Materiały źródłowe

• #1 Bronchiolitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565

  Bronchiolitis is a common lung infection in young children and infants. It causes swelling and irritation and a buildup of mucus in the small airways of the lung. These small airways are called bronchioles. Bronchiolitis is almost always caused by a virus. […] Most children get better with care at home. A small number of children need a stay in the hospital. […] If symptoms become serious, call your child’s health care provider. This is especially important if your child is younger than 12 weeks old or has other risk factors for bronchiolitis for example, being born too early, also called premature, or having a heart condition. […] If any of these happen, your child may need to be in the hospital. Severe respiratory failure may require that a tube be guided into the windpipe. This helps your child breathe until the infection improves.

• #2 Patient education: Bronchiolitis and RSV in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics

  Bronchiolitis is common in infants and young children and is one of the leading reasons for hospitalization in this age group. Treatment includes measures to ensure that the child consumes enough fluids and is able to breathe without significant difficulty. […] There is no treatment that can get rid of bronchiolitis, so treatment is aimed at relieving symptoms until the infection resolves. Treatment at home usually includes making sure the child drinks enough and using saline nose drops (or suctioning for infants) to keep the nose clear. […] Severe bronchiolitis should be evaluated in an emergency department or clinic capable of handling urgent respiratory illnesses in children. This is a life-threatening illness, and treatment should not be delayed for any reason. […] Most children who require hospitalization are well enough to return home within three to four days. Children who require a machine to help them breathe usually need to stay in the hospital for a longer period of time before they are ready to go home. […] Most children with bronchiolitis who are otherwise healthy begin to improve within two to five days. However, coughing and wheezing may persist in some infants for a week or longer, and it may take as long as four weeks for the child to return to their „normal” self.

• #3 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  Since no definitive antiviral therapy exists for most causes of bronchiolitis, management of these infants should be directed toward symptomatic relief and maintenance of hydration and oxygenation. Although numerous medications and interventions have been studied for the treatment of bronchiolitis, at present, only oxygen appreciably improves the condition of young children with bronchiolitis and many other medical therapies remain controversial. […] Bronchodilator therapy to relax bronchial smooth muscle, though commonly used, is not supported as routine practice by convincing evidence. If bronchodilator therapy is started, it may be continued in selected patients who demonstrate clinical improvement. […] Despite the prominent role that inflammation plays in the pathogenesis of airway obstruction, large multicenter trials of corticosteroids have clearly failed to show a significant benefit in improving the clinical status of patients with bronchiolitis.

• #4 Pharmacological management of acute bronchiolitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2621418/

  This article reviews the current knowledge base related to the pharmacological treatments for acute bronchiolitis. The mainstays of therapy include airway support, supplemental oxygen, and support of fluids and nutrition. Frequently tried pharmacological interventions, such as ribavirin, nebulized bronchodilators, and systemic corticosteroids, have not been proven to benefit patients with bronchiolitis. Antibiotics do not improve the clinical course of patients with bronchiolitis, and should be used only in those patients with proven concurrent bacterial infection. Exogenous surfactant and heliox therapy also cannot be recommended for routine use, but surfactant replacement holds promise and should be further studied. […] The mainstay of therapy remains supportive care, which includes respiratory support and adequate fluid and nutrition management.

• #5 Bronchiolitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

  Bronchiolitis usually lasts for 1 to 2 weeks but symptoms occasionally last longer. Most children with bronchiolitis can be cared for at home with comfort measures. It’s important to be alert for problems with breathing that are getting worse. […] Because viruses cause bronchiolitis, antibiotics which are used to treat infections caused by bacteria don’t work against viruses. Bacterial infections such as pneumonia or an ear infection can happen along with bronchiolitis. In this case, your child’s health care provider may give an antibiotic for the bacterial infection. […] Medicines called bronchodilators that open the airways don’t seem to help bronchiolitis, so they usually aren’t given. In severe cases, your child’s health care provider may try a nebulized albuterol treatment to see if it helps. During this treatment, a machine creates a fine mist of medicine that your child breathes into the lungs.

• #6 Bronchiolitis Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/8272-bronchiolitis

  How is bronchiolitis treated? Treatment for bronchiolitis focuses on symptom relief, including: Antipyretic (fever reducer) medications. Antiviral medications (like oseltamivir for the flu). […] Bronchiolitis doesn’t always need treatment, so talk to your child’s provider if they have symptoms. Antibiotics won’t help because they’re ineffective at treating viral infections. […] Your child may need to stay in the hospital if they have trouble breathing. Your child may need oxygen therapy or intravenous (IV) fluids in the hospital. […] In addition to monitoring your child’s breathing during their illness, you can help your child feel better at home by: Encouraging your child to get plenty of rest. Feeding your child multiple small meals throughout the day if they don’t have an appetite for a full meal during regular meal times. Giving your child plenty of fluids to prevent dehydration. Breast milk or formula is appropriate for children younger than 1 year. Infants can drink electrolyte beverages like Pedialyte. Setting up a humidifier near your child. Moist, wet air helps loosen mucus. Using saline nose drops and a nasal suction to relieve a stuffy nose. Giving your child a fever reducer like acetaminophen (Tylenol) as directed by their healthcare provider. Giving aspirin to children can increase their risk of developing Reyes syndrome.

• #7 Bronchiolitis Symptoms, Diagnosis and Treatment | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiolitis/symptoms-diagnosis-treatment

  There are no vaccines or specific treatments for bronchiolitis. Antibiotics and cold medicine are not effective in treating bronchiolitis. Most cases go away on their own and can be cared for at home. […] It is key that your child drinks lots of fluids to avoid dehydration. To aid your infants breathing, your doctor may recommend saline nose drops. Using a suction bulb to clear your childs nasal airways is also a simple solution. Your doctor may recommend acetaminophen if they develop a fever. About three percent of children with bronchiolitis will need to be hospitalized. Here the child may be put on humidified oxygen and receive fluids through an IV to prevent dehydration. For the most severe cases, the child may have to have a tube inserted into the windpipe to aid breathing. Most children will be sent home between 2 and 8 days in the hospital.

• #8 Bronchiolitis (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/bronchiolitis.html

  Most cases of bronchiolitis are mild and don’t need specific medical treatment. Antibiotics can’t help because viruses cause bronchiolitis. Antibiotics work only against bacterial infections. […] Treatment focuses on easing symptoms. Kids with bronchiolitis need time to recover and plenty of fluids. Make sure your child gets enough to drink by offering fluids in small amounts often. […] You can use a cool-mist vaporizer or humidifier in your child’s room to help loosen mucus in the airway and relieve cough and congestion. Clean it as recommended to prevent buildup of mold or bacteria. Avoid hot-water and steam humidifiers, which can cause scalding. […] To clear nasal congestion, try a nasal aspirator and saline (saltwater) nose drops. This can be especially helpful before feeding and sleeping.

• #9 Bronchiolitis (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/bronchiolitis.html

  Talk to the doctor before giving your child any medicine. For babies who are old enough, you may be able to give medicine to help with fever and make your child more comfortable. Follow the package directions about how much to give and how often. Do not give aspirin to children who have a viral illness. Such use is linked to Reye syndrome, which can be life-threatening. Babies and young kids should not be given any cough or cold medicines.

• #10 Bronchiolitis Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/8272-bronchiolitis

  How is bronchiolitis treated? Treatment for bronchiolitis focuses on symptom relief, including: Antipyretic (fever reducer) medications. Antiviral medications (like oseltamivir for the flu). […] Bronchiolitis doesn’t always need treatment, so talk to your child’s provider if they have symptoms. Antibiotics won’t help because they’re ineffective at treating viral infections. […] Your child may need to stay in the hospital if they have trouble breathing. Your child may need oxygen therapy or intravenous (IV) fluids in the hospital. […] In addition to monitoring your child’s breathing during their illness, you can help your child feel better at home by: Encouraging your child to get plenty of rest. Feeding your child multiple small meals throughout the day if they don’t have an appetite for a full meal during regular meal times. Giving your child plenty of fluids to prevent dehydration. Breast milk or formula is appropriate for children younger than 1 year. Infants can drink electrolyte beverages like Pedialyte. Setting up a humidifier near your child. Moist, wet air helps loosen mucus. Using saline nose drops and a nasal suction to relieve a stuffy nose. Giving your child a fever reducer like acetaminophen (Tylenol) as directed by their healthcare provider. Giving aspirin to children can increase their risk of developing Reyes syndrome.

