From the Guidelines
Bronchiolitis treatment primarily focuses on supportive care rather than medications, with the cornerstone of management including ensuring adequate hydration, nasal suctioning, and monitoring oxygen saturation with supplemental oxygen provided when levels fall below 90-92%. The management of bronchiolitis is largely based on the self-limiting nature of the disease, which typically resolves within 1-2 weeks as the viral infection runs its course and the small airways heal from inflammation 1.
Key Components of Supportive Care
- Ensuring adequate hydration through oral or IV fluids
- Nasal suctioning to clear secretions
- Monitoring oxygen saturation with supplemental oxygen provided when levels fall below 90-92%
- Most cases can be managed at home with careful attention to feeding, hydration, and respiratory status
- Hospitalization is indicated for infants with severe respiratory distress, inability to maintain hydration, or oxygen saturation consistently below 90%
Limited Role of Medications
- Bronchodilators like albuterol are not routinely recommended as they show minimal benefit
- Corticosteroids, antibiotics, and nebulized hypertonic saline have not demonstrated consistent efficacy and are not recommended for routine use
- Antiviral medications like ribavirin are rarely used due to limited efficacy, high cost, and potential toxicity
Prevention Strategies
- Good hand hygiene
- Avoiding exposure to cigarette smoke
- In high-risk infants (premature, with chronic lung disease or congenital heart disease), palivizumab prophylaxis may be considered during RSV season 1.
The American Academy of Pediatrics provides evidence-based recommendations on the diagnosis and management of bronchiolitis, emphasizing the use of only diagnostic and management modalities that have been shown to affect clinical outcomes 1.
From the Research
Treatment and Management of 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, 5, 6.
- High-flow nasal cannula has been shown to improve the delivery of oxygen and may reduce the need for intubation 2, 5.
- Nebulized hypertonic saline may provide some benefit for airway cleaning and respiratory function, but its use is not routinely recommended 2, 5.
- Pharmacological interventions, such as bronchodilators, corticosteroids, and antibiotics, have limited or no evidence of efficacy and are not advised by National Institute of Health and Care Excellence 3, 4, 5, 6.
- Prophylaxis with RSV intravenous immune globulin or palivizumab, a human monoclonal antibody, can reduce hospitalization rates in high-risk patients, but its use is restricted due to high costs 4, 6.
Supportive Care Measures
- Supplemental oxygen should be used to maintain oxyhemoglobin concentrations ≥90% 5.
- Intravenous or nasogastric tube hydration should be used when oral hydration is not sufficient 5.
- Continuous pulse oximetry should not be routinely used in stable patients as it may be associated with longer length of stay (LOS) 5.