Diagnosis and Management of Bronchiolitis

Diagnosis

The American Academy of Pediatrics recommends that bronchiolitis diagnosis be based on history and physical examination alone, without routine laboratory or radiology tests 1
Bronchiolitis is the most common lower respiratory tract infection in infants, characterized by prodromal symptoms of upper respiratory tract infection, followed by cough, tachypnea, and distress 1, 2

Evaluation of risk factors for severe disease is crucial to determine outpatient or inpatient management 1
Risk factors for severe disease include age < 12 weeks, history of prematurity, underlying cardiopulmonary disease, and immunodeficiency 1
Signs of severe disease that require hospitalization include tachypnea with respiratory distress, difficulty feeding, hypoxemia, and significant use of accessory muscles 1, 3, 4

The American Academy of Pediatrics recommends supportive care with oxygen therapy and hydration as the primary treatment for bronchiolitis 1
Oxygen supplementation should be provided to maintain oxygen saturation > 90% 5
Hydration should be maintained through nasogastric or intravenous routes if the infant is unable to maintain hydration with oral intake 2
Nasal suctioning can help clear secretions and saline nasal drops can help relieve congestion 2, 5

Bronchodilators, such as salbutamol or epinephrine, are not recommended for routine use in infants with bronchiolitis 1
Corticosteroids are not recommended for bronchiolitis, as they have not been shown to be effective 1
Antibiotics are not recommended for routine use in bronchiolitis, as it is a viral infection 1

Most cases of bronchiolitis are self-limited and resolve within several days to weeks 6
Cough can persist for up to 3-4 weeks after bronchiolitis 6
If cough persists > 4 weeks, consider protracted bacterial bronchitis and treat with antibiotics for 2 weeks 7, 8, 9

Avoid over-diagnosis of asthma in infants with isolated cough 10, 5
Avoid empirical use of asthma medications without evidence of airway obstruction 5
Avoid use of over-the-counter cough medications in children < 6 years due to lack of efficacy and risk of side effects 2, 5
Avoid routine use of chest radiographs or laboratory tests for diagnosis of bronchiolitis 1