Management of bronchiolitis.

The incidence, etiology, epidemiology, clinical presentation, treatment, prognosis, and prevention of bronchiolitis are discussed with a critical evaluation of the available studies on various therapeutic approaches. Bronchiolitis is a lower respiratory-tract viral infection that affects 6-10% of all children below two years of age. Respiratory syncytial virus (RSV) is the usual pathogen. The symptoms range from mild wheezing to severe respiratory distress. An infected child usually has a fever, a rapid pulse, an increased breathing rate, and difficulty in breathing. Because most of the infants hospitalized with bronchiolitis have hypoxemia, the administration of oxygen is the mainstay of therapy. Correct fluid therapy is essential to avoid dehydration and overhydration. Limited data are available on the use of drugs in the management of bronchiolitis. Although a variety of adrenergic drugs, theophylline, and corticosteroids are used, sound efficacy data are lacking, and most studies have documented a lack of therapeutic benefits. One study reported that the combined use of corticosteroids and albuterol may be beneficial in severely ill patients. Recent studies have shown that the continuous administration of ribavirin may decrease viral shedding. Antibiotics are not indicated unless a secondary bacterial infection is present. Oxygen and fluid therapy have a clear role in the management of patients with bronchiolitis; however, no specific guidelines are available for the use of drugs in the treatment of these patients.