Management of Bronchiolitis

by Julia Millikan, MD (’24)

Bronchiolitis accounts for 18% of pediatric hospitalizations for children under the age of 1 and 2.1 million annual outpatient pediatric visits. The Clinical Practice Guidelines for bronchiolitis published in 2014 outline the diagnosis, management, and prevention of bronchiolitis. Most importantly there are strong recommendations that clinicians should not administer albuterol, epinephrine, or corticosteroids to patients admitted for bronchiolitis and additionally should not obtain routine chest x-rays for these patients.

Bronchiolitis accounts for 18% of pediatric hospitalizations for children under the age of 1 and 2.1 million annual outpatient pediatric visits. The Clinical Practice Guidelines for bronchiolitis published in 2014 outline the diagnosis, management, and prevention of bronchiolitis. Most importantly there are strong recommendations that clinicians should not administer albuterol, epinephrine, or corticosteroids to patients admitted for bronchiolitis and additionally should not obtain routine chest x-rays for these patients.

A survey conducted with pediatric RNs, RTs, and physicians/licensed practitioners about the benefits of bronchiolitis interventions was published in 2023 with significant differences in the perceived benefits of albuterol based on specialty with physicians/licensed practitioners having the smallest percentage (2%) surveyed holding the belief that albuterol would be “extremely or somewhat likely” to improve work of breathing.  In one study, the use of chest x-ray had decreased to 15.3% and bronchodilator use decreased to 13.5% for admitted patients.

A survey conducted with pediatric RNs, RTs, and physicians/licensed practitioners about the benefits of bronchiolitis interventions was published in 2023 with significant differences in the perceived benefits of albuterol based on specialty with physicians/licensed practitioners having the smallest percentage (2%) surveyed holding the belief that albuterol would be “extremely or somewhat likely” to improve work of breathing.  In one study, the use of chest x-ray had decreased to 15.3% and bronchodilator use decreased to 13.5% for admitted patients.

 

References:

Akenroye, A.T., Thurm, C.W., Neuman, M.I., Alpern, E.R., Srivastava, G., Spencer, S.P., Simon, H.K., Tejedor-Sojo, J., Gosdin, C.H., Brennan, E., Gottlieb, L.M., Gay, J.C., McClead, R.E., Shah, S.S. and Stack, A.M. (2014), Prevalence and predictors of return visits to pediatric emergency departments. J. Hosp. Med., 9: 779-787. https://doi.org/10.1002/jhm.2273

Cody Meissner, Brian K. Alverson, Jill E. Baley, Anne M. Gadomski, David W. Johnson, Michael J. Light, Nizar F. Maraqa, Eneida A. Mendonca, Kieran J. Phelan, Joseph J. Zorc, Danette Stanko-Lopp, Mark A. Brown, Ian Nathanson, Elizabeth Rosenblum, Stephen Sayles, Sinsi Hernandez-Cancio; Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics November 2014; 134 (5): e1474–e1502. 10.1542/peds.2014-2742

 

Mario A. Reyes, Veronica Etinger, Carla Hronek, Matt Hall, Amber Davidson, Rita Mangione-Smith, Sunitha V. Kaiser, Kavita Parikh; Pediatric Respiratory Illnesses: An Update on Achievable Benchmarks of Care. Pediatrics August 2023; 152 (2): e2022058389. 10.1542/peds.2022-058389

Michelle Dunn, Naveen Muthu, Caroline C. Burlingame, Anne M. Gahman, Maureen McCloskey, Lisa M. Tyler, Eileen P. Ware, Joseph J. Zorc; Reducing Albuterol Use in Children With Bronchiolitis. Pediatrics January 2020; 145 (1): e20190306. 10.1542/peds.2019-0306

Remien KA, Amarin JZ, Horvat CM, et al. Admissions for Bronchiolitis at Children’s Hospitals Before and During the COVID-19 Pandemic. JAMA Netw Open. 2023;6(10):e2339884. doi:10.1001/jamanetworkopen.2023.39884

Shawn L. Ralston, Allan S. Lieberthal, H. Cody Meissner, Brian K. Alverson, Jill E. Baley, Anne M. Gadomski, David W. Johnson, Michael J. Light, Nizar F. Maraqa, Eneida A. Mendonca, Kieran J. Phelan, Joseph J. Zorc, Danette Stanko-Lopp, Mark A. Brown, Ian Nathanson, Elizabeth Rosenblum, Stephen Sayles, Sinsi Hernandez-Cancio, Shawn L. Ralston, Allan S. Lieberthal, H. Julia A. Marlow, Sonal Kalburgi, Vedant Gupta, Kristin Shadman, Nicole E. Webb, Pearl W. Chang, Xiao Ben Wang, Patricia A. Frost, Susan L. Flesher, Matthew K. Le, Lavanya G Shankar, Alan R. Schroeder, Pediatric Research in Inpatient Settings Network; Perspectives of Health Care Personnel on the Benefits of Bronchiolitis Interventions. Pediatrics June 2023; 151 (6): e2022059939. 10.1542/peds.2022-059939