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Published on: November 4, 2010
Management of bronchiolitis
Madeleine Adams1,2, Iolo Doull1,2
1is a Specialist Registrar in Paediatrics at the Cystic Fibrosis/Respiratory Unit, Children's Hospital for Wales, Cardiff, UK.
Insights
Bronchiolitis, a common infant illness, is best managed with supportive care like oxygen and fluids. Many treatments lack benefit, but hypertonic saline may shorten hospital stays, and palivizumab can prevent severe respiratory syncytial virus (RSV) disease.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Bronchiolitis is a frequent cause of infant hospitalization.
- Severity ranges from mild to respiratory failure.
- Respiratory syncytial virus (RSV) is the most common cause.
Purpose of the Study:
- To review the evidence for various treatments and preventative strategies for bronchiolitis.
- To identify effective supportive care measures.
- To highlight treatments lacking proven benefit.
Main Methods:
- Systematic review of existing literature on bronchiolitis management.
- Analysis of clinical trial data for different therapeutic agents.
- Evaluation of preventative strategies like immunoglobulins and monoclonal antibodies.
Main Results:
- Supportive care (fluids, oxygen) is the primary treatment.
- Many agents, including bronchodilators and corticosteroids, show no benefit.
- Nebulized hypertonic saline may reduce hospital stay; nebulized epinephrine offers short-term relief.
- Palivizumab and RSV immunoglobulin can decrease disease severity.
Conclusions:
- Bronchiolitis management relies on supportive care.
- Avoidance of ineffective treatments is crucial.
- Specific interventions like hypertonic saline and palivizumab show promise for improving outcomes and prevention.
Abstract:
Bronchiolitis is the commonest cause of hospital admission in infancy. Severity varies from mild and self-limiting through to respiratory failure requiring intensive care and ventilation. Many viruses cause bronchiolitis, the commonest being respiratory syncytial virus (RSV). Supportive care is the mainstay of treatment, with emphasis on fluid replacement and oxygen therapy. Agents with evidence of no benefit in acute bronchiolitis include β2 agonists, ipratropium, montelukast, corticosteroids, antiviral agents such as ribavirin or RSV immunoglobulin, physiotherapy, nebulized deoxyribonuclease or antibiotics. It is possible that nebulized epinephrine has a small short-term effect, and that nebulized 3% hypertonic saline administered with a bronchodilator may decrease length of stay in hospital. Preventative strategies such as RSV immunoglobulin or the anti-RSV monoclonal antibody palivizumab can decrease disease severity.
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