The Management and Treatment of Acute Bronchiolitis in Infants

Acute bronchiolitis (AB) is the most common lower respiratory tract infection in young infants. It usually has viral etiology, being Respiratory Syncytial Virus (RSV) most frequently involved. The diagnosis is based on clinical history and physical examination, whereas diagnostic studies – including chest radiograph and blood tests – are generally not recommended in routine evaluation. To date, no etiologic antiviral drug is regularly used for the treatment of AB. Ribavirin is the only drug approved for RSV infection but its use is limited by the adverse side effects in patients and by the potential toxic risks it poses to health care providers. Other new antiviral agents are now object of ongoing studies. While these trials are still progressing, the current management of AB is essentially supportive, including oxygen therapy and hydration. Supplemental oxygen is the mainstay of treatment.in infants with respiratory distress and hypoxia; it can be administered with several techniques according to the severity of the respiratory impairment, starting from low-flow nasal cannula up to mechanical ventilation. The use of intravenous or nasogastric fluids supplementation is recommended to avoid dehydration in patients with AB and impaired feeding. Although several pharmacological treatments (nebulized hypertonic saline or bronchodilators, systemic corticosteroids or antibiotics) have been routinely administered in infants with AB over the past decades, at present their real efficacy is highly debated and their indication is controversial. Despite the existence of several clinical practice guidelines, many children with AB continue to undergo unnecessary tests and ineffective therapies worldwide. In the present chapter, we summarize the most recent literature about AB to provide an evidence-based approach to the management and treatment of this disease.