What is the treatment for bronchiolitis?

From the Guidelines

Bronchiolitis treatment primarily involves supportive care rather than medications, focusing on ensuring adequate hydration, nasal suctioning, and monitoring oxygen levels, as medications like bronchodilators, corticosteroids, and antibiotics show little benefit in this self-limiting viral illness. The mainstay of treatment includes ensuring adequate hydration through oral or IV fluids, nasal suctioning to clear secretions, and monitoring oxygen levels with supplemental oxygen provided if saturation falls below 90% 1. Most cases can be managed at home with careful monitoring, nasal saline drops, and bulb syringe suctioning.

Key Considerations

• Medications like bronchodilators (albuterol), corticosteroids, and antibiotics are generally not recommended as they show little benefit in bronchiolitis, which is typically caused by respiratory syncytial virus (RSV) 1.
• Hospitalization is necessary for infants with severe respiratory distress, inability to maintain hydration, or oxygen saturation below 90%.
• This supportive approach is preferred because bronchiolitis is a self-limiting viral illness where the inflammation must run its course, and medications targeting bronchospasm or inflammation have not demonstrated significant improvement in outcomes.
• Parents should be educated about monitoring for worsening symptoms including increased work of breathing, poor feeding, and lethargy, which would warrant immediate medical attention.

Specific Therapies

• Nebulized hypertonic saline may be considered in specific cases, particularly where the length of stay is expected to be more than 3 days, as it has been shown to improve symptoms and reduce hospital length of stay in such settings 1.
• The use of ribavirin, an antiviral medication, is not routinely recommended due to its marginal benefit, cumbersome delivery requirements, potential health risks for caregivers, and high cost 1.
• Corticosteroids have not been shown to provide significant benefits in the treatment of bronchiolitis and are not recommended for routine use 1.

Prevention and Control

• Prevention of respiratory syncytial virus infection with palivizumab may be considered in high-risk infants, and control of nosocomial spread of infection is crucial in healthcare settings 1.

Overall, the management of bronchiolitis should focus on supportive care, with a careful assessment of the need for hospitalization and the use of specific therapies in selected cases, always prioritizing the well-being and safety of the infant 1.

From the FDA Drug Label

SYNAGIS is a prescription medication that is used to help prevent a serious lung disease caused by Respiratory Syncytial Virus (RSV) in children: born prematurely (at or before 35 weeks) and who are 6 months of age or less at the beginning of RSV season, who have a chronic lung condition called bronchopulmonary dysplasia (BPD), that needed medical treatment within the last 6 months, and who are 24 months of age or less at the beginning of RSV season, born with certain types of heart disease and who are 24 months of age or less at the beginning of RSV season.

The treatment for Bronchiolitis is not directly addressed in the provided drug label for palivizumab (Synagis). The label discusses the use of Synagis for the prevention of serious lung disease caused by Respiratory Syncytial Virus (RSV) in high-risk children, but it does not provide information on the treatment of bronchiolitis itself.

• Key points:
  • Synagis is used for RSV prophylaxis in certain high-risk groups.
  • The label does not mention the treatment of bronchiolitis.
  • Bronchiolitis treatment is not addressed in the provided information 2.

From the Research

Treatment Options for Bronchiolitis

• Supportive care is the mainstay of treatment for bronchiolitis, including assisted feeding and hydration, minimal handling, nasal suctioning, and oxygen therapy 3, 4, 5, 6, 7
• Oxygen therapy should be used to maintain oxyhemoglobin concentrations ≥90% 6, 7
• High-flow nasal cannula may reduce intubation rate, but its effect on length of stay is unclear 7
• Nebulized hypertonic saline may provide some benefit for patients with anticipated prolonged length of stay, but is not routinely recommended 5, 7
• Intravenous or nasogastric tube hydration should be used when oral hydration is not sufficient 7

Pharmacological Therapies

• Many pharmacological therapies, such as bronchodilators, corticosteroids, and antibiotics, have been found to offer no benefit in the treatment of bronchiolitis 3, 4, 5, 6, 7
• Nebulized epinephrine may have a small short-term effect, but its use is not widely recommended 3, 5
• Prophylaxis with palivizumab may be considered for infants at high risk of severe infection 6

Prevention and Prophylaxis

• Preventative strategies, such as RSV immunoglobulin or the anti-RSV monoclonal antibody palivizumab, can decrease disease severity in high-risk infants 3, 5, 6
• Standard precautions, such as hand hygiene, surface cleaning, and avoiding contact with sick individuals, are recommended to prevent the spread of RSV 6