Indian Journal of Respiratory Care

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VOLUME 11 , ISSUE 4 ( October-December, 2022 ) > List of Articles

REVIEW ARTICLE

Managing Bronchiolitis in Pediatric Patients: Current Evidence

Subhranshu Sekhar Dhal, Hiremath Sagar

Keywords : Bronchiolitis, bronchodilator, epinephrine, hypertonic saline

Citation Information : Dhal SS, Sagar H. Managing Bronchiolitis in Pediatric Patients: Current Evidence. Indian J Respir Care 2022; 11 (4):291-295.

DOI: 10.4103/ijrc.ijrc_153_22

License: CC BY-NC-SA 4.0

Published Online: 01-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Acute bronchiolitis is an inflammatory process affecting small airways. Although most cases are self-limiting, it is still one of the most common causes of hospitalization below 24 months of age. Treatment is mainly supportive. The purpose of this narrative review was to look for recent evidence in the management of bronchiolitis. Methods: PubMed, EMBASE, Global Health, MEDLINE, SCOPUS, and Cochrane database searches were performed using keywords such as bronchiolitis, management, bronchodilators, nebulized epinephrine, corticosteroids, and hypertonic saline. Systematic reviews, original articles, and clinical practice guidelines with evidence for bronchiolitis management were included during our search. We excluded guidelines and clinical trials which solely focused on high-risk children, articles by a single author, and trials that are not part of a clinical practice guideline. Discussion: The safety and efficacy of various therapies for bronchiolitis such as bronchodilators, epinephrine, hypertonic saline, and corticosteroid were analyzed. Bronchodilators have not shown consistent benefits in bronchiolitis and may be tried in the selected population. Current evidence does not suggest routine use of nebulized epinephrine in bronchiolitis except as rescue therapy in selected cases. Hypertonic saline showed positive results in some studies but questions still remain regarding its effectiveness in all. Recent trials also do not support the use of systemic or inhaled corticosteroids in bronchiolitis. Conclusion: In conclusion, there is no strong evidence to routinely recommend the use of bronchodilator, epinephrine, hypertonic saline, or corticosteroids in acute bronchiolitis. Supportive care still remains the mainstay of therapy for bronchiolitis.


