Fall 2014 – Acute Bronchiolitis – Case Report and Review of Management Guidelines

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Acute Bronchiolitis – Case Report and Review of Management Guidelines.

Author: Neil D. Dattani, Clare M. Hutchinson

Author Affiliations: Norwich Medical School, Faculty of Medicine and health Sciences, University of East Anglia, Norwich, United Kingdom

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Corresponding Author: Clare M. Hutchinson, claremhutchinson[at]gmail.com

Key Words: Bronchiolitis; Case reports; Pediatrics; Practice guidelines; Therapeutics.

Abstract: Introduction: The treatment of acute bronchiolitis is controversial, despite the fact that several well-designed trials have been conducted on the subject. Patient profile: A 10-month-old boy presented to the emergency department with a 3-day history of upper respiratory tract symptoms and an expiratory wheeze. Chest X-ray showed right upper lobe atelectasis. He was diagnosed with acute bronchiolitis. Interventions: He received nebulized salbutamol (albuterol) and oral dexamethasone in the emergency department. He was admitted to hospital overnight for continued salbutamol treatment via a metered-dose inhaler. Discussion: Five main treatment regimens exist for acute bronchiolitis nebulized epinephrine (adrenaline), other bronchodilators, nebulized hypertonic saline, glucocorticoids, and combinations of these. Nebulized epinephrine decreases the rate of hospitalization, other bronchodilators improve symptoms, and nebulized hypertonic saline reduces the length of hospitalization. There is no strong evidence for glucocorticoids or combinations of these treatments. Combined treatment with epinephrine and dexamethasone reduces rate of hospitalization.

Published on date: September 31, 2014

Senior Editor: Kevin Patterson

Junior Editor: Patrick Roach

DOI: Pending

Citation: Dattani ND, Hutchinson CM. Acute Bronchiolitis – Case Report and Review of Management Guidelines. Medical Student Research Journal. 2014;4(Fall):8-11.

References:

  1. Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010 Feb;125(2):342-9. doi: 10.1542/peds.2009-2092
  2. Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen TP, Patel H, Fernandes RM. Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD003123. doi: 10.1002/14651858.CD003123.pub3
  3. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. New England Journal of Medicine2013 June 13;368(24):2286-93. doi: 10.1016/j.jemermed.2013.10.022
  4. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD001266. doi: 10.1002/14651858.CD001266.pub4
  5. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD006458. doi: 10.1002/14651858.CD006458.pub3
  6. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson DW, Klassen TP, Hartling L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004878. doi: 10.1001/jama.2013.284921
  7. Ducharme FM. Management of acute bronchiolitis. British Medical Journal 2011 Apr 6;342:d1658. doi: 10.1136/bmj.d1658
  8. Plint AC, Johnson DW, Patel H, et al. Epinephrine and Dexamethasone in Children with Bronchiolitis. New England Journal of Medicine 2009 May 14;360(20):2079-89. doi: 10.1056/NEJMoa0900544
  9. Enriquez A, Chu IW, Mellis C, Lin WY. Nebulised deoxyribonuclease for viral bronchiolitis in children younger than 24 months. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008395. doi: 10.1002/14651858.CD008395.pub2
  1. Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004873. doi: 10.1002/14651858.CD004873.pub4
  2. Beggs S, Wong Z, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD009609. doi: 10.1002/14651858.CD009609.pub2
  3. Umoren R, Odey F, Meremikwu MM. Steam inhalation or humidified oxygen for acute bronchiolitis in children up to three years of age. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD006435. doi: 10.1002/14651858.CD006435.pub2
  4. Liet J, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD006915. doi:  10.1002/14651858.CD006915.pub2
  5. Spurling GKP, Doust J, Del Mar CB, Eriksson L. Antibiotics for bronchiolitis in children. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD005189. doi: 10.1002/14651858.CD005189.pub3
  6. American Academy of Pediatrics Committee on Infectious Diseases; American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014 Aug;134(2):415-20. doi: 10.1542/peds.2014-1665