Treatment of bronchiolitis

Bronchiolitis is the leading cause of hospitalization for very young children in the USA. You’ll find various definitions of what bronchiolitis is, but a standard one is a viral illness that starts in the upper respiratory tract with runny nose, congestion, and cough. This is soon followed by symptoms in the lower respiratory tract — the lungs — such as rapid breathing, wheezing, and sometimes the need for extra oxygen. The culprit in half to three-quarters of cases is what we call respiratory syncytial virus, or RSV, but a variety of viruses can do it. Interestingly, 10-30% of children with bronchiolitis and RSV have another respiratory virus, too. Researchers aren’t sure if this combined infection contributes to how severe the symptoms are.

Any child can get bronchiolitis, but children who were born prematurely or who have some preexisting problem with their lungs are particularly susceptible to experiencing severe cases of it. But even otherwise normal children can get critically ill. I just cared for such a child, one who needed a week of a mechanical ventilator for it, and all pediatric intensivists have now and then had similar cases.

Because it’s so common, and because some of the symptoms of bronchiolitis resemble asthma, physicians for many years treated it with asthma drugs. Unfortunately, these drugs rarely help. But the urge to do something, anything, for this often frustrating illness is a strong one, and I still often see full-bore asthma treatment given for bronchiolitis. Indeed, in spite of multiple recommendations by panels of experts, more than a few American doctors seem reluctant to concede that little in the way of drug therapy helps. It’s hard-wired into our nature to treat things. The problem is that no drugs are risk-free, so we shouldn’t use them unless there is a reasonable chance they will do good.

What helps bronchiolitis? For a child at high risk of getting a severe case of RSV we can give a monthly shot of a drug called Synagis that can reduce the chances of getting RSV, or, if it happens, having a less severe case. For the rest, we use frequent suctioning of all the nasal mucus, oxygen if a child’s blood oxygen level shows it to be a bit low, and time. For now, that’s about it.