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  1. Fretzayas A, Moustaki M. Etiology and clinical features of viral bronchiolitis in infancy. World J Pediatr 2017;13:293-9.
  2. Verma N, Lodha R, Kabra SK. Recent advances in management of bronchiolitis. Indian Pediatr 2013;50:939-49.
  3. Panda S, Mohakud NK, Suar M, Kumar S. Etiology, seasonality, and clinical characteristics of respiratory viruses in children with respiratory tract infections in Eastern India (Bhubaneswar, Odisha). J Med Virol 2017;89:553-8.
  4. Skjerven HO, Megremis S, Papadopoulos NG, Mowinckel P, Carlsen KH, Lødrup Carlsen KC, et al. Virus type and genomic load in acute bronchiolitis: Severity and treatment response with inhaled adrenaline. J Infect Dis 2016;213:915-21.
  5. National Institute for Health and Care Excellence. Bronchiolitis: Diagnosis and Management in Children (Clinical guideline). London UK: National Institute for Health and Care Excellence; 2015. p. 9.
  6. Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than
  7. Lancet 2022;399:2047-64.
  8. Schlapbach LJ, Straney L, Gelbart B, Alexander J, Franklin D, Beca J, et al. Burden of disease and change in practice in critically ill infants with bronchiolitis. Eur Respir J 2017;49:1601648.
  9. Heppe Montero M, Gil-Prieto R, Walter S, Aleixandre Blanquer F, Gil De Miguel Á. Burden of severe bronchiolitis in children up to
  10. Hum Vaccin Immunother 2022;18:1883379.
  11. Oakley E, Borland M, Neutze J, Acworth J, Krieser D, Dalziel S, et al. Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: A randomised trial. Lancet Respir Med 2013;1:113-20.
  12. Del Vecchio MT, Doerr LE, Gaughan JP. The use of albuterol in young infants hospitalized with acute RSV bronchiolitis. Interdiscip Perspect Infect Dis 2012;2012:585901.
  13. Karadag B, Ceran O, Guven G, Dursun E, Ipek IO, Karakoc F, et al. Efficacy of salbutamol and ipratropium bromide in the management of acute bronchiolitis – A clinical trial. Respiration 2008;76:283-7.
  14. Patel H, Gouin S, Platt RW. Randomized, double-blind, placebo-controlled trial of oral albuterol in infants with mild-to-moderate acute viral bronchiolitis. J Pediatr 2003;142:509-14.
  15. Levin DL, Garg A, Hall LJ, Slogic S, Jarvis JD, Leiter JC. A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation. Pediatr Crit Care Med 2008;9:598-604.
  16. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2014;2014:CD001266.
  17. Nino G, Rodríguez-Martínez CE, Castro-Rodriguez JA. The use of ß2-adrenoreceptor agonists in viral bronchiolitis: Scientific rationale beyond evidence-based guidelines. ERJ Open Res 2020;6:00135-2020.
  18. Bottau P, Liotti L, Laderchi E, Palpacelli A, Calamelli E, Colombo C, et al. Something is changing in viral infant bronchiolitis approach. Front Pediatr 2022;10:865977.
  19. Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: Systematic review and meta-analysis. BMJ 2011;342:d1714.
  20. Wainwright C, Altamirano L, Cheney M, Cheney J, Barber S, Price D, et al. A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis. N Engl J Med 2003;349:27-35.
  21. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, Brun AC, Engen H, Eskedal L, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med 2013;368:2286-93.
  22. Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med 2009;360:2079-89.
  23. Lan J, Plint AC, Dalziel SR, Klassen TP, Offringa M, Heath A, et al. Remote, real-time expert elicitation to determine the prior probability distribution for Bayesian sample size determination in international randomised controlled trials: Bronchiolitis in Infants Placebo Versus Epinephrine and Dexamethasone (BIPED) study. Trials 2022;23:279.
  24. Toaimah FH, Al-Ansari K. Life-threatening cardiac arrhythmia after a single dose of nebulized epinephrine in pediatric emergency department. J Trop Pediatr 2011;57:497-9.
  25. Gelbart B, McSharry B, Delzoppo C, Erickson S, Lee K, Butt W, et al. Pragmatic randomized trial of corticosteroids and inhaled epinephrine for bronchiolitis in children in intensive care. J Pediatr 2022;244:17-23.e1.
  26. Mandelberg A, Amirav I. Hypertonic saline or high volume normal saline for viral bronchiolitis: Mechanisms and rationale. Pediatr Pulmonol 2010;45:36-40.
  27. Miraglia Del Giudice M, Saitta F, Leonardi S, Capasso M, Niglio B, Chinellato I, et al. Effectiveness of nebulized hypertonic saline and epinephrine in hospitalized infants with bronchiolitis. Int J Immunopathol Pharmacol 2012;25:485-91.
  28. Flores-González JC, Matamala-Morillo MA, Rodríguez-Campoy P, Pérez-Guerrero JJ, Serrano-Moyano B, Comino-Vazquez P, et al. Epinephrine improves the efficacy of nebulized hypertonic saline in moderate bronchiolitis: A randomised clinical trial. PLoS One 2015;10:e0142847.
  29. Wu S, Baker C, Lang ME, Schrager SM, Liley FF, Papa C, et al. Nebulized hypertonic saline for bronchiolitis: A randomized clinical trial. JAMA Pediatr 2014;168:657-63.
  30. Sharma BS, Gupta MK, Rafik SP. Hypertonic (3%) saline vs 0.93% saline nebulization for acute viral bronchiolitis: A randomized controlled trial. Indian Pediatr 2013;50:743-7.
  31. Silver AH, Esteban-Cruciani N, Azzarone G, Douglas LC, Lee DS, Liewehr S, et al. 3% Hypertonic saline versus normal saline in inpatient bronchiolitis: A randomized controlled trial. Pediatrics 2015;136:1036-43.
  32. Jacobs JD, Foster M, Wan J, Pershad J. 7% hypertonic saline in acute bronchiolitis: A randomized controlled trial. Pediatrics 2014;133:e8-13.
  33. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2008;(4):CD006458.
  34. Heikkilä P, Korppi M. Hypertonic saline in bronchiolitis: An updated meta-analysis. Arch Dis Child 2021;106:102.
  35. Harrison W, Angoulvant F, House S, Gajdos V, Ralston SL. Hypetronic saline in bronchiolitis and type 1 error: A trial sequential analysis. Pedistrics 2018;142:e20181144.
  36. Alansari K, Sakran M, Davidson BL, Ibrahim K, Alrefai M, Zakaria I. Oral dexamethasone for bronchiolitis: A randomized trial. Pediatrics 2013;132:e810-6.
  37. Mesquita M, Castro-Rodríguez JA, Heinichen L, Fariña E, Iramain R. Single oral dose of dexamethasone in outpatients with bronchiolitis: A placebo controlled trial. Allergol Immunopathol (Madr) 2009;37:63-7.
  38. Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007;357:331-9.
  39. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2013;2013:CD004878.
  40. Kua KP, Lee SW. Systematic review and meta-analysis of the efficacy and safety of combined epinephrine and corticosteroid therapy for acute bronchiolitis in infants. Front Pharmacol 2017;8:396.
  41. Panickar J, Lakhanpaul M, Lambert PC, Kenia P, Stephenson T, Smyth A, et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med 2009;360:329-38.
  42. Green P, Aronoff SC, DelVecchio M. The Effects of Inhaled Steroids on Recurrent Wheeze After Acute Bronchiolitis: A Systematic Review and Meta-Analysis of 748 Patients. Glob Pediatr Health 2015;2:2333794X15595964. doi: 10.1177/2333794X15595964.
  43. Blom D, Ermers M, Bont L, van Aalderen WM, van Woensel JB. Inhaled corticosteroids during acute bronchiolitis in the prevention of post-bronchiolitic wheezing. Cochrane Database Syst Rev 2007;(1):CD004881.
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