The viral infections that cause bronchiolitis are quite contagious. Additional preventive measures include hand washing and reduction of tobacco-smoke exposure. Educating parents and staff on the importance of hand washing is an essential component to reducing the spread of the disease.2 Similarly, counseling parents on the importance of reduction of smoke exposure and the availability of cessation resources may help reduce morbidity. Evidence shows increased rates of lower respiratory tract illness, ear infections, cough, asthma, and hospitalizations in children exposed to second-hand smoke.20


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Conclusion

Evidence-based reviews suggest limited use of diagnostic testing and treatment modalities in the management of bronchiolitis. Although most studies have shown a lack of efficacy for the use of pharmacologic treatments, preliminary research shows promise with a combination of bronchodilators and corticosteroids. Clinicians must remain cognizant of current practice recommendations in the diagnosis and treatment of bronchiolitis.


Christina Robohm, MS, PA-C, is Clinical Professor and Director of Physician Assistant Studies at Carroll University in Waukesha, Wisc.

References

  1. Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360:588-598. 
  2. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118:1774-1793.
  3. Yorita KL, Holman RC, Sejvar JJ, et al. Infectious disease hospitalizations among infants in the United States. Pediatrics. 2008;121:244-252. 
  4. Pelletier AJ, Mansbach JM, Camargo CA Jr. Direct medical costs of bronchiolitis hospitalizations in the United States. Pediatrics. 2006;118:2418-2423. 
  5. Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management.  Pediatrics. 2010;125:342-349.
  6. Berman S, Simoes EA, Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child. 1991;66:81-84.
  7. Schuh S, Lalani A, Allen U, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150:429-433.
  8. Bordley WC, Viswanathan M, King VJ, et al. Diagnosis and testing in ­bronchiolitis: a systematic review. Arch Pediatr Adolesc Med. 2004;158:119-126.
  9. Wagner T. Bronchiolitis. Pediatr Rev. 2009;30:386-395.
  10. Ralston S, Hill V, Waters A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Arch Pediatr Adolesc Med. 2011;165:951-956. 
  11. Schroeder AR, Marmor AK, Pantell RH, Newman TB. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Arch Pediatr Adolesc Med. 2004;158:527-530.
  12. Tie SW, Hall GL, Peter S, et al. Home oxygen for children with acute bronchiolitis. Arch Dis Child. 2009;94:641-643.
  13. Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2010;12:CD001266.
  14. Hartling L, Bialy LM, Vandermeer B, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2011;6:CD003123.
  15. Corneli HM, Zorc JJ, Mahajan P, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007;357:331-339.
  16. Fernandes RM, Bialy LM, Vandermeer B, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2010;10:CD004878.
  17. Spurling GK, Doust J, Del Mar CB, Eriksson L. Antibiotics for bronchiolitis in children. Cochrane Database Syst Rev. 2011;6:CD005189.
  18. Carroll KN, Wu P, Gebretsadik T, et al. The severity-dependent relationship of infant bronchiolitis on the risk and morbidity of early childhood asthma. J Allergy Clin Immunol. 2009;123:1055-1061.
  19. American Academy of Pediatrics. Respiratory syncytial virus. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:560-569.
  20. Best D; Committee on Environmental Health; Committee on Native American Child  Health; Committee on Adolescence. From the American Academy of Pediatrics: Technical report–Secondhand and prenatal tobacco smoke exposure. Pediatrics. 2009;124:e1017-e1044.
  21. All electronic documents accessed October 15, 2012.