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Am Fam Physician. 2023;108(1):online

Author disclosure: No relevant financial relationships.

Details for This Review

Study Population: Children younger than 24 months diagnosed with mild to moderate bronchiolitis in emergency department, inpatient, and outpatient settings

Efficacy End Points: The rate and length of hospitalization, clinical severity score, and readmission rates

Harm End Points: Adverse events (e.g., worsening cough, agitation, bronchospasm, bradycardia, desaturation, vomiting, diarrhea)

1 in 17 was helped (hospitalization prevented)1 in 50 experienced adverse events

Narrative: Acute bronchiolitis is the most common lower respiratory tract infection in children younger than two years. A respiratory syncytial virus is responsible for most cases, with almost all infections occurring before two years of age. Approximately 1% to 2% of patients who are infected require hospitalization. Acute bronchiolitis includes peribronchial inflammation, airway edema, and excess mucus secretion that can lead to airway obstruction, atelectasis, and impaired gas exchange. The standard treatment involves supportive therapy with humidified oxygen, fluid intake, mucus clearance, and nutritional supplementation, although additional interventions to reduce airway swelling and mucus plugging are being studied. Nebulized hypertonic saline has been used to lower the viscosity of secretions, improve mucus clearance, and decrease the length of hospitalization among infants and children with bronchiolitis.

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This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

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