Management of Bronchiolitis in Adults

Diagnostic Evaluation and Treatment

• Adult bronchiolitis requires cause-specific treatment tailored to the underlying etiology, with infectious bacterial bronchiolitis requiring prolonged antibiotic therapy, while toxic/antigenic exposure or drug-related bronchiolitis necessitates cessation of the offending agent plus corticosteroids for those with physiologic impairment 1
• The American Academy of Pediatrics guidelines do not apply to adult management, as adult bronchiolitis is fundamentally different from the viral pediatric disease 2
• Comprehensive evaluation is mandatory before initiating treatment and includes spirometry with and without bronchodilator, lung volumes and gas exchange testing, chest radiograph and high-resolution CT (HRCT) with expiratory cuts, bronchoscopy when bacterial suppurative airways disease cannot be excluded, and surgical lung biopsy when clinical syndrome, physiology, and HRCT findings do not provide confident diagnosis 1
• Prolonged antibiotic therapy is recommended and improves cough in infectious bacterial bronchiolitis 1
• Smoking cessation is the primary intervention for respiratory bronchiolitis (smoking-related) 1
• Cessation of the exposure or medication is essential, and add corticosteroid therapy for those with physiologic impairment in toxic/antigenic exposure or drug-related bronchiolitis 1
• The American College of Chest Physicians recommends that pediatric bronchiolitis treatment paradigms should not be applied to adults, as adult disease often requires targeted pharmacologic intervention based on etiology 1