From the Guidelines
The best treatment for cough from bronchiolitis is supportive care, as there is no specific medication that effectively treats the underlying viral infection. Focus on keeping your child comfortable with adequate hydration, using saline nasal drops followed by gentle suction to clear nasal passages, and using a cool-mist humidifier in the room to ease breathing. Over-the-counter cough and cold medications are not recommended for young children with bronchiolitis and may be harmful. Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can be used for fever or discomfort at age-appropriate doses. Most importantly, ensure your child is drinking enough fluids to prevent dehydration. The cough from bronchiolitis typically lasts 2-3 weeks as the body naturally fights the viral infection.
Key Considerations
- Antibiotics are not effective since bronchiolitis is caused by viruses, not bacteria, as noted in the study by 1.
- For children with chronic cough (> 4 weeks) after acute viral bronchiolitis, the cough should be managed according to the CHEST pediatric chronic cough guidelines, which include evaluating for the presence of cough pointers and using 2 weeks of antibiotics targeted to common respiratory bacteria, as suggested by 1.
- Asthma medications should not be used for the cough unless other evidence of asthma is present, such as recurrent wheeze and/or dyspnea, as stated in the study by 1.
- Inhaled osmotic agents should not be used for children with chronic cough (> 4 weeks) after acute viral bronchiolitis, as recommended by 1.
When to Seek Medical Attention
Seek immediate medical attention if your child has difficulty breathing, is breathing very rapidly, has blue lips or fingernails, is extremely irritable, lethargic, or shows signs of dehydration such as decreased urination.
From the Research
Treatment Options for Cough from Bronchiolitis
- The mainstay of therapy for bronchiolitis is supportive care, including assisted feeding and hydration, minimal handling, nasal suctioning, and oxygen therapy 2, 3, 4.
- Nebulized hypertonic saline has been shown to enable better airway cleaning with a benefit for respiratory function 2, 3, 4.
- Nebulized epinephrine has demonstrated a short-term benefit in the treatment of bronchiolitis 2, 4.
- The combination of oral dexamethasone with nebulised epinephrine may decrease the need for hospitalisation, while nebulised 3% hypertonic saline mixed with a bronchodilator may decrease the length of hospitalisation 4.
- Bronchodilators and corticosteroids are commonly used treatments, but there is little evidence to support their routine use in the treatment of bronchiolitis 5, 3.
Pharmacological Interventions
- Many pharmacological therapies, including bronchodilators and corticosteroids, have been found to offer no benefit in the treatment of bronchiolitis 2, 5, 3.
- There is no clear evidence to support the use of antibiotics, antiviral therapy, and chest physiotherapy in the management of bronchiolitis 3.
- The potential effect of hypertonic saline on the course of the acute disease is promising, but further studies are required 3.
Supportive Care
- Supportive care, including administration of oxygen and fluids, is the cornerstone of current treatment for bronchiolitis 3, 4.
- Nasal continuous positive airway pressure may be beneficial in children with severe bronchiolitis, but a large trial is needed to determine its value 3.
- High-flow nasal cannula has been shown to improve the delivery of oxygen in the treatment of bronchiolitis 2.