• #11 Bronchiolitis

  https://www.nhs.uk/conditions/bronchiolitis/

  There’s no specific treatment for bronchiolitis. It usually gets better on its own and you can look after your child at home. […] But it can be serious in some children, who may need to be treated in hospital. […] give children’s paracetamol to babies and children over 2 months old or ibuprofen to babies and children over 3 months old but do not give aspirin to a child under 16 […] try using salt water (saline) drops if your child’s nose is blocked […] keep your child upright as much as possible when they’re awake this will help them breathe more easily […] encourage your child to drink lots of fluids try smaller feeds more often in babies, and give older children extra water or diluted fruit juice. […] do not smoke around your child […] do not try to lower your child’s temperature by sponging them with cool water or taking off all their clothes. […] Some children may have a higher risk of getting seriously ill with bronchiolitis. […] These children may be able to have treatment in the winter (between October and March) to stop them getting severe bronchiolitis.

• #12 Bronchiolitis

  https://www.nhs.uk/conditions/bronchiolitis/

  There’s no specific treatment for bronchiolitis. It usually gets better on its own and you can look after your child at home. […] But it can be serious in some children, who may need to be treated in hospital. […] give children’s paracetamol to babies and children over 2 months old or ibuprofen to babies and children over 3 months old but do not give aspirin to a child under 16 […] try using salt water (saline) drops if your child’s nose is blocked […] keep your child upright as much as possible when they’re awake this will help them breathe more easily […] encourage your child to drink lots of fluids try smaller feeds more often in babies, and give older children extra water or diluted fruit juice. […] do not smoke around your child […] do not try to lower your child’s temperature by sponging them with cool water or taking off all their clothes. […] Some children may have a higher risk of getting seriously ill with bronchiolitis. […] These children may be able to have treatment in the winter (between October and March) to stop them getting severe bronchiolitis.

• #13 Bronchiolitis

  https://www2.hse.ie/conditions/bronchiolitis/

  Most cases are mild and clear up within 2 to 3 weeks without treatment. […] Antibiotics are not needed and will not help to treat it. […] There’s no specific treatment for bronchiolitis. It will usually clear up on its own after 2 to 3 weeks. […] Do the following for your child as part of your at-home care: Check on them often, day and night. Contact your GP if their symptoms get worse. Give them as much chance to rest as possible. Keep them upright to help them breathe and feed. Offer your child their usual milk feeds. They may need to take smaller amounts more often. You may need to give your child extra water or fruit juice to stop them getting dehydrated. Keep the air moist – making your home too warm will dry out the air. […] If your child is uncomfortable with their high temperature, you can give them medicine to help reduce their temperature. You could give them liquid infant paracetamol. Or, if they are older than 3 months, you can give them liquid ibuprofen.

• #14 Patient education: Bronchiolitis and RSV in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics

  Bronchiolitis is common in infants and young children and is one of the leading reasons for hospitalization in this age group. Treatment includes measures to ensure that the child consumes enough fluids and is able to breathe without significant difficulty. […] There is no treatment that can get rid of bronchiolitis, so treatment is aimed at relieving symptoms until the infection resolves. Treatment at home usually includes making sure the child drinks enough and using saline nose drops (or suctioning for infants) to keep the nose clear. […] Severe bronchiolitis should be evaluated in an emergency department or clinic capable of handling urgent respiratory illnesses in children. This is a life-threatening illness, and treatment should not be delayed for any reason. […] Most children who require hospitalization are well enough to return home within three to four days. Children who require a machine to help them breathe usually need to stay in the hospital for a longer period of time before they are ready to go home. […] Most children with bronchiolitis who are otherwise healthy begin to improve within two to five days. However, coughing and wheezing may persist in some infants for a week or longer, and it may take as long as four weeks for the child to return to their „normal” self.

• #15 How is bronchiolitis treated and managed? | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/bronchiolitis/treatment

  Most babies have very mild bronchiolitis and this can be managed really safely at home. […] A few babies, maybe about three in 100 will develop bronchiolitis that’s severe enough that requires treatment in hospital. […] The thing to remember is bronchiolitis is caused by a virus infection, so there’s no specific treatment for the actual infection. […] But what we do is treat the babies and support them while their body fights the infection naturally. […] The two main things we consider are: have they got enough oxygen in their blood stream, and if they haven’t then they may need oxygen which is delivered either by a face mask or some small tubes in the nostril. […] Oxygen therapy is one reason a baby may need to be admitted and the other is if they’re not taking enough fluids. […] If they’re not managing enough fluids at home, they may to be admitted to either have fluids by a tube which goes into the nose and sits in the tummy, a feeding tube.

• #16 How is bronchiolitis treated and managed? | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/bronchiolitis/treatment

  If they’re not tolerating that because their breathing is a bit fast and difficult and laboured, then they may need fluids into their vein to stop them from becoming dehydrated. […] They’re the main sort of measures we use to manage babies in hospital. […] Around 3 in 100 babies with bronchiolitis need treating in hospital. […] If your baby has low blood oxygen levels, they may be given oxygen through a small soft tube placed in their nostril (nasal canula) or a face mask. […] If your child is given CPAP, they will breathe in air and oxygen through small tubes placed in their nose (nasal prongs) or a face mask. […] If your baby cannot drink enough fluids, they might get feeding support. […] If your baby has extra phlegm (mucus) in their airways and they cannot clear it by themselves, they might get airway suctioning.

• #17 Bronchiolitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

  Oral corticosteroid medicines and pounding on the chest to loosen mucus, a treatment called chest physiotherapy, have not been shown to be effective for bronchiolitis and are not recommended. […] A small number of children may need a stay in the hospital. Your child may receive oxygen through a face mask to get enough oxygen into the blood. Your child also may get fluids through a vein to prevent dehydration. In severe cases, a tube may be guided into the windpipe to help breathing.

• #18 Bronchiolitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441959/

  Bronchiolitis is managed supportively with hydration and oxygen. No specific medications treat the infection. […] The hallmark of management for children with bronchiolitis is symptomatic care. All infants and children who are diagnosed with bronchiolitis should be carefully assessed for adequacy of hydration, respiratory distress, and presence of hypoxia. […] Children who present with mild to moderate symptoms can be treated with interventions like nasal saline, antipyretics, and a cool-mist humidifier. Those children with severe symptoms of acute respiratory distress, signs of hypoxia, and/or dehydration should be admitted and monitored. These children need aggressive hydration. […] The use of beta-adrenergic agonists like epinephrine or albuterol, or even steroids, has not been shown to be effective in children with bronchiolitis. Instead, these children should be provided with humidified oxygen and nebulized hypertonic saline. Ensuring that the infant is well hydrated is key, especially for those who cannot eat.

• #19 How is bronchiolitis treated and managed? | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/bronchiolitis/treatment

  Most babies have very mild bronchiolitis and this can be managed really safely at home. […] A few babies, maybe about three in 100 will develop bronchiolitis that’s severe enough that requires treatment in hospital. […] The thing to remember is bronchiolitis is caused by a virus infection, so there’s no specific treatment for the actual infection. […] But what we do is treat the babies and support them while their body fights the infection naturally. […] The two main things we consider are: have they got enough oxygen in their blood stream, and if they haven’t then they may need oxygen which is delivered either by a face mask or some small tubes in the nostril. […] Oxygen therapy is one reason a baby may need to be admitted and the other is if they’re not taking enough fluids. […] If they’re not managing enough fluids at home, they may to be admitted to either have fluids by a tube which goes into the nose and sits in the tummy, a feeding tube.

