Written by Andy Hogan
Despite decades of research on adjunctive interventions, the core of bronchiolitis therapy remains supportive care for work of breathing, hypoxemia, and hydration.
Why does this matter?
Bronchiolitis accounts for about 15% of both pediatric emergency visits and hospitalizations. Despite best evidence and expert recommendations, treatment patterns in 2022 vary widely and commonly include ineffective therapies.
Adjuncts for bronchiolitis? Snot just yet.
Bronchiolitis is a frequent presentation and disposition dilemma for the emergency physician. Waxing and waning symptoms, caused by dynamic obstruction and clearing of small airways, make assessment of response to many treatments difficult to assess. Prolonged observation via admission is often needed. Supportive care for work of breathing and dehydration historically forms the backbone of treatment. In recent decades, many adjunctive therapies have been investigated, with few demonstrating an impact on reducing disease progression or hospital length of stay. Despite messaging from specialty societies about lack of utility, many ineffective interventions remain in wide use. This review article by Dalziel et al. summarizes current evidence behind interventions for bronchiolitis management. Highlights are summarized below.
Bronchiolitis. Lancet. 2022 Jul 30;400(10349):392-406. doi: 10.1016/S0140-6736(22)01016-9. Epub 2022 Jul 1.