Acute
viral bronchiolitis represents the most common lower
respiratory tract infection in infants and young children and is associated with substantial morbidity and mortality. Respiratory syncytial virus is the most frequently identified virus, but many other viruses may also cause acute
bronchiolitis. There is no common definition of acute
viral bronchiolitis used internationally, and this may explain part of the
confusion in the literature. Most children with
bronchiolitis have a self limiting mild disease and can be safely managed at home with careful attention to feeding and respiratory status. Criteria for referral and admission vary between hospitals as do clinical practice in the management of acute
viral bronchiolitis, and there is
confusion and lack of evidence over the best treatment for this condition. Supportive care, including administration of
oxygen and fluids, is the cornerstone of current treatment. The majority of infants and children with
bronchiolitis do not require specific measures.
Bronchodilators should not be routinely used in the management of acute
viral bronchiolitis, but may be effective in some patients. Most of the commonly used management modalities have not been shown to have a clear beneficial effect on the course of the disease. For example, inhaled and systemic
corticosteroids,
leukotriene receptor antagonists,
immunoglobulins and
monoclonal antibodies,
antibiotics,
antiviral therapy, and chest physiotherapy should not be used routinely in the management of
bronchiolitis. The potential effect of hypertonic saline on the course of the
acute disease is promising, but further studies are required. In
critically ill children with
bronchiolitis, today there is little justification for the use of
surfactant and
heliox.
Nasal continuous positive airway pressure may be beneficial in children with severe
bronchiolitis but a large trial is needed to determine its value. Finally, very little is known on the effect of the various interventions on the development of post-bronchiolitic wheeze.