A child with mild to moderate bronchiolitis can be managed at home. Pharmacological treatment is not required. It should
be explained to parents and caregivers that in the first 72 hours the symptoms may worsen before starting to improve.
Instructions should be given on how to identify concerning signs of deterioration, e.g. marked dehydration and respiratory
distress, and to access after-hours care if required. This is especially important for Māori and Pacific families,
as Māori or Pacific ethnicity is an independent risk factor for hospitalisation for bronchiolitis.2
Infants who become dehydrated or who are feeding at below half of the normal amount in a 24 hour period should be assessed
and referred to hospital if necessary. High risk-infants, e.g. aged under three months or with underlying co-morbidities,
who are examined early in the illness, should be reassessed within 24 hours for signs of deterioration.
Fluids (e.g. breast milk) should be given in small amounts, frequently, to prevent dehydration.
Saline drops may be be trialled if there is nasal congestion.
Steam inhalation is sometimes used for symptomatic relief, however, there is no evidence that it is
effective in the treatment of bronchiolitis.7
Antibiotics are ineffective as bronchiolitis is viral in origin.
Inhaled bronchodilators are not recommended for the treatment of infants with bronchiolitis and no
other history of recurrent wheeze.8 The respiratory symptoms of bronchiolitis are caused by