Clinical Practice Guideline

Bronchiolitis

Diagnosis and Management of Bronchiolitis

(Endorsed, June 2012)

The guideline, Diagnosis and Management of Bronchiolitis, was developed by the American Academy of Pediatrics and endorsed by the American Academy of Family Physicians. This endorsement was reaffirmed in 2012.

Key Recommendations

  • The diagnosis of bronchiolitis and assessment of disease severity should be based on history and physical examination. Laboratory and radiologic studies should not be routinely ordered for diagnosis.
  • Risk factors for severe disease such as age < 12 weeks, premature birth and underlying cardiopulmonary disease and immunodeficiency should be assessed when making decisions for evaluation and management of children with bronchiolitis.
  • Bronchodilators should not be used routinely in the management of bronchiolitis.
  • Corticosteroid medications should not be routinely used in the management of bronchiolitis.
  • Ribavirin should not be routinely used in children with bronchiolitis.
  • Antibiotics should only be used in children with bronchiolitis who have specific indications of the coexistence of a bacterial infection. When present, bacterial infection should be treated in the same manner as in the absence of bronchiolitis.
  • Chest physiotherapy should not be used routinely in management of bronchiolitis.
  • Hydration and ability to take fluids orally should be assessed.
  • Supplemental oxygen is indicated if SpO2 falls persistently below 90% in previously healthy infants.
  • Palivizumab prophylaxis may be administered to selected infants and children with chronic lung disease or prematurity (< 35 weeks gestation) or with congenital heart disease. When given, palivizumab should be given at 15mg/kg per dose intramuscularly in 5 monthly doses beginning in November or December.
  • To prevent spread of respiratory syncytial virus, hands should be decontaminated before and after direct contact with patients, after contact with inanimate objects in vicinity of the patient, and after removing gloves. Alcohol rubs are the preferred method for hand decontamination. Clinicians should educate personnel and family on hand sanitation.
  • Infants should not be exposed to passive smoking. Breastfeeding is recommended to decrease child's risk of lower respiratory disease.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.