Which Bronchiolitis Treatment is Best? (Article)

Bronchiolitis, a common viral infection of the lungs in infants, is a very difficult condition for pediatricians to treat. Fortunately, a new study has given doctors a way to improve an old treatment that seems to really help the infants who are afflicted: on-demand nebulized breathing treatments.

In a recent study, researchers who were focusing on the most effective treatments of acute bronchiolitis in infants found that “on-demand” breathing treatment schedules reduced hospital stays more than traditional fixed-treatment intervals. Acute bronchiolitis is a common respiratory virus that limits the passage of air through tiny pathways, known as bronchioles, in infants’ lungs. The bronchioles become inflamed and mucus fills the pathways, making breathing difficult. Acute bronchiolitis is most often caused by a virus called RSV but can also be brought on by the same virus that causes the common cold or even the flu. Symptoms include a stuffy or runny nose, coughing, or a mild fever, followed by worsening coughing and wheezing. The illness sometimes results in hospitalization, mostly in infants less than 4 months of age. There are a wide variety of treatment options available, including inhaled racemic adrenaline, inhaled bronchodilators like albuterol, and inhaled saline, all designed to open these tiny airways.

Both adrenaline and saline mist treatments were found to reduce airway blockage and clear mucosal obstructions in infants with bronchiolitis, but the researchers found that the timing of the treatments made quite a difference; infants who received treatment on-demand, whenever a treatment was deemed necessary, had, on average, a 14 hour shorter hospital stay. Interestingly enough, they also received fewer treatments and had less need of supplemental treatments such as ventilators or oxygen.

A simple change in the timing of breathing treatments is making healthcare better for infants with bronchiolitis.  The shortening of hospitalization time can reduce the costs associated with treatment and  reduce the risk of inadvertently contracting another illnesses by exposure to other sick children. The on-demand schedule also allows infants to have minimal sleep disruption, more comfort, and an even faster recovery.  Good news for everyone!

Your comments are welcome at www.dosmo.com, the home of portable, practical pediatrics. Until next time.

Smo notes:

1.  Håvard Ove Skjerven, M.D., et al, Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis,

N Engl J Med 2013; 368:2286-2293June 13, 2013DOI: 10.1056/NEJMoa1301839