Treatment of Respiratory Bronchiolitis

Pediatric Viral Bronchiolitis (Infants and Young Children)

• The American Academy of Pediatrics recommends that supportive care is the mainstay of treatment, and bronchodilators, corticosteroids, antibiotics, and chest physiotherapy should not be used routinely 1, 2.
• Assess the child's ability to feed and hydrate orally as the first priority, and provide intravenous or nasogastric fluids for infants who cannot feed safely due to respiratory distress 5, 6.
• Administer supplemental oxygen if SpO₂ falls persistently below 90% in previously healthy infants, and maintain SpO₂ at or above 90% with adequate supplemental oxygen 5, 6.
• Discontinue oxygen when SpO₂ ≥ 90%, the infant is feeding well, and has minimal respiratory distress 6, 2.
• Do not routinely administer albuterol or other bronchodilators, as studies using pulmonary function tests show no effect of albuterol among hospitalized infants with bronchiolitis 1, 2.
• Corticosteroids should not be used routinely in the treatment of bronchiolitis, as multiple high-quality trials demonstrate no benefit 1, 2.
• Antibiotics should only be used when there are specific indications of coexisting bacterial infection, as routine antibacterial therapy shows no benefit and contributes to antibiotic resistance 2, 7.
• Chest physiotherapy should not be used routinely in the management of bronchiolitis, as a Cochrane Review found no clinical benefit using vibration, percussion, or passive expiratory techniques 2, 7.
• Consider palivizumab prophylaxis for high-risk infants, such as those born prematurely or with chronic lung disease of prematurity, to prevent respiratory syncytial virus infection 3, 4.
• Hand hygiene with alcohol-based disinfectants is the most important step in preventing nosocomial spread of respiratory viruses 3, 4.

Adult Respiratory Bronchiolitis (RB)

• The American Thoracic Society recommends that treatment for adult respiratory bronchiolitis must be tailored to the specific cause or diagnosis, with infectious bacterial bronchiolitis requiring prolonged antibiotic therapy 8.
• Comprehensive evaluation requires spirometry with and without bronchodilator, lung volumes, gas exchange testing, chest radiograph, and HRCT with expiratory cuts to diagnose adult respiratory bronchiolitis 8.
• Bronchoscopy is required before excluding bacterial suppurative airways disease as a cause when more common causes have been excluded, and surgical lung biopsy should be performed when the combination of clinical syndrome, physiology, and HRCT findings do not provide a confident diagnosis 8.
• Prolonged antibiotic therapy improves cough and is recommended for infectious bacterial bronchiolitis, while cessation of the exposure or medication is essential for toxic/antigenic exposure or drug-related bronchiolitis 8.
• Add corticosteroid therapy for those with physiologic impairment due to toxic/antigenic exposure or drug-related bronchiolitis 8.