic intervention based on underlying etiology, not the supportive care paradigm used in viral pediatric disease 1
• The American College of Chest Physicians emphasizes that pediatric treatment paradigms should never be extrapolated to adults 1

Mandatory Diagnostic Workup Before Treatment

Comprehensive evaluation is required before initiating any therapy: 1

• Pulmonary function testing: Spirometry with and without bronchodilator, lung volumes, and gas exchange testing 1
• Imaging: Chest radiograph and high-resolution CT (HRCT) with expiratory cuts to assess small airways disease 1
• Bronchoscopy: When bacterial suppurative airways disease cannot be excluded clinically 1
• Surgical lung biopsy: When clinical syndrome, physiology, and HRCT findings do not provide confident diagnosis 1

Etiology-Specific Treatment Algorithm

Infectious Bacterial Bronchiolitis

• Prolonged antibiotic therapy is recommended and improves cough 1
• Duration and specific agent selection should be guided by culture results and clinical response 1

Respiratory Bronchiolitis (Smoking-Related)

• Smoking cessation is the primary and essential intervention 1
• No role for antibiotics or corticosteroids in this subtype 1

Toxic/Antigenic Exposure or Drug-Related Bronchiolitis

• Immediate cessation of the exposure or offending medication is mandatory 1
• Add corticosteroid therapy for patients with documented physiologic impairment 1
• Corticosteroids should not be used empirically without evidence of functional decline 1

Common Pitfalls to Avoid

• Do not apply pediatric supportive care protocols (hydration, oxygen monitoring, chest physiotherapy) to adults, as these do not address the underlying pathology in adult disease 1
• Do not initiate treatment without establishing the specific etiology, as inappropriate therapy (e.g., antibiotics for toxic exposure, or corticosteroids for infectious bacterial disease) may worsen outcomes 1
• Do not assume viral etiology as in pediatric cases—adult bronchiolitis is rarely viral and requires different diagnostic and therapeutic approaches 1