• #20 How is bronchiolitis treated and managed? | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/bronchiolitis/treatment

  If they’re not tolerating that because their breathing is a bit fast and difficult and laboured, then they may need fluids into their vein to stop them from becoming dehydrated. […] They’re the main sort of measures we use to manage babies in hospital. […] Around 3 in 100 babies with bronchiolitis need treating in hospital. […] If your baby has low blood oxygen levels, they may be given oxygen through a small soft tube placed in their nostril (nasal canula) or a face mask. […] If your child is given CPAP, they will breathe in air and oxygen through small tubes placed in their nose (nasal prongs) or a face mask. […] If your baby cannot drink enough fluids, they might get feeding support. […] If your baby has extra phlegm (mucus) in their airways and they cannot clear it by themselves, they might get airway suctioning.

• #21 UPDATE – 2022 Italian guidelines on the management of bronchiolitis in infants | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01392-6

  A gentle, superficial and reasonably frequent nasal aspiration, especially in younger children, is recommended to improve airway patency, O2 saturation measured by pulse oximetry (SpO2), and feeding. Supplemental O2 should be administered if O2 saturation levels are persistently below 92% in room air. […] Since there is no vaccine against RSV (i.e., the main aetiologic agent of bronchiolitis), environmental prophylaxis is crucial in preventing and limiting bronchiolitis spreading. Pharmacological immunoprophylaxis (Palivizumab) has proven beneficial to populations at increased risk for RSV infection-related complications.

• #22 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  Corticosteroids should not routinely be used. […] Nutrition and hydration should be assessed. The ability of an infant with respiratory distress due to bronchiolitis to take oral fluids should be evaluated and nasogastric or intravenous hydration may be used as needed. […] Chest physiotherapy has not shown to benefit infants with bronchiolitis. […] Medical therapy for bronchiolitis seems to be disappointing, but chest physiotherapy cannot be recommended either. […] Medications have a limited role in the management of bronchiolitis. Several drugs are commonly used (eg, bronchodilators), but there is little in the way of conclusive evidence to support routine use of any drug in the management of bronchiolitis. […] Antiviral therapy is not routinely recommended for cases of bronchiolitis.

• #23 Bronchiolitis | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/bronchiolitis-16689519.html

  Place the infant in a semi-reclining position. […] Nasal irrigation, small, frequent feeds, treatment of fever: as for outpatient treatment. […] Gentle oro-pharyngeal suction if needed. […] Monitor fluid intake: normal requirements are 80 to 100 ml/kg/day + 20 to 25 ml/kg/day with high fever or very profuse secretions. […] Humidified nasal oxygen if respiratory distress or SpO2 92%. […] Bronchodilator therapy is not indicated but a trial treatment may be given in case of severe respiratory distress (salbutamol metered-dose inhaler, 100 micrograms/puff: 2 to 3 puffs with spacer, repeated 2 times at an interval of 30 minutes). If inhaled salbutamol appears effective in relieving symptoms, the treatment is continued (2 to 3 puffs every 6 hours in the acute phase, then gradual reduction as recovery takes place). If the trial is ineffective, the treatment is discontinued. […] Antibiotics are not indicated unless there is concern about complications such as secondary bacterial pneumonia.

• #24 Bronchiolitis – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/bronchiolitis/

  IF your baby or child is not able to drink at all they may need to be given either: Feeds or special fluids through a nasogastric tube (a small tube) passed through their nose into their stomach. […] Special fluids through a cannula (a fine tube) inserted into a vein in the back of their hand, arm or foot using a small, fine needle. This is called an intravenous drip. […] When your baby or child is able to feed and breathe more easily and no longer needs extra oxygen you will be able to take them home.

• #25 How is bronchiolitis treated and managed? | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/bronchiolitis/treatment

  If they’re not tolerating that because their breathing is a bit fast and difficult and laboured, then they may need fluids into their vein to stop them from becoming dehydrated. […] They’re the main sort of measures we use to manage babies in hospital. […] Around 3 in 100 babies with bronchiolitis need treating in hospital. […] If your baby has low blood oxygen levels, they may be given oxygen through a small soft tube placed in their nostril (nasal canula) or a face mask. […] If your child is given CPAP, they will breathe in air and oxygen through small tubes placed in their nose (nasal prongs) or a face mask. […] If your baby cannot drink enough fluids, they might get feeding support. […] If your baby has extra phlegm (mucus) in their airways and they cannot clear it by themselves, they might get airway suctioning.

• #26 In-patient Care of Babies and Children with Bronchiolitis – Alder Hey Children’s Hospital Trust

  https://www.alderhey.nhs.uk/conditions/patient-information-leaflets/in-patient-care-of-babies-and-children-with-bronchiolitis/

  There are no medicines to treat the viruses that cause bronchiolitis, but there are things we can do for your baby / child whilst in hospital to help them recover: […] Feeding – To help with your baby / child’s feeding, a nasogastric tube (NGT) may be passed through the nose directly into their stomach. A satisfactory amount of milk will be given according to your baby / child’s weight. If you are breast feeding, we may ask you to express your milk so that it can be used if your baby / child is unable to feed by mouth. […] Oxygen – This is given to help with your baby / child’s breathing. Small prongs are placed in the nose and a small volume of oxygen is delivered this way. If your child requires more oxygen, they will be placed on “high flow”. […] Suction – This is a small tube that is placed into the nose and can be used to help clear secretions.

• #27 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  Corticosteroids should not routinely be used. […] Nutrition and hydration should be assessed. The ability of an infant with respiratory distress due to bronchiolitis to take oral fluids should be evaluated and nasogastric or intravenous hydration may be used as needed. […] Chest physiotherapy has not shown to benefit infants with bronchiolitis. […] Medical therapy for bronchiolitis seems to be disappointing, but chest physiotherapy cannot be recommended either. […] Medications have a limited role in the management of bronchiolitis. Several drugs are commonly used (eg, bronchodilators), but there is little in the way of conclusive evidence to support routine use of any drug in the management of bronchiolitis. […] Antiviral therapy is not routinely recommended for cases of bronchiolitis.

• #28 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  The belief that corticosteroids can prevent or reduce the major pathology of inflammation and edema of the bronchiolar mucosa is tempting. However, the data indicate that these agents should not be used routinely in this setting. […] Numerous studies have failed to conclusively define a beneficial role for routine use of glucocorticoids in the treatment of infants with bronchiolitis. […] While nebulized hypertonic saline have been used for treating hospitalized, as well as ambulatory, children with viral bronchiolitis with varying degrees of success, there is accumulating convincing evidence that does not support hypertonic saline’s effect in reducing length of hospital stay for acute viral bronchiolitis in a typical US population. […] A 2012 Cochrane review, which included 9 studies of children younger than 2 years with acute bronchiolitis, confirmed that chest physiotherapy does not decrease the severity of the disease, improve respiratory parameters, shorten the hospital stay, or reduce oxygen requirements in nonventilated hospitalized patients.

• #29 Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months | Canadian Paediatric Society

  https://cps.ca/documents/position/bronchiolitis

  The use of corticosteroids is not recommended in routine cases. […] The use of antibiotics is not recommended unless there is evidence, or strong suspicion of an underlying bacterial infection. […] The use of chest physiotherapy is not recommended. […] Thoughtful use of oxygen saturation monitoring in hospitalized patients is recommended. Continuous saturation monitoring may be indicated for high-risk children in the acute phase of illness, and intermittent monitoring or spot checks are appropriate for lower-risk children and patients who are improving clinically.

• #30 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  The authors’ confidence in the effects of these treatments was low due to imprecisions of the contributing studies, and they concluded that no changes to current clinical practice guidelines are needed based on the current knowledge. […] As a consequence of the lack of evidence-based support for medicinal interventions to treat bronchiolitis, admission rates and treatment approaches vary widely, particularly in the ED. […] A survey of members of the Emergency Medicine section of the American Academy of Pediatrics (AAP) found that 96% recommended bronchodilators and 8% recommended steroids. […] Bronchodilators should not be routinely used; routine use of a trial of bronchodilator therapy was de-emphasized in the updated guidelines due to the lack of supportive evidence of benefit exceeding potential harm.

