Regarding the management of severe bronchiolitis in a 7-month-old infant, which ONE of the following is TRUE?
Answer: B: The treatment for bronchiolitis remains controversial and is mainly supportive. Infants with respiratory distress are at increased risk of aspiration. It may be necessary to suspend oral feeding because of concerns about pulmonary aspiration. However, whether nasogastric or intravenous fluids are most efficacious is still uncertain. Two large prospective randomized controlled trials are currently comparing the two therapies to assess which is most efficacious.
Nebulized adrenaline, which has both β2-agonist and α-agonist activity, has also been proposed as a useful therapy in bronchiolitis as it might reduce airway oedema. However, an Australian randomized controlled trial and a Cochrane review failed to demonstrate any clinically significant benefit for the use of nebulized adrenaline for infants admitted to hospital with bronchiolitis.
Additionally, adrenaline cannot be instituted as outpatient therapy. The American Academy of Pediatrics still suggests a carefully monitored trial of α-adrenergic or β2-adrenergic medication as an option but emphasises that therapy should be continued only if there is a documented positive clinical response to the trial using an objective means of evaluation.
A Cochrane review found no evidence to support the use of physiotherapy in the care of infants with bronchiolitis (table below).
Nasal continuous positive airway pressure has been shown to be efficacious in the setting of rising oxygen requirements in an infant who is tiring, where it is useful for reducing the need for endotracheal intubation. More data with larger trial numbers is needed to further confirm these findings.
SUMMARY OF COCHRANE REVIEWS OF TREATMENT OPTIONS IN BRONCHIOLITIS:
References:
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