CASE MANAGEMENT OF BRONCHIOLITIS: AN EVIDENCE-BASED APPROACH

Key words: Bronchiolitis, Evidence-based medicine, Adrenaline, Bronchodilators, Steroids, Ribavirine

The Authors discuss the major decision points in the case-management of bronchiolitis with an evidence-based approach. On this basis, they recommend that criteria for admissions should be restricted to at risk infants or infants with respiratory rate over 70 or difficult feeding; diagnostic examinations should be limited to cases where etiology is dubious or complications are possible, bronchodilators should not be used for their scarce efficacy or limited to a trial dose; there is some evidence indicating that inhaled adrenaline is more efficacious and should be preferred. Steroids should not be used and ribavirine has very limited indications and precise requisites for effective use. Clinical and instrumental (SatO2) monitoring, oxygen therapy when required, proper hydration and feeding remain the mainstems of management of bronchiolitis.