New Guidelines on Bronchiolitis from AAP

The American Academy of Pediatrics (AAP) released new guidelines for the management of bronchiolitis in children 1 to 23 months of age [Pediatrics. 2014; DOI:10.1542/peds.2014-2742]. The new guidelines no longer require testing for specific viruses or a trial dose of a bronchodilator.

According to a comprehensive evidence review, the new AAP guidelines on diagnosing, treating, and preventing bronchiolitis is an update to the 2006 recommendations. The guidelines target pediatricians, family physicians, emergency medicine specialists, hospitalists, nurse practitioners, and physician assistants who care for children.

Bronchiolitis is the most common cause of hospitalization among <1 year of age. The new guidelines emphasizes that only supportive care, including oxygen and hydration, is strongly recommended for young children with bronchiolitis.

"Bronchiolitis is a disorder commonly caused by viral lower respiratory tract infection in infants," noted Shawn L. Ralston, MD, and colleagues, who were involved in producing the guidelines. "Bronchiolitis is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, and increased mucus production. Signs and symptoms typically begin with rhinitis and cough, which may progress to tachypnea, wheezing, rales, use of accessory muscles, and/or nasal flaring."

Changes from the 2006 guideline include that testing for specific viruses is no longer needed, because multiple viruses may cause bronchiolitis. Routine radiographic or laboratory studies are also unnecessary, and clinicians should diagnose bronchiolitis and assess its severity on the basis of history and physical examination.

The AAP also no longer recommends a trial dose of a bronchodilator, such as albuterol or salbutamol, because evidence to date shows that bronchodilators are ineffective in changing the course of bronchiolitis.

Other recommendations include that when making decisions about the assessment and management of children with bronchiolitis, clinicians should evaluate risk factors for severe disease, such as those <12 weeks of age, prematurity, underlying cardiopulmonary disease, or immunodeficiency. Also, clinicians should not give epinephrine to infants and children diagnosed with bronchiolitis, nor should they receive chest physiotherapy.—Kerri Fitzgerald