Management of acute bronchiolitis

Abstract

The onset of winter heralds the annual influx of babies with acute bronchiolitis requiring admission to paediatric wards all over the country, resulting in the familiar severe pressure on cots and consequent high stress levels in medical and nursing staff. In our district general hospital, with a birth rate of 4000 per year and serving a child population of 70 000, we admit about 150 such babies each winter, the vast majority of whom (90-96%) are respiratory syncytial virus (RSV)-positive. Bronchiolitis can cause significant morbidity in previously healthy infants and is potentially lethal, especially to babies with severe cardiorespiratory disease or immunological compromise. Despite a global effort and enormous resources devoted to research into both the RSV itself and various treatments for bronchiolitis, we are little further advanced in our management of the condition than in 1963 when Reynolds and Cook made the much cited observation that 'oxygen is vitally important in bronchiolitis and there is little convincing evidence that any other therapy is consistently or even occasionally useful'? There are, however, a number of treatments that are promoted; with more or less evidence to justify their use, and it is on these treatments that this review will concentrate.