Treatment

Treatment is supportive. Intercostal recession indicates hospital admission with:

• nursing isolated in a cubicle, or with other patients with the same infection.
• give oxygen supplementation to babies and children with bronchiolitis if their oxygen saturation is (1):
  • persistently less than 90%, for children aged 6 weeks and over
  • persistently less than 92%, for babies under 6 weeks or children of any age with underlying health conditions
• ventilation may be required
• monitor carefully for apnoea and bradycardia
• paracetamol for fever
• antibiotics only if there is good evidence of secondary infection
• feeds may need to be given nasogastrically, orogastrically or intravenous support may be needed.

NICE state that (1):

• chest X-ray should not be routinely performed in children with bronchiolitis, because changes on X-ray may mimic pneumonia and should not be used to determine the need for antibiotics
• do not use any of the following to treat bronchiolitis in children:
  • antibiotics
  • hypertonic saline
  • adrenaline (nebulised)
  • salbutamol
  • montelukast
  • ipratropium bromide
  • systemic or inhaled corticosteroids
  • a combination of systemic corticosteroids and nebulised adrenaline

Note that:

• systemic corticosteroids
  • in infants and young children with acute viral bronchiolitis, systemic corticosteroids do not shorten hospital length of stay or improve respiratory distress more than placebo or no corticosteroid treatment (2)
  • in infants presenting to the emergency department with bronchiolitis, a single dose of dexametheasone did not differ from placebo for change in respiratory status or admission to hospital (3)
• a trial of bronchodilator may be useful to rule out asthma
• ribavirin is of questionable use in most cases, but may be indicated in children with severe disease, or with underlying congenital heart disease or cystic fibrosis. It is not given to ventilated children

Reference:

• (1) NICE (August 2021). Bronchiolitis in children
• (2) Patel H et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2004;(3): CD004878.
• (2) Corneli HM et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007 Jul 26;357(4):331-9.