Adult bronchiolitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

The optimal medical therapy for adult bronchiolitis is unknown. Therapy is mainly the cessation of exposure to irritant agent. Bronchiolitis is treated based on severity, however, the disease is progressive and inevitably, leads to respiratory failure. Therefore, supportive therapy includes supplemental oxygen, bronchodilators, cough suppressant, anti-reflux therapy, antibiotic macrolides, immunosuppressants and glucocorticoids. Bronchodilators have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.

Medical Therapy

• The optimal medical therapy for adult bronchiolitis is unknown.
• Therapy is mainly the cessation of exposure to irritant agent.
• Bronchiolitis is treated based on severity, however, the disease is progressive and inevitably, leads to respiratory failure.
• Therefore, supportive therapy includes supplemental oxygen, bronchodilators, cough suppressant, anti-reflux therapy, antibiotic macrolides, immunosuppressants and glucocorticoids.
• Bronchodilators have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.

Adult bronchiolitis

• 1 Stage 1 - Respiratory compromise
  • 1.1 Supplemental oxygen
    • 1.1.1 Adult
      • Preferred regimen (1): maintain oxygen saturation at higher than 90% for 24 hours on standard flow rate
      • Preferred regimen (2): maintain oxygen saturation at higher than 90% for 20 hours on high flow humidified oxygen
      • Preferred regimen (3): maintain oxygen saturation at higher than 90% for 24 hours using Heliox (20 - 30% oxygen and 70 - 80% helium)
  • 1.2 Antibiotic macrolide
    • 1.1.2 Adult
      • Preferred regimen (1): Erythromycin 200 - 600mg PO per day
      • Preferred regimen (2): Clarithromycin 250 - 500mg PO per day
    • 1.1.3 Bronchiolitis obliterans syndrome
      • Preferred regimen (1): Azithromycin 250 mg daily for 5 days followed by 250 mg 3 times a week