Bronchiolitis Management Guidelines

Pathophysiology and Diagnosis

The American Academy of Pediatrics recommends that bronchiolitis is a clinical diagnosis based on history and physical examination alone, and routine testing such as chest radiographs, viral testing, or laboratory studies should not be ordered 3
The pathophysiologic cascade of bronchiolitis begins with viral infection causing acute inflammation, edema, and necrosis of epithelial cells lining the small airways, combined with increased mucus production and bronchospasm, with the most common causative agent being respiratory syncytial virus (RSV) 1, 2
Key diagnostic features include age between 1-24 months, prodrome of upper respiratory symptoms, and progression to lower respiratory tract symptoms such as tachypnea, wheezing, and increased work of breathing 1, 2, 3

The American Academy of Pediatrics recommends that the cornerstone of bronchiolitis management is supportive care alone, and routine pharmacologic interventions should be avoided 4
Oxygen therapy should be administered only if SpO2 persistently falls below 90%, and maintained at ≥90% 3, 4, 5
Hydration management should include oral feeding if the infant feeds well without respiratory compromise, and IV/nasogastric fluids should be reserved for infants who cannot maintain adequate oral intake 3
Airway clearance with gentle nasal suctioning may provide temporary relief, but chest physiotherapy is not recommended 3

The American Academy of Pediatrics recommends that infection control measures such as avoiding tobacco smoke exposure, limiting visitor exposure during respiratory virus season, and promoting hand hygiene can help prevent RSV transmission 3, 5
Exclusive breastfeeding can reduce hospitalization risk by 72% 3, 5
Palivizumab (RSV prophylaxis) is recommended for high-risk infants, including those born before 29 weeks gestation, with chronic lung disease of prematurity, or with hemodynamically significant congenital heart disease 5

Infants <12 weeks require particularly close monitoring due to higher risk of apnea and severe disease 1, 3, 4
Discharge readiness criteria include SpO2 ≥90% on room air, feeding well without respiratory compromise, minimal respiratory distress, reliable follow-up arranged, and parents educated on warning signs 3, 4, 5
Long-term sequelae of bronchiolitis include increased risk of recurrent wheezing as older children 1