Update on management of bronchiolitis

Bronchiolitis impacts millions of infants worldwide. Although several therapeutic options stem from highly plausible theoretical rationales for success and some may even offer modest short-term symptom relief, none has been conclusively shown to alter the course of the disease or its major outcomes. However, several recent papers shed light on which treatments show promising preliminary evidence and offer insight into future research endeavors on this topic. This review will summarize bronchiolitis therapy in view of this recent evidence.

The agents in which theory promises but treatment does not deliver include systemic corticosteroids alone, inhaled bronchodilators alone and antileukotrienes. The most promising combination to date appears to be that of oral dexamethasone and inhaled epinephrine but numerous related issues need to be clarified further. Caretakers need to be counselled about the usual protracted clinical course of bronchiolitis.

Because bronchiolitis is a highly heterogeneous entity, future research challenges should include detailed characterization of infants most likely to benefit from given interventions. In the meantime, stick with the good old time-honored supportive route!