From the Guidelines
Bronchiolitis treatment should primarily focus on supportive care, with an emphasis on hydration, nasal suctioning, and monitoring for worsening symptoms, as medications like albuterol, epinephrine, corticosteroids, and antibiotics show limited benefit 1.
Key Considerations
- Most cases can be managed at home with adequate hydration, nasal suctioning to clear secretions, and monitoring for worsening symptoms.
- Ensure the child receives enough fluids through frequent small feedings or oral rehydration solutions.
- For hospitalized children, supplemental oxygen may be provided when oxygen saturation falls below 90-92%.
- Hypertonic saline nebulization (3%) may help in hospitalized infants, particularly in settings where the average length of stay is more than 3 days, as it has been shown to improve symptoms and reduce hospital length of stay in such cases 1.
Warning Signs and Monitoring
- Parents should monitor for warning signs including increased work of breathing, decreased feeding, lethargy, or apnea episodes.
- The illness typically peaks around day 3-5 and gradually improves over 1-2 weeks, though cough may persist longer.
Approach Alignment
- This approach aligns with the understanding that bronchiolitis is a self-limiting viral infection where airway inflammation and mucus production cause the symptoms, and time is the most effective treatment while supporting the child through the illness.
Medication Use
- Contrary to common practice, medications like albuterol, epinephrine, corticosteroids, and antibiotics are generally not recommended as they show limited benefit in bronchiolitis 1.
- The use of hypertonic saline nebulization (3%) is supported by evidence for hospitalized infants in specific settings, but its routine use in outpatient settings is not recommended 1.
From the FDA Drug Label
VIRAZOLE® (Ribavirin for Inhalation Solution, USP) is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV. Treatment early in the course of severe lower respiratory tract infection may be necessary to achieve efficacy. Only severe RSV lower respiratory tract infection should be treated with VIRAZOLE The treatment for bronchiolitis due to RSV is ribavirin (INH), specifically VIRAZOLE, in hospitalized infants and young children with severe lower respiratory tract infections.
- The decision to treat with VIRAZOLE should be based on the severity of the RSV infection.
- Underlying conditions such as prematurity, immunosuppression, or cardiopulmonary disease may increase the severity of clinical manifestations and complications of RSV infection. 2
From the Research
Treatment Options for Bronchiolitis
- The primary treatment for bronchiolitis is supportive care, which includes oxygen therapy, fluid replacement, and nutritional support 3, 4, 5, 6.
- Respiratory support, such as non-invasive ventilation and nasal high flow therapy, may also be used to manage infants with bronchiolitis 7.
- The use of pharmacological interventions, such as bronchodilators, corticosteroids, and ribavirin, is not recommended as they have not been proven to be effective in treating bronchiolitis 3, 4, 5, 6.
Recommended Therapies
- Intravenous or nasogastric hydration and nutritional support 3
- Supplemental oxygen 3, 4, 5, 6
- Respiratory support, such as non-invasive ventilation and nasal high flow therapy 7
Non-Recommended Therapies
- Chest radiographs 3
- Viral testing or laboratory evaluation 3
- Routine administration of bronchodilators, including albuterol and nebulized epinephrine 3, 6
- Corticosteroids 3, 4, 5, 6
- Hypertonic saline 3
- Antibiotics, unless there is a proven concurrent bacterial infection 5
- Exogenous surfactant and heliox therapy, except in severe cases or for further study 4, 5