Bronchiolitis – best practice summed up

What is bronchiolitis?

Bronchiolitis is the most common severe lower respiratory infection in infants. It occurs when a viral infection causes infants’ lower airways to become inflamed. They have difficulty breathing, sleeping and feeding.

What is its incidence?

Bronchiolitis affects 10-20% of infants under the age of two. Three percent of these are admitted to hospital, meaning that around 1.8 million infants are taken to US hospitals each year. Of these, 2.7% need intensive care, 1.5% need ventilation and 0.2% die.

Clinical comment

If there is no respiratory distress, feeding difficulties or specific risk factors, the infant can be treated at home with advice on when to return for re-assessment. If there are respiratory problems infants should be hospitalized and clinical treatment is normally limited to ensuring the infant is given adequate fluids, and oxygen. This can allow time for the infant to recover. Nebulised epinephrine may produce marginal relief, and could help some infants go home. The effect, however, is mild.

Various treatments have been tried in patients who are more severely affected, but none produce any marked effects. Bronchodilators and epinephrine produce no benefits, though some people suggest they may reduce restlessness and sleeplessness. Similarly, neither injecting steroids or immunoglobulins, nor giving vibration or percussive physiotherapy reduces symptoms.

A clear need for research

“What we need is a large randomised trial that carefully studies all of the currently available therapies and sees whether adjusting dose, type or frequency of treatment can produce greater benefit – then we need to examine new-comers,” says Dr. Michael Smith, author of the review, who works in the Department of Paediatrics, Craigavon Area Group Hospital Trust, Craigavon, Northern Ireland.

Evidence-Based Child Health: A Cochrane Review Journal is available online via Wiley InterScience, the online content service at: www.evidence-basedchildhealth.com