• #31 Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months | Canadian Paediatric Society

  https://cps.ca/documents/position/bronchiolitis

  Bronchiolitis is a self-limiting disease, usually managed with supportive care at home. […] For those requiring admission, supportive care with assisted feeding, minimal handling, gentle nasal suctioning and oxygen therapy still forms the mainstay of treatment. […] Supplemental oxygen therapy is a mainstay of treatment in hospital. Oxygen should be administered if saturations fall below 90% and used to maintain saturations at 90%. […] Some degree of fluid supplementation is required in 30% of hospitalized patients with bronchiolitis. […] The use of epinephrine is not recommended in routine cases. […] Current evidence does not support the use of hypertonic 3% sodium chloride in routine cases of bronchiolitis. […] The use of salbutamol (Ventolin) is not recommended in routine cases.

• #32 UPDATE – 2022 Italian guidelines on the management of bronchiolitis in infants | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01392-6

  Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. […] Since a specific etiological treatment is not available, bronchiolitis therapy includes general supportive management to control pulmonary and systemic clinical symptoms. Therapy for bronchiolitis and related recommendations for clinical practice are summarized in Table 6. Inhaled bronchodilators, nebulized adrenaline, steroids (systemic or nebulized) and antibiotics are not recommended.

• #33 Bronchiolitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

  Bronchiolitis usually lasts for 1 to 2 weeks but symptoms occasionally last longer. Most children with bronchiolitis can be cared for at home with comfort measures. It’s important to be alert for problems with breathing that are getting worse. […] Because viruses cause bronchiolitis, antibiotics which are used to treat infections caused by bacteria don’t work against viruses. Bacterial infections such as pneumonia or an ear infection can happen along with bronchiolitis. In this case, your child’s health care provider may give an antibiotic for the bacterial infection. […] Medicines called bronchodilators that open the airways don’t seem to help bronchiolitis, so they usually aren’t given. In severe cases, your child’s health care provider may try a nebulized albuterol treatment to see if it helps. During this treatment, a machine creates a fine mist of medicine that your child breathes into the lungs.

• #34 Treating Acute Bronchiolitis Associated with RSV | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p325.html

  Treatment for infants with bronchiolitis caused by respiratory syncytial virus (RSV) includes supplemental oxygen, nasal suctioning, fluids to prevent dehydration, and other supportive therapies. […] Inhaled beta2-agonist bronchodilators, the anticholinergic agent ipratropium bromide, and nebulized epinephrine have not been shown to be effective for treating RSV bronchiolitis. […] However, the Agency for Healthcare Research and Quality states that nebulized epinephrine and nebulized ipratropium bromide are possibly effective. […] The appropriate use of corticosteroids remains controversial. […] Prophylaxis with RSV intravenous immune globulin or palivizumab, a human monoclonal antibody, can reduce hospitalization rates in high-risk patients, although difficulties with administering the medications and high costs may preclude their widespread use.

• #35 Treating Acute Bronchiolitis Associated with RSV | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p325.html

  Recent meta-analyses show that among patients with RSV infections, beta2-agonist bronchodilators do not reduce hospital admission rates or meaningfully improve oxygen saturation levels among patients with RSV infections. […] Ipratropium bromide (Atrovent) is an anticholinergic bronchodilator with no proven efficacy for RSV bronchiolitis. […] The AAP generally does not recommend ribavirin treatment for RSV infections. […] The AHRQ classifies ribavirin as probably ineffective. […] The empiric use of broad-spectrum intravenous antibiotics is therefore unnecessary in children with typical signs and symptoms of RSV bronchiolitis, and may be harmful.

• #36 Respiratory Syncytial Virus Bronchiolitis in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0115/p94.html

  Bronchodilators should not be administered to infants and children with bronchiolitis. Despite short-term improvement in clinical symptom scores, they have no effect on the need for hospitalization, oxygen saturation, length of hospitalization, or disease resolution. […] Epinephrine should not be administered to children with bronchiolitis in the inpatient setting. […] Systemic or inhaled corticosteroids should not be used to treat bronchiolitis in any setting. […] Antibiotics should not be administered to infants and children with bronchiolitis and should be reserved for those with concomitant bacterial infection. […] Other treatments with no clear clinical benefit include chest physiotherapy and excessive nasal suction of secretions.

• #37 Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months | Canadian Paediatric Society

  https://cps.ca/documents/position/bronchiolitis

  Bronchiolitis is a self-limiting disease, usually managed with supportive care at home. […] For those requiring admission, supportive care with assisted feeding, minimal handling, gentle nasal suctioning and oxygen therapy still forms the mainstay of treatment. […] Supplemental oxygen therapy is a mainstay of treatment in hospital. Oxygen should be administered if saturations fall below 90% and used to maintain saturations at 90%. […] Some degree of fluid supplementation is required in 30% of hospitalized patients with bronchiolitis. […] The use of epinephrine is not recommended in routine cases. […] Current evidence does not support the use of hypertonic 3% sodium chloride in routine cases of bronchiolitis. […] The use of salbutamol (Ventolin) is not recommended in routine cases.

• #38 Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2023.01676

  Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis […] This study compared the efficacy of different treatment modalities for infants with bronchiolitis in terms of hospital stay and clinical severity scores. […] Inhalation therapy with epinephrine and hypertonic saline reduced the length of hospital stay and the clinical severity of bronchiolitis among infants under 2 years of age. […] Inhalation therapy with epinephrine (standard mean difference [SMD], -0.41; 95% confidence interval [CI], -0.8 to -0.03) and hypertonic saline (SMD, -0.29; 95% CI, -0.55 to -0.03) reduced the length of hospital stay compared with normal saline. Hypertonic saline was the most effective at improving the clinical severity score (SMD, -0.52; 95% CI, -0.95 to -0.10).

• #39 Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2023.01676

  This study analyzed 45 randomized controlled trials (5,061 participants, 13 interventions) of the comparative efficacies of treatments for acute bronchiolitis in infants. Inhalation therapy with epinephrine and hypertonic saline significantly reduced the length of hospital stay compared with normal saline. Hypertonic saline had the greatest ability to improve the clinical severity score of bronchiolitis in infants younger than 2 years of age. […] Based on our results, epinephrine and hypertonic saline can be considered as effective treatment options. […] A Cochrane review demonstrated that epinephrine significantly decrease the risk of hospitalization. In addition, the combination of epinephrine and hypertonic saline has been reported to reduce the length of hospital stay. […] Consequently, epinephrine and hypertonic saline are regarded to have an effect to reduce the length of hospital stay.

• #40 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  Corticosteroids should not routinely be used. […] Nutrition and hydration should be assessed. The ability of an infant with respiratory distress due to bronchiolitis to take oral fluids should be evaluated and nasogastric or intravenous hydration may be used as needed. […] Chest physiotherapy has not shown to benefit infants with bronchiolitis. […] Medical therapy for bronchiolitis seems to be disappointing, but chest physiotherapy cannot be recommended either. […] Medications have a limited role in the management of bronchiolitis. Several drugs are commonly used (eg, bronchodilators), but there is little in the way of conclusive evidence to support routine use of any drug in the management of bronchiolitis. […] Antiviral therapy is not routinely recommended for cases of bronchiolitis.

• #41 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  The belief that corticosteroids can prevent or reduce the major pathology of inflammation and edema of the bronchiolar mucosa is tempting. However, the data indicate that these agents should not be used routinely in this setting. […] Numerous studies have failed to conclusively define a beneficial role for routine use of glucocorticoids in the treatment of infants with bronchiolitis. […] While nebulized hypertonic saline have been used for treating hospitalized, as well as ambulatory, children with viral bronchiolitis with varying degrees of success, there is accumulating convincing evidence that does not support hypertonic saline’s effect in reducing length of hospital stay for acute viral bronchiolitis in a typical US population. […] A 2012 Cochrane review, which included 9 studies of children younger than 2 years with acute bronchiolitis, confirmed that chest physiotherapy does not decrease the severity of the disease, improve respiratory parameters, shorten the hospital stay, or reduce oxygen requirements in nonventilated hospitalized patients.

