From the Guidelines
Viral respiratory bronchiolitis should be managed with supportive care, focusing on ensuring adequate hydration, oxygen supplementation if oxygen saturation falls below 90-92%, and nasal suctioning to clear secretions, as recommended by the American Academy of Pediatrics 1.
Key Considerations
- The diagnosis of bronchiolitis is primarily clinical, based on history and physical examination, and does not require diagnostic testing 1.
- Bronchodilators like albuterol may be tried but should be continued only if there's clear clinical improvement 1.
- Corticosteroids are not routinely recommended for the treatment of bronchiolitis 1.
- For severe cases requiring hospitalization, high-flow nasal cannula oxygen therapy may be used before considering mechanical ventilation 1.
- Prevention strategies include handwashing, avoiding exposure to cigarette smoke, and limiting contact with sick individuals 1.
- For high-risk infants (premature, with chronic lung disease or congenital heart disease), palivizumab prophylaxis may be given monthly during RSV season (typically 15mg/kg intramuscularly) 1.
Disease Characteristics
- Bronchiolitis is most commonly caused by respiratory syncytial virus (RSV), which inflames and obstructs the small airways, leading to wheezing, coughing, and respiratory distress 1.
- The disease primarily affects infants and young children under 2 years of age 1.
- Most cases resolve within 1-2 weeks, though some children may experience recurrent wheezing episodes following the initial infection 1.
Management Approach
- The management approach should prioritize supportive care and monitoring for signs of severe disease, such as apnea, severe respiratory distress, or hypoxemia 1.
- Routine virologic testing is not recommended, except in cases where cohorting of patients is feasible or to determine if RSV is the etiologic agent in an infant receiving monthly palivizumab prophylaxis 1.
- Chest radiography should be reserved for cases where respiratory effort is severe enough to warrant ICU admission or where signs of an airway complication are present 1.
From the FDA Drug Label
Synagis is indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients: with a history of premature birth (less than or equal to 35 weeks gestational age) and who are 6 months of age or younger at the beginning of RSV season, with bronchopulmonary dysplasia (BPD) that required medical treatment within the previous 6 months and who are 24 months of age or younger at the beginning of RSV season, with hemodynamically significant congenital heart disease (CHD) and who are 24 months of age or younger at the beginning of RSV season
The answer to the question about Viral respiratory bronchiolitis is that palivizumab (IM) is indicated for the prevention of serious lower respiratory tract disease caused by RSV in certain pediatric patients, but it does not directly address viral respiratory bronchiolitis. However, since RSV is a common cause of viral respiratory bronchiolitis, palivizumab may be used to prevent RSV infection, which can lead to viral respiratory bronchiolitis in high-risk infants 2.
- Key points:
- Palivizumab is used to prevent serious lower respiratory tract disease caused by RSV.
- It is indicated for certain pediatric patients with a history of premature birth, bronchopulmonary dysplasia, or hemodynamically significant congenital heart disease.
- While it does not directly address viral respiratory bronchiolitis, it may be used to prevent RSV infection, which can lead to viral respiratory bronchiolitis in high-risk infants.
From the Research
Viral Respiratory Bronchiolitis
- Viral respiratory bronchiolitis is a common lower respiratory tract infection in young children, with Respiratory Syncytial Virus (RSV) being the most common viral cause 3, 4.
- The infection is spread through respiratory droplets, and the number of cases varies with season 3.
- Initial symptoms occur after an incubation period of four to six days and include rhinorrhea, congestion, sneezing, and fever, followed by signs of lower respiratory tract involvement such as cough, tachypnea, retractions, difficulty feeding, and accessory muscle use 3.
Diagnosis and Treatment
- Diagnosis is typically clinical, and routine use of radiography or viral testing is not recommended 3, 4.
- Treatment of RSV bronchiolitis is mainly supportive, with oxygen saturation maintained above 90%, and hydration and nutrition maintained by nasogastric or intravenous routes if needed 3, 5.
- Therapies such as bronchodilators, epinephrine, nebulized hypertonic saline, corticosteroids, antibiotics, and chest physiotherapy are not recommended for routine use 3, 4, 5.
- However, some studies suggest that bronchodilators such as albuterol may be beneficial in certain patients, such as older infants with rhinovirus bronchiolitis or those with wheezing at presentation 6, 7.
Use of Albuterol
- Despite recommendations against routine use, albuterol is widely prescribed to patients with viral bronchiolitis, with predictors of prescription including age, prolonged length of stay, and implementation of clinical practice guidelines 7.
- Some studies suggest that albuterol may be beneficial in patients with specific characteristics, such as rhinovirus bronchiolitis or a family history of asthma 6.
- Further research is needed to determine the effectiveness of albuterol in the treatment of viral bronchiolitis and to identify which patients are most likely to benefit from its use 6, 7.