1. A new American Academy of Pediatrics (AAP) Clinical Practice Guideline has been released for the diagnosis and management of bronchiolitis.
2. These guidelines include an updated recommendation against albuterol (or salbutamol) for infants with bronchiolitis.
Evidence Rating Level: 1 (Excellent)
Study Rundown: The AAP released a new Clinical Practice Guideline for the diagnosis and management of bronchiolitis for children aged 1 month through 23 months, updating its earlier 2006 version. Bronchiolitis – a viral lower respiratory tract infection leading to inflammatory changes and increased mucous production – is the most common cause of hospitalization amongst infants. Recommendations still include bronchiolitis to be diagnosed exclusively from the history and physical examination, including assessment regarding disease severity. When the diagnosis of bronchiolitis is made, no further laboratory or radiologic evaluation is needed. Special considerations should be given to those at highest risk for severe disease, such as infants < 12 weeks old, and those with history of cardiopulmonary disease or immunodeficiency. A major change in this guideline is the recommendation against albuterol (or salbutamol) for bronchiolitis; this recommendation is based upon multiple meta-analyses and systematic reviews failing to demonstrate a clear benefit for beta-agonists on need for inpatient treatment or length of hospitalization and disease resolution. Beta agonists may provide transient changes in clinical scores; however, they are still not recommended as these are subjective measures and no overall improvement in disease progression was noted. Similarly, bronchiolitis treatment should be only supportive with fluids for dehydration and supplemental oxygen as needed to keep saturations > 90%. Use of continuous pulse oximetry is left to the clinician’s decision with the reminder that pulse oximetry should not be used as a proxy for respiratory status. The AAP recommends against nebulized hypertonic saline, systemic corticosteroids, antibiotics, and chest physiotherapy. Bronchiolitis prevention suggestions include palivizumab for infants < 12 months with hemodynamically significant heart disease or chronic lung disease of prematurity, exclusive breastfeeding for infants < 6 months, and appropriate hand-hygiene and tobacco smoke exposure avoidance for all infants and counseling for families who smoke both inside or outside the home.
Relevant Reading: Management of Bronchiolitis in Infants and Children
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