Bronchiolitis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
There is no effective specific treatment for bronchiolitis. Therapy is principally supportive. Frequent small feeds are encouraged to maintain good urine output, and sometimes oxygen may be required to maintain blood oxygen levels. In severe cases the infant may need to be fed via a nasogastric tube or it may even need intravenous fluids. In extreme cases, mechanical ventilation (for example, using Continuous positive airway pressure (CPAP) might be necessary.
Bronchodilator drugs such as salbutamol/albuterol or ipratropium are no longer recommended, but many clinicians offer a trial dose to see if there is any benefit (especially if there is a family history of asthma, since it can be difficult to clinically distinguish bronchiolitis from a viral-induced wheeze). Racemic epinephrine is another drug that is sometimes given.
Ribavirin is an antiviral drug which has a controversial role in treating RSV infection. There is no proven benefit but it is used sometimes for infants with pre-existing lung, heart or immune disease. Antibiotics are often given in case of a bacterial infection complicating bronchiolitis, but have no effect on the underlying viral infection.
Corticosteroids have no proven benefit in bronchiolitis treatment and are not advised.
There is some interest in the use of hypertonic saline in bronchiolitis. Initially recommended for use in cystic fibrosis patients, it is speculated to increase hydration of secretions, thus facilitating their removal.