Bronchiolitis

Alyssa H. Silver; Joanne M. Nazif

doi:10.1542/pir.2018-0260

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Alyssa H. Silver, MD*
Joanne M. Nazif, MD*

^*Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY

AUTHOR DISCLOSURE
Drs Silver and Nazif have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

AAP:: American Academy of Pediatrics
LOS:: length of stay
RSV:: respiratory syncytial virus

Practice Gaps

Clinicians should be able to identify and diagnose patients with a clinical presentation of bronchiolitis, limiting the use of extensive diagnostic testing.
Although bronchiolitis is a condition commonly encountered in pediatrics, there is no single effective therapeutic agent; therefore, with an aim to provide high-value and high-quality care, clinicians should be aware that the main treatment plan for bronchiolitis is supportive care.

Objectives

After completing this article, readers should be able to:

Evaluate and diagnose patients with bronchiolitis.
Summarize the 2014 American Academy of Pediatrics guidelines for the management and prevention of bronchiolitis.
Identify potential current therapies as well as interventions not recommended for routine use in bronchiolitis.
Discuss prevention measures for bronchiolitis.
Describe the prognosis for patients diagnosed as having bronchiolitis.

Introduction

Acute bronchiolitis refers to airway inflammation and obstruction of the lower respiratory tract and is caused almost exclusively by viral infection in children younger than 2 years. Commonly, symptoms of bronchiolitis begin with rhinitis or congestion and cough and may develop into symptoms of increasing respiratory distress (tachypnea, wheezing, and accessory muscle use). (1) Severity of bronchiolitis can vary from mild symptoms that can be managed at home to acute respiratory failure requiring invasive ventilation. There is wide variation in care for infants admitted to the hospital with bronchiolitis, which persists despite the existence of guidelines. (2)(3)(4) In 2014, the American Academy of Pediatrics (AAP) published the “Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis” (1) (summarized in Table 1), an updated, revised version of a previous 2006 AAP guideline. (5) The strength of these recommendations are explained in Table 2. (1 …