AbstractIn this issue of
EM Practice Guidelines Update, 3 practice guidelines that address the management of bronchiolitis are reviewed. Bronchiolitis is a viral-induced inflammatory disease of the lower respiratory tract in infants, characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucous production, and bronchospasm. Signs and symptoms of bronchiolitis include rhinitis, tachypnea, wheezing, cough, crackles, use of accessory muscles, and/or nasal flaring. The majority of cases of bronchiolitis are caused by respiratory syncytial virus (RSV); other viral causes include metapneumovirus, influenza, parainfluenza, and adenovirus. There are more than 200,000 annual ED visits for bronchiolitis among children less than 2 years of age in the US, with a 19% hospital admission rate,
1 with most cases occurring December through March. There is wide variation in how bronchiolitis is diagnosed and treated. The guidelines reviewed here use an evidence-based approach to address diagnosis and acute management of this common and potentially severe respiratory illness.
Practice Guideline Impact
- Bronchiolitis is a clinical diagnosis; radiographic and laboratory testing are not indicated in the assessment of uncomplicated bronchiolitis.
- Infants who are less than 3 months of age, were born prematurely, and/or have underlying cardiac or pulmonary disease should be considered separately, because they have a higher risk of apnea or respiratory insufficiency in the setting of bronchiolitis.
- While bronchodilators are not routinely indicated in the treatment of bronchiolitis, a trial of nebulized albuterol and/or racemic epinephrine may be performed; inhaled bronchodilators should be continued only if there is a positive clinical response.
- Corticosteroids and antibiotics are not indicated for the treatment of bronchiolitis.
