Respiratory syncytial virus bronchiolitis: supportive care and therapies designed to overcome airway obstruction.

Treatment of respiratory syncytial virus bronchiolitis rests primarily on supportive care with oxygen and fluid management. Other therapies commonly used include bronchodilators, corticosteroids and ribavirin, when considered appropriate. Small studies have also suggested that exogenous surfactant, helium/oxygen mixtures (heliox) and combination therapies may offer clinical benefit as well. Management of bronchiolitis can be facilitated by (1) recognizing the risks and benefits of various therapies, (2) understanding the markers of disease severity and (3) gaining familiarity with the time course of viral replication compared with presentation of symptoms. Although oxygen administration and judicious fluid replacement are the only interventions proved to be of reliable benefit to infants with bronchiolitis, newer studies support a role for adjunctive therapies aimed at relieving airway obstruction, especially when administered very early in the course of the illness or given to infants with more severe disease.