Bronchiolitis

Antibiotics

As bronchiolitis is almost always caused by infection of susceptible children with RSV, antibiotics are of no use.

β-Agonists and anticholinergic therapy

Reviews conclude that β-agonists produce only a modest short-term improvement; their use has no effect on hospitalization rate. There is insufficient evidence to support the use of epinephrine for bronchiolitis. The combination of ipratropium and a β₂-agonist produced some improvement, but there is not enough evidence to support the uncritical use of anticholinergic therapy for wheezing infants.

Corticosteroids

The evidence for beneficial effects of corticosteroids for treating bronchiolitis is weak compared with that for treating croup. Any beneficial effect is likely to be small and must be weighed against the acute adverse effects of corticosteroids. A meta-analysis (Garrison et al) suggests corticosteroids can be effective. A Cochrane Review (Patel et al) that suggested they had no benefit was subsequently withdrawn. Two studies have found that the combination of dexamethasone and salbutamol result in a swifter resolution of bronchiolitis symptoms than either agent alone.

Antiviral and immunoglobulin agents

Administration of the antiviral ribavirin compared with placebo does not reduce rates of respiratory deterioration or death. Immunoglobulin agents have been tried for children at high risk of underlying congenital heart disease or bronchopulmonary dysplasia. The incidence of hospitalization (number needed to treat = 17) and the incidence of admission to the intensive care unit (number needed to treat = 50) were halved, but there was no reduced hospital stay, duration of ventilation, or duration of treatment with supplementary oxygen. There is currently no good evidence for the use of these agents to treat moderate or severe cases of bronchiolitis.

Other therapies

Supportive therapy is the mainstay of treatment. Most children have only mild infections and recover with nursing care alone. Severely ill children require oxygen supplementation, intubation, and assisted ventilation. When confronted with an infant who has symptoms of bronchiolitis, the FP needs to assess whether or not the child is ill enough to go to hospital.

• Possible effective treatments include the following:

  • – nebulized epinephrine,

  • – β-agonists,

  • – ipratropium,

  • – corticosteroids, and

  • – oxygen.

• Treatments of little value include the following:

  • – ribavirin,

  • – antibiotics, and

  • – nursing measures.