• #42 Pharmacological management of acute bronchiolitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2621418/

  Bronchodilators are frequently tried in infants presenting with wheezing due to bronchiolitis because of its similarity to asthma. Their routine use is controversial. Despite many randomized, controlled trials (RCT), no consistent benefit has been demonstrated. […] In summary, albuterol has not been shown to consistently reduce the duration or severity of illness or length of hospital stay, and so cannot be recommended for routine care of the patient with bronchiolitis. […] Corticosteroids have not been shown to be effective and are not recommended for routine use. […] Ribavirin is not recommended for routine use in patients with bronchiolitis, although it may be of benefit in immunocompromised patients. […] We conclude that antibiotics should be used in patients with bronchiolitis only when specific evidence of coexistent bacterial infection is present and confirmed bacterial infections should be managed no differently than in the absence of bronchiolitis. […] Administration of exogenous surfactant to infants with severe respiratory failure due to bronchiolitis seems promising. […] Heliox therapy may be tried for the treatment of severe respiratory failure, although additional studies are needed before they can be recommended for routine use.

• #43 Treating Acute Bronchiolitis Associated with RSV | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p325.html

  Supportive care, attention to adequate hydration and, possibly, supplemental oxygen are the basis of therapy for RSV infection. […] The basic management principles for infants hospitalized with acute viral bronchiolitis are oxygen therapy, fluids to prevent dehydration, respiratory support, and parental education. […] One evidence-based practice guideline states that routine laboratory studies for RSV infection, including nasopharyngeal washing to determine the presence of the RSV antigen, are not indicated. […] The evidence for and appropriate use of corticosteroids in the treatment of RSV infection remains controversial. […] The AAP does not recommend the use of corticosteroids in hospitalized infants with RSV. […] The AHRQ suggests that further studies are needed. […] The recent AHRQ evidence report states that nebulized epinephrine is possibly effective.

• #44 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  The belief that corticosteroids can prevent or reduce the major pathology of inflammation and edema of the bronchiolar mucosa is tempting. However, the data indicate that these agents should not be used routinely in this setting. […] Numerous studies have failed to conclusively define a beneficial role for routine use of glucocorticoids in the treatment of infants with bronchiolitis. […] While nebulized hypertonic saline have been used for treating hospitalized, as well as ambulatory, children with viral bronchiolitis with varying degrees of success, there is accumulating convincing evidence that does not support hypertonic saline’s effect in reducing length of hospital stay for acute viral bronchiolitis in a typical US population. […] A 2012 Cochrane review, which included 9 studies of children younger than 2 years with acute bronchiolitis, confirmed that chest physiotherapy does not decrease the severity of the disease, improve respiratory parameters, shorten the hospital stay, or reduce oxygen requirements in nonventilated hospitalized patients.

• #45 Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2023.01676

  Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis […] This study compared the efficacy of different treatment modalities for infants with bronchiolitis in terms of hospital stay and clinical severity scores. […] Inhalation therapy with epinephrine and hypertonic saline reduced the length of hospital stay and the clinical severity of bronchiolitis among infants under 2 years of age. […] Inhalation therapy with epinephrine (standard mean difference [SMD], -0.41; 95% confidence interval [CI], -0.8 to -0.03) and hypertonic saline (SMD, -0.29; 95% CI, -0.55 to -0.03) reduced the length of hospital stay compared with normal saline. Hypertonic saline was the most effective at improving the clinical severity score (SMD, -0.52; 95% CI, -0.95 to -0.10).

• #46 Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2023.01676

  This study analyzed 45 randomized controlled trials (5,061 participants, 13 interventions) of the comparative efficacies of treatments for acute bronchiolitis in infants. Inhalation therapy with epinephrine and hypertonic saline significantly reduced the length of hospital stay compared with normal saline. Hypertonic saline had the greatest ability to improve the clinical severity score of bronchiolitis in infants younger than 2 years of age. […] Based on our results, epinephrine and hypertonic saline can be considered as effective treatment options. […] A Cochrane review demonstrated that epinephrine significantly decrease the risk of hospitalization. In addition, the combination of epinephrine and hypertonic saline has been reported to reduce the length of hospital stay. […] Consequently, epinephrine and hypertonic saline are regarded to have an effect to reduce the length of hospital stay.

• #47 Update on the Management of Bronchiolitis in Children

  https://www.uspharmacist.com/article/update-on-the-management-of-bronchiolitis-in-children

  Viral bronchiolitis is a common respiratory infection in children. […] In 2014, the American Academy of Pediatrics published new treatment guidelines for bronchiolitis. Treatment with ribavirin continues to be reserved for life-threatening situations, while the efficacy of corticosteroids remains questionable. Bronchodilators are no longer a recommended therapy for bronchiolitis; however, there may be a role for inhaled epinephrine. Inhaled hypertonic saline has been endorsed for its advantages in reducing symptoms, hospital admissions, and length of hospital stay. […] Pharmacotherapy for patients hospitalized with bronchiolitis has included a trial of bronchodilators, corticosteroids in some instances, and ribavirin for severely ill patients. In 2014, the American Academy of Pediatrics (AAP) published guidelines that discourage the use of bronchodilators and newly endorse the use of inhaled hypertonic saline in hospitalized children.

• #48 Update on the Management of Bronchiolitis in Children

  https://www.uspharmacist.com/article/update-on-the-management-of-bronchiolitis-in-children

  The updated AAP guidelines list transient improvements that did not translate to better disease resolution, reduced hospital length of stay (LOS), or hospitalization rates. […] The 2014 AAP guidelines recommend administration of HS in hospitalized bronchiolitis patients, but advise against its use in patients in the ED. […] With no clear evidence for a benefit from corticosteroids in the management of bronchiolitis, the updated AAP guidelines do not recommend their routine use. […] Ribavirin is reserved as a last-line agent for life-threatening bronchiolitis in patients who are immunocompromised or who have hemodynamically significant cardiopulmonary disease. […] The management of bronchiolitis remains focused on symptom alleviation in otherwise healthy children; however, based on recent trials, the 2014 AAP guidelines have significantly changed the choice of pharmacotherapy. […] The new therapy recommended by the AAP is HS inhalation. Its benefits include reducing symptoms of bronchiolitis, reducing hospital LOS, and potentially preventing hospital admissions from the ED without causing AEs.

• #49 Bronchiolitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

  Bronchiolitis usually lasts for 1 to 2 weeks but symptoms occasionally last longer. Most children with bronchiolitis can be cared for at home with comfort measures. It’s important to be alert for problems with breathing that are getting worse. […] Because viruses cause bronchiolitis, antibiotics which are used to treat infections caused by bacteria don’t work against viruses. Bacterial infections such as pneumonia or an ear infection can happen along with bronchiolitis. In this case, your child’s health care provider may give an antibiotic for the bacterial infection. […] Medicines called bronchodilators that open the airways don’t seem to help bronchiolitis, so they usually aren’t given. In severe cases, your child’s health care provider may try a nebulized albuterol treatment to see if it helps. During this treatment, a machine creates a fine mist of medicine that your child breathes into the lungs.

• #50 Pharmacological management of acute bronchiolitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2621418/

  Bronchodilators are frequently tried in infants presenting with wheezing due to bronchiolitis because of its similarity to asthma. Their routine use is controversial. Despite many randomized, controlled trials (RCT), no consistent benefit has been demonstrated. […] In summary, albuterol has not been shown to consistently reduce the duration or severity of illness or length of hospital stay, and so cannot be recommended for routine care of the patient with bronchiolitis. […] Corticosteroids have not been shown to be effective and are not recommended for routine use. […] Ribavirin is not recommended for routine use in patients with bronchiolitis, although it may be of benefit in immunocompromised patients. […] We conclude that antibiotics should be used in patients with bronchiolitis only when specific evidence of coexistent bacterial infection is present and confirmed bacterial infections should be managed no differently than in the absence of bronchiolitis. […] Administration of exogenous surfactant to infants with severe respiratory failure due to bronchiolitis seems promising. […] Heliox therapy may be tried for the treatment of severe respiratory failure, although additional studies are needed before they can be recommended for routine use.

• #51 Respiratory Syncytial Virus Bronchiolitis in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0115/p94.html

  Bronchodilators should not be administered to infants and children with bronchiolitis. Despite short-term improvement in clinical symptom scores, they have no effect on the need for hospitalization, oxygen saturation, length of hospitalization, or disease resolution. […] Epinephrine should not be administered to children with bronchiolitis in the inpatient setting. […] Systemic or inhaled corticosteroids should not be used to treat bronchiolitis in any setting. […] Antibiotics should not be administered to infants and children with bronchiolitis and should be reserved for those with concomitant bacterial infection. […] Other treatments with no clear clinical benefit include chest physiotherapy and excessive nasal suction of secretions.

• #52 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  Corticosteroids should not routinely be used. […] Nutrition and hydration should be assessed. The ability of an infant with respiratory distress due to bronchiolitis to take oral fluids should be evaluated and nasogastric or intravenous hydration may be used as needed. […] Chest physiotherapy has not shown to benefit infants with bronchiolitis. […] Medical therapy for bronchiolitis seems to be disappointing, but chest physiotherapy cannot be recommended either. […] Medications have a limited role in the management of bronchiolitis. Several drugs are commonly used (eg, bronchodilators), but there is little in the way of conclusive evidence to support routine use of any drug in the management of bronchiolitis. […] Antiviral therapy is not routinely recommended for cases of bronchiolitis.

• #53 Pharmacological management of acute bronchiolitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2621418/

  Bronchodilators are frequently tried in infants presenting with wheezing due to bronchiolitis because of its similarity to asthma. Their routine use is controversial. Despite many randomized, controlled trials (RCT), no consistent benefit has been demonstrated. […] In summary, albuterol has not been shown to consistently reduce the duration or severity of illness or length of hospital stay, and so cannot be recommended for routine care of the patient with bronchiolitis. […] Corticosteroids have not been shown to be effective and are not recommended for routine use. […] Ribavirin is not recommended for routine use in patients with bronchiolitis, although it may be of benefit in immunocompromised patients. […] We conclude that antibiotics should be used in patients with bronchiolitis only when specific evidence of coexistent bacterial infection is present and confirmed bacterial infections should be managed no differently than in the absence of bronchiolitis. […] Administration of exogenous surfactant to infants with severe respiratory failure due to bronchiolitis seems promising. […] Heliox therapy may be tried for the treatment of severe respiratory failure, although additional studies are needed before they can be recommended for routine use.

• #54 Treating Acute Bronchiolitis Associated with RSV | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p325.html

  Recent meta-analyses show that among patients with RSV infections, beta2-agonist bronchodilators do not reduce hospital admission rates or meaningfully improve oxygen saturation levels among patients with RSV infections. […] Ipratropium bromide (Atrovent) is an anticholinergic bronchodilator with no proven efficacy for RSV bronchiolitis. […] The AAP generally does not recommend ribavirin treatment for RSV infections. […] The AHRQ classifies ribavirin as probably ineffective. […] The empiric use of broad-spectrum intravenous antibiotics is therefore unnecessary in children with typical signs and symptoms of RSV bronchiolitis, and may be harmful.

• #55 Pharmacological management of acute bronchiolitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2621418/

  Bronchodilators are frequently tried in infants presenting with wheezing due to bronchiolitis because of its similarity to asthma. Their routine use is controversial. Despite many randomized, controlled trials (RCT), no consistent benefit has been demonstrated. […] In summary, albuterol has not been shown to consistently reduce the duration or severity of illness or length of hospital stay, and so cannot be recommended for routine care of the patient with bronchiolitis. […] Corticosteroids have not been shown to be effective and are not recommended for routine use. […] Ribavirin is not recommended for routine use in patients with bronchiolitis, although it may be of benefit in immunocompromised patients. […] We conclude that antibiotics should be used in patients with bronchiolitis only when specific evidence of coexistent bacterial infection is present and confirmed bacterial infections should be managed no differently than in the absence of bronchiolitis. […] Administration of exogenous surfactant to infants with severe respiratory failure due to bronchiolitis seems promising. […] Heliox therapy may be tried for the treatment of severe respiratory failure, although additional studies are needed before they can be recommended for routine use.

• #56

  https://indianpediatrics.net/oct2013/oct-939-949.htm

  Clinical symptoms and post-bronchiolitis cough and wheeze are attributed to the increased cysteinyl leukotrienes in airway secretions of children with bronchiolitis during acute phase as well as in short term follow up. […] Heliox (mixture of helium and oxygen) may improve alveolar ventilation as it flows through airways with less turbulence and resistance. […] Ribavirin may be considered in high risk infants (immunocompromised and/or hemodynamically significant cardiopulmonary disease) and in infants requiring mechanical ventilation. […] Current evidence suggests that surfactant therapy may have potential use in acute severe bronchiolitis requiring mechanical ventilation. […] The current management primarily consists of supportive care, including hydration, supplemental oxygen, and mechanical ventilation when required. At this point, there is no specific treatment for bronchiolitis for which there is a strong or convincing evidence of effectiveness.

• #57 Pharmacological management of acute bronchiolitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2621418/

  This article reviews the current knowledge base related to the pharmacological treatments for acute bronchiolitis. The mainstays of therapy include airway support, supplemental oxygen, and support of fluids and nutrition. Frequently tried pharmacological interventions, such as ribavirin, nebulized bronchodilators, and systemic corticosteroids, have not been proven to benefit patients with bronchiolitis. Antibiotics do not improve the clinical course of patients with bronchiolitis, and should be used only in those patients with proven concurrent bacterial infection. Exogenous surfactant and heliox therapy also cannot be recommended for routine use, but surfactant replacement holds promise and should be further studied. […] The mainstay of therapy remains supportive care, which includes respiratory support and adequate fluid and nutrition management.

• #58

  https://indianpediatrics.net/oct2013/oct-939-949.htm

  Clinical symptoms and post-bronchiolitis cough and wheeze are attributed to the increased cysteinyl leukotrienes in airway secretions of children with bronchiolitis during acute phase as well as in short term follow up. […] Heliox (mixture of helium and oxygen) may improve alveolar ventilation as it flows through airways with less turbulence and resistance. […] Ribavirin may be considered in high risk infants (immunocompromised and/or hemodynamically significant cardiopulmonary disease) and in infants requiring mechanical ventilation. […] Current evidence suggests that surfactant therapy may have potential use in acute severe bronchiolitis requiring mechanical ventilation. […] The current management primarily consists of supportive care, including hydration, supplemental oxygen, and mechanical ventilation when required. At this point, there is no specific treatment for bronchiolitis for which there is a strong or convincing evidence of effectiveness.

• #59 Pharmacological management of acute bronchiolitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2621418/

  Bronchodilators are frequently tried in infants presenting with wheezing due to bronchiolitis because of its similarity to asthma. Their routine use is controversial. Despite many randomized, controlled trials (RCT), no consistent benefit has been demonstrated. […] In summary, albuterol has not been shown to consistently reduce the duration or severity of illness or length of hospital stay, and so cannot be recommended for routine care of the patient with bronchiolitis. […] Corticosteroids have not been shown to be effective and are not recommended for routine use. […] Ribavirin is not recommended for routine use in patients with bronchiolitis, although it may be of benefit in immunocompromised patients. […] We conclude that antibiotics should be used in patients with bronchiolitis only when specific evidence of coexistent bacterial infection is present and confirmed bacterial infections should be managed no differently than in the absence of bronchiolitis. […] Administration of exogenous surfactant to infants with severe respiratory failure due to bronchiolitis seems promising. […] Heliox therapy may be tried for the treatment of severe respiratory failure, although additional studies are needed before they can be recommended for routine use.

• #60

  https://indianpediatrics.net/oct2013/oct-939-949.htm

  Clinical symptoms and post-bronchiolitis cough and wheeze are attributed to the increased cysteinyl leukotrienes in airway secretions of children with bronchiolitis during acute phase as well as in short term follow up. […] Heliox (mixture of helium and oxygen) may improve alveolar ventilation as it flows through airways with less turbulence and resistance. […] Ribavirin may be considered in high risk infants (immunocompromised and/or hemodynamically significant cardiopulmonary disease) and in infants requiring mechanical ventilation. […] Current evidence suggests that surfactant therapy may have potential use in acute severe bronchiolitis requiring mechanical ventilation. […] The current management primarily consists of supportive care, including hydration, supplemental oxygen, and mechanical ventilation when required. At this point, there is no specific treatment for bronchiolitis for which there is a strong or convincing evidence of effectiveness.

• #61 Inhaled nitric oxide therapy in acute bronchiolitis: A multicenter randomized clinical trial | Scientific Reports

  https://www.nature.com/articles/s41598-020-66433-8

  Currently, there are no approved treatments for infants with acute bronchiolitis, the leading cause for hospitalization of infants worldwide, and thus the recommended approach is supportive. Inhaled Nitric oxide (iNO), possesses anti-viral properties, improves oxygenation, and was shown to be safe in infants with respiratory conditions. Hospitalized infants with acute bronchiolitis were therefore recruited to a prospective double-blinded, multi-center, randomized controlled pilot study. […] Overall, high dose iNO (160ppm) was safe, well-tolerated, reduced LOS and showed rapid improvement of oxygen saturation, compared to the standard therapy. […] This study shows that treating hospitalized infants with bronchiolitis with intermittent high dose iNO is safe, tolerable, and demonstrated trends in improving clinical efficacy endpoints compared to standard treatment, though due to small sample size statistical significance was not reached after adjusting for age as a covariate.

• #62 Inhaled nitric oxide therapy in acute bronchiolitis: A multicenter randomized clinical trial | Scientific Reports

  https://www.nature.com/articles/s41598-020-66433-8

  In conclusion, in this study of hospitalized infants with acute bronchiolitis, the safety and tolerability of inhalations of high dose NO were comparable to those in the standard-supportive treatment. Promising treatment benefits in terms of decreased LOS and time to achieve 92% saturation and accelerated clinical improvement following iNO were presented. Larger scale trials are needed to corroborate the beneficial effect of iNO in bronchiolitis.

• #63 Home oxygen therapy for acute bronchiolitis

  https://www.oatext.com/home-oxygen-therapy-for-acute-bronchiolitis.php

  Objective: To investigate the utility of home oxygen treatment for acute bronchiolitis in infants. […] Conclusion: The administration of supplementary oxygen treatment at home in children aged 12 months with RSV bronchiolitis is effective and safe, leading to a reduction in emergency department referrals and hospital admissions and an increase in caregiver satisfaction. […] Short term home intermittent oxygen therapy to infants with RSV bronchiolitis in addition to other treatments modalities will reduce hypoxias and emergency department referrals, and in so hospitalization. […] Treatment is mainly supportive, consisting of supplemental oxygen, suction, and hydration. […] The administration of supplemental oxygen (O2) in previously healthy children with bronchiolitis requires hospitalization.

• #64 Home oxygen therapy for acute bronchiolitis

  https://www.oatext.com/home-oxygen-therapy-for-acute-bronchiolitis.php

  Our results indicated that home oxygen therapy successfully increased SpO2 and reduced illness severity, thereby lowering the need for hospital admission for oxygen supplementation. […] In conclusion, home-administered oxygen treatment combined with bronchodilator or 3% hypertonic solution to carefully selected infants with mild to moderate acute bronchiolitis appears to improve clinical symptoms and the rate of chest complications, thereby reducing the rate of referrals to the ED and hospital admissions.

• #65 Bronchiolitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565

  In the U.S., respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia in children who are less than a year old. Two options for immunization can help prevent young infants from getting severe RSV. […] You and your healthcare professional should discuss which option is best to protect your child: Antibody product called nirsevimab (Beyfortus). This antibody product is a single-dose shot given in the month before or during RSV season. […] In rare situations, when nirsevimab is not available or a child is not eligible for it, another antibody product called palivizumab may be given. But palivizumab requires monthly shots given during the RSV season, while nirsevimab is only one shot. […] The FDA approved an RSV vaccine called Abrysvo for pregnant people to prevent RSV in infants from birth through 6 months of age.

• #66 Bronchiolitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441959/

  Children who develop signs of severe respiratory distress may progress to respiratory failure. These children may require intensive care for mechanical ventilation or non-invasive support. A high-flow nasal cannula is an emerging modality of non-invasive support for children with bronchiolitis. […] Passive immunization against RSV is available with palivizumab for those who are at the greatest risk for severe illness. […] Current recommendations by the American Academy of Pediatrics support the use of palivizumab during the first year of life for children with a gestational age less than 29 weeks, symptomatic congenital heart disease, chronic lung disease of prematurity, neuromuscular disorders that make it difficult to clear the airways, airway abnormalities, and immunodeficiency. Prophylaxis may be continued in the second year of life for children who require continued interventions for chronic lung disease of prematurity or those who remain immunosuppressed.

• #67 UPDATE – 2022 Italian guidelines on the management of bronchiolitis in infants | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01392-6

  A gentle, superficial and reasonably frequent nasal aspiration, especially in younger children, is recommended to improve airway patency, O2 saturation measured by pulse oximetry (SpO2), and feeding. Supplemental O2 should be administered if O2 saturation levels are persistently below 92% in room air. […] Since there is no vaccine against RSV (i.e., the main aetiologic agent of bronchiolitis), environmental prophylaxis is crucial in preventing and limiting bronchiolitis spreading. Pharmacological immunoprophylaxis (Palivizumab) has proven beneficial to populations at increased risk for RSV infection-related complications.

• #68 Bronchiolitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565

  In the U.S., respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia in children who are less than a year old. Two options for immunization can help prevent young infants from getting severe RSV. […] You and your healthcare professional should discuss which option is best to protect your child: Antibody product called nirsevimab (Beyfortus). This antibody product is a single-dose shot given in the month before or during RSV season. […] In rare situations, when nirsevimab is not available or a child is not eligible for it, another antibody product called palivizumab may be given. But palivizumab requires monthly shots given during the RSV season, while nirsevimab is only one shot. […] The FDA approved an RSV vaccine called Abrysvo for pregnant people to prevent RSV in infants from birth through 6 months of age.

• #69 Bronchiolitis

  https://www2.hse.ie/conditions/bronchiolitis/

  Breastfeeding your baby may prevent them from getting bronchiolitis. This is because babies get special proteins called antibodies from breastmilk. Antibodies can protect your child from infection. […] Children with existing health problems or who were born premature are at high risk of severe bronchiolitis. They might get monthly antibody injections. This will reduce the severity of an infection.

• #70 Bronchiolitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565

  In the U.S., respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia in children who are less than a year old. Two options for immunization can help prevent young infants from getting severe RSV. […] You and your healthcare professional should discuss which option is best to protect your child: Antibody product called nirsevimab (Beyfortus). This antibody product is a single-dose shot given in the month before or during RSV season. […] In rare situations, when nirsevimab is not available or a child is not eligible for it, another antibody product called palivizumab may be given. But palivizumab requires monthly shots given during the RSV season, while nirsevimab is only one shot. […] The FDA approved an RSV vaccine called Abrysvo for pregnant people to prevent RSV in infants from birth through 6 months of age.

• #71 UPDATE – 2022 Italian guidelines on the management of bronchiolitis in infants | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01392-6

  A gentle, superficial and reasonably frequent nasal aspiration, especially in younger children, is recommended to improve airway patency, O2 saturation measured by pulse oximetry (SpO2), and feeding. Supplemental O2 should be administered if O2 saturation levels are persistently below 92% in room air. […] Since there is no vaccine against RSV (i.e., the main aetiologic agent of bronchiolitis), environmental prophylaxis is crucial in preventing and limiting bronchiolitis spreading. Pharmacological immunoprophylaxis (Palivizumab) has proven beneficial to populations at increased risk for RSV infection-related complications.

• #72 Bronchiolitis

  https://www.nhs.uk/conditions/bronchiolitis/

  There’s no specific treatment for bronchiolitis. It usually gets better on its own and you can look after your child at home. […] But it can be serious in some children, who may need to be treated in hospital. […] give children’s paracetamol to babies and children over 2 months old or ibuprofen to babies and children over 3 months old but do not give aspirin to a child under 16 […] try using salt water (saline) drops if your child’s nose is blocked […] keep your child upright as much as possible when they’re awake this will help them breathe more easily […] encourage your child to drink lots of fluids try smaller feeds more often in babies, and give older children extra water or diluted fruit juice. […] do not smoke around your child […] do not try to lower your child’s temperature by sponging them with cool water or taking off all their clothes. […] Some children may have a higher risk of getting seriously ill with bronchiolitis. […] These children may be able to have treatment in the winter (between October and March) to stop them getting severe bronchiolitis.

• #73 Bronchiolitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

  Bronchiolitis usually lasts for 1 to 2 weeks but symptoms occasionally last longer. Most children with bronchiolitis can be cared for at home with comfort measures. It’s important to be alert for problems with breathing that are getting worse. […] Because viruses cause bronchiolitis, antibiotics which are used to treat infections caused by bacteria don’t work against viruses. Bacterial infections such as pneumonia or an ear infection can happen along with bronchiolitis. In this case, your child’s health care provider may give an antibiotic for the bacterial infection. […] Medicines called bronchodilators that open the airways don’t seem to help bronchiolitis, so they usually aren’t given. In severe cases, your child’s health care provider may try a nebulized albuterol treatment to see if it helps. During this treatment, a machine creates a fine mist of medicine that your child breathes into the lungs.

• #74 Patient education: Bronchiolitis and RSV in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics

  Bronchiolitis is common in infants and young children and is one of the leading reasons for hospitalization in this age group. Treatment includes measures to ensure that the child consumes enough fluids and is able to breathe without significant difficulty. […] There is no treatment that can get rid of bronchiolitis, so treatment is aimed at relieving symptoms until the infection resolves. Treatment at home usually includes making sure the child drinks enough and using saline nose drops (or suctioning for infants) to keep the nose clear. […] Severe bronchiolitis should be evaluated in an emergency department or clinic capable of handling urgent respiratory illnesses in children. This is a life-threatening illness, and treatment should not be delayed for any reason. […] Most children who require hospitalization are well enough to return home within three to four days. Children who require a machine to help them breathe usually need to stay in the hospital for a longer period of time before they are ready to go home. […] Most children with bronchiolitis who are otherwise healthy begin to improve within two to five days. However, coughing and wheezing may persist in some infants for a week or longer, and it may take as long as four weeks for the child to return to their „normal” self.

• #75 Patient education: Bronchiolitis and RSV in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics/print

  A small minority of infants and children with bronchiolitis (<5 percent) require monitoring and treatment in a hospital. Most children receive monitoring of vital signs and supportive care, including oxygen therapy and intravenous (IV) fluids, if necessary. Other treatments are individualized, based upon the child’s needs and response to therapy. [...] Infants and children who are hospitalized for management of bronchiolitis often require breathing treatments, which may include: Oxygen therapy – This is usually given by placing a tube (called a nasal cannula) under a child’s nose or by placing a face mask over the nose and mouth. [...] Nebulizer treatments are not used as a routine for children with bronchiolitis, but they are sometimes used in infants and children with more severe symptoms. [...] Most children who require hospitalization are well enough to return home within three to four days. Children who require a machine to help them breathe usually need to stay in the hospital for a longer period of time before they are ready to go home.

• #76 Bronchiolitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/961963-overview

  Among numerous medications and interventions used to treat bronchiolitis, thus far, only oxygen appreciably improves the condition of young children. Therefore, therapy is directed toward symptomatic relief and maintenance of hydration and oxygenation. […] Supportive care for patients with bronchiolitis may include the following: Supplemental humidified oxygen, Maintenance of hydration, Mechanical ventilation, Nasal and oral suctioning, Apnea and cardiorespiratory monitoring, Temperature regulation in small infants. […] Medications have a limited role in the treatment of bronchiolitis. Otherwise-healthy children with bronchiolitis usually have limited disease and do well with supportive care only. […] The following medications are used in selected patients with bronchiolitis: Alpha/beta agonists (eg, albuterol, racemic epinephrine), Monoclonal antibodies (eg, palivizumab, nirsevimab), Antibiotics (eg, ampicillin, cefotaxime, ceftriaxone), Antiviral agents (eg, ribavirin), Intranasal decongestants (eg, oxymetazoline), Corticosteroids (eg, dexamethasone, prednisone, methylprednisolone). […] Therapy is based on supportive care, oxygenation, hydration, and fever control. With early recognition and treatment, prognosis is usually very good. Most children with bronchiolitis, regardless of severity, recover without sequelae.

• #77 Bronchiolitis Treatment & Management: Approach Considerations, Initial Management, Admission Criteria

  https://emedicine.medscape.com/article/961963-treatment

  The authors’ confidence in the effects of these treatments was low due to imprecisions of the contributing studies, and they concluded that no changes to current clinical practice guidelines are needed based on the current knowledge. […] As a consequence of the lack of evidence-based support for medicinal interventions to treat bronchiolitis, admission rates and treatment approaches vary widely, particularly in the ED. […] A survey of members of the Emergency Medicine section of the American Academy of Pediatrics (AAP) found that 96% recommended bronchodilators and 8% recommended steroids. […] Bronchodilators should not be routinely used; routine use of a trial of bronchodilator therapy was de-emphasized in the updated guidelines due to the lack of supportive evidence of benefit exceeding potential harm.

• #78 Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months | Canadian Paediatric Society

  https://cps.ca/documents/position/bronchiolitis

  Bronchiolitis is a self-limiting disease, usually managed with supportive care at home. […] For those requiring admission, supportive care with assisted feeding, minimal handling, gentle nasal suctioning and oxygen therapy still forms the mainstay of treatment. […] Supplemental oxygen therapy is a mainstay of treatment in hospital. Oxygen should be administered if saturations fall below 90% and used to maintain saturations at 90%. […] Some degree of fluid supplementation is required in 30% of hospitalized patients with bronchiolitis. […] The use of epinephrine is not recommended in routine cases. […] Current evidence does not support the use of hypertonic 3% sodium chloride in routine cases of bronchiolitis. […] The use of salbutamol (Ventolin) is not recommended in routine cases.

• #79 UPDATE – 2022 Italian guidelines on the management of bronchiolitis in infants | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01392-6

  Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. […] Since a specific etiological treatment is not available, bronchiolitis therapy includes general supportive management to control pulmonary and systemic clinical symptoms. Therapy for bronchiolitis and related recommendations for clinical practice are summarized in Table 6. Inhaled bronchodilators, nebulized adrenaline, steroids (systemic or nebulized) and antibiotics are not recommended.

• #80 Frontiers | Something Is Changing in Viral Infant Bronchiolitis Approach

  https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.865977/full

  Acute Viral Bronchiolitis is one of the leading causes of hospitalization in the first 12–24 months of life. International guidelines on the management of bronchiolitis broadly agree in recommending a minimal therapeutic approach, not recommending the use of bronchodilators. […] Today, there is growing evidence that bronchiolitis is not a single illness but can have different “endotypes” and “phenotypes,” based on age, personal or family history of atopy, etiology, and pathophysiological mechanism. […] While waiting for new research to define the relationship between therapeutic options and different phenotypes, a bronchodilator-trial (using short-acting β2 agonists with metered-dose inhalers and valved holding chambers) seems appropriate in every child with bronchiolitis and age > 6 months.

• #81 Frontiers | Something Is Changing in Viral Infant Bronchiolitis Approach

  https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.865977/full

  Among international guidelines, there is broad agreement on the role of support therapy; it is well-established that bronchiolitis management should be focused on guaranteeing proper hydration and oxygenation of the child. […] Drug administration is ground for controversy, as corticosteroids, nebulized hypertonic saline, and nebulized epinephrine are mostly not recommended, while β2 agonist bronchodilators are contemplated in some guidelines and object of a long-lasting debate. […] The indication on the utility of bronchodilators is mainly based on Gadomski and Scribani Chochrane systematic review, which states that albuterol administration does not result in a significant reduction in hospitalization or disease duration in non-hospitalized children. […] Considering all these data, there is evidence that some phenotypes of bronchiolitis are more strongly associated with asthma features and are linked to higher risk for asthma development. In these populations, use of bronchodilators might have a better impact. […] To conclude, there is evidence that some phenotypes of bronchiolitis are more strongly associated with asthma features and are also linked to higher risk for asthma development. In these populations, use of bronchodilators might have a better impact.

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