Diagnosis & Management of Bronchiolitis in Children: An Update

Bronchiolitis is the most common respiratory cause of hospitalization during infancy. It is caused by viral infections most commonly respiratory syncytial virus. It is characterized by acute inflammation, edema and necrosis of epithelial cell lining of small airways and increased mucus production. Signs and symptoms typically begin with nasal discharge & cough which may progress to tachypnea, wheezing, rales, use of accessory muscles, nasal flaring and feeding difficulty. In most of patients disease is self limiting, typically lasting for 3 to 7 days. The management of Bronchiolitis in the outpatient as well as inpatient setting remains a challenge to the treating physician. There is widespread variation in management of patients with bronchiolitis. The effectiveness of various interventions used for treatment of bronchiolitis is still unclear. The objective of the present article is to review the available evidence and guidelines - 1. To reduce the use of unnecessary investigations and therapies by providing practical guidelines to the practitioners managing children with bronchiolitis. 2. To evaluate the evidence supporting the use of currently available treatment for infants with bronchiolitis. 3. To provide evidence based approach to the diagnosis and management of bronchiolitis. Conclusions: The diagnosis of acute bronchiolitis is primarily clinical and laboratory investigations a well as chest radiograph are rarely required to make diagnosis. Pulse oximetry helps to guide the need for oxygen administration. The supportive care remains the cornerstone of therapy in bronchiolitis which comprises oxygenation & hydration. Many recent evidence based reviews have suggested that bronchodilators and corticosteroids should not be used routinely. Number of other therapies like CPAP, hypertonic saline, surfactant, heliox and inhaled furosemide have been evaluated in clinical trials but has not proved to be of definite help consistently and hence not recommended for routine use.