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Published online January 25, 2010
PEDIATRICS Vol. 125 No. 2 February 2010, pp. 342-349 (doi:10.1542/peds.2009-2092)
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STATE-OF-THE-ART REVIEWS

Bronchiolitis: Recent Evidence on Diagnosis and Management

Joseph J. Zorc, MD, MSCEa,b, Caroline Breese Hall, MDc

a Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
b Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and
c Departments of Pediatrics and Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York

Viral bronchiolitis is a leading cause of acute illness and hospitalization of young children. Research into the variation in treatment and outcomes for bronchiolitis across different settings has led to evidence-based clinical practice guidelines. Ongoing investigation continues to expand this body of evidence. Authors of recent surveillance studies have defined the presence of coinfections with multiple viruses in some cases of bronchiolitis. Underlying comorbidities and young age remain the most important predictors for severe bronchiolitis. Pulse oximetry plays an important role in driving use of health care resources. Evidence-based reviews have suggested a limited role for diagnostic laboratory or radiographic tests in typical cases of bronchiolitis. Several large, recent trials have revealed a lack of efficacy for routine use of either bronchodilators or corticosteroids for treatment of bronchiolitis. Preliminary evidence suggests a potential future role for a combination of these therapies and other novel treatments such as nebulized hypertonic saline.

Key Words: bronchiolitis • respiratory syncytial virus

Abbreviations: RSV = respiratory syncytial virus • AAP = American Academy of Pediatrics • HMPV = human metapneumovirus • ED = emergency department

Accepted Nov 5, 2009.


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