From the Guidelines
The treatment for Bronchiolitis is primarily supportive, focusing on relieving symptoms and supporting the body's immune response.
Key Components of Treatment
- Supportive care: This includes ensuring adequate hydration, oxygen therapy if necessary, and monitoring for signs of respiratory distress or failure 1.
- Nebulized hypertonic saline: May be used to help loosen and clear mucus from the airways, potentially reducing the length of hospital stay in settings where the average length of stay is more than 3 days 1.
- Bronchodilators: Not recommended for routine use, as they have not been shown to provide significant benefit in most cases of bronchiolitis, and may be associated with adverse effects such as tachycardia 1.
- Corticosteroids: Should not be used routinely, as they have not been shown to provide significant benefit in the management of bronchiolitis, and may be associated with risks 1.
Additional Considerations
- Antiviral agents: May be considered in certain cases, such as those caused by respiratory syncytial virus (RSV), but their use is not routine and should be guided by specific clinical circumstances 1.
- Prevention: Measures such as palivizumab prophylaxis for high-risk infants, and infection control practices to prevent the spread of RSV and other viruses, are important in preventing bronchiolitis 1.
From the Research
Treatment Overview
The treatment for bronchiolitis is primarily supportive, focusing on managing symptoms and preventing complications.
- Supportive care includes fluid replacement, gentle suctioning of nasal secretions, prone position (if in hospital), oxygen therapy, and respiratory support if necessary 2.
- There is no specific antiviral drug used on a routine basis for the treatment of RSV infections, although ribavirin is approved but its use is limited due to adverse side effects 3.
Pharmacologic Interventions
Several pharmacologic interventions have been studied for the treatment of bronchiolitis, including:
- Bronchodilators: beta2-agonist bronchodilators have been commonly used, but their efficacy is often not confirmed by clinical evidence 4.
- Corticosteroids: systemic corticosteroids have shown marginal benefits, but their use is limited due to the risk of adrenal suppression 5.
- Epinephrine: nebulised epinephrine has been demonstrated to offer short-term benefits, and its combination with oral dexamethasone may decrease the need for hospitalization 2.
- Hypertonic saline: inhalations of hypertonic saline did not substantially shorten the stay in hospital for bronchiolitis 5.
Emerging Therapies
Newer therapies, such as high-flow oxygen therapy (HFOT), have shown promise in the treatment of bronchiolitis:
- HFOT with warmed and humidified air-oxygen mixture was superior to traditional low-flow oxygenation in two recent RCTs from Australia and New Zealand 5.
- HFOT is considered a new and promising approach for the treatment of infants with bronchiolitis 5.
Guidelines and Recommendations
The American Academy of Pediatrics (AAP) recommends supportive care as the mainstay of treatment for bronchiolitis, and several national and international guidelines have been published to guide treatment decisions 3, 6.