HWN Suggests

Bronchiolitis – “Seriously, what should I do?”

Bottom Line {from my unscientific and non-randomized opinion}...

Bronchiolitis will continue to be studied and these studies will continue to yield conflicting results. It offers you the opportunity to actually use your clinical skills to determine the best management strategy. Tailor the management to the particular patient. These children should be assessed multiple times to determine their respiratory status while alert, sleepy, eating, playing, etc. A trial of bronchodilator is appropriate… but you must assess them right before and after its use to determine efficacy in that patient (not useful to go back 2 hours later to see if it worked). For those who aren’t responding… try…

read full article

Articles of Interest

Acute Bronchiolitis: Assessment and Management in the Emergency Department

While studies have demonstrated a lack of efficacy for bronchodilators and corticosteroids, more recent studies suggest a potential role for combination therapies and high-flow nasal cannula therapy.

Episode 59: Bronchiolitis

Remember that bronchiolitis symptoms peak around days 3-5. If the patient presents on Day 2, you can expect the patient may get worse before they get better. This should be factored into your disposition decision. Also, 50% of patients who develop severe disease do so after their first ED visit, so clear discharge instructions are very important.

PEM Playbook – Bronchiolitis

Should we use bronchodilators in bronchiolitis? It seems lately that this is a loaded question – with strong feelings on either side amongst colleagues. The short answer is that the American Academy of Pediatrics, the UK’s National Institute for Health and Care Excellence, as well as the Canadian Pediatric Society currently recommend against them. However, in continental Europe and Australia, the language is softened to “not routinely recommended”.

Summer Surprise...RSV Bronchiolitis

Routine administration of albuterol has not been shown to have benefit, the most recent AAP guidelines have a recommendation against trial of albuterol (common practices continue to be variable). It should be noted that children with severe disease were excluded from the studies used to make this recommendation.

Resources

Core EM

Routine use of nebulized bronchodilators does not alter clinical course (Gadomski 2014, PMID: 24937099).

WikEM

Randomized controlled trials of bronchodilator or corticosteroid therapy have shown mixed results. Bronchodilators could aggravate the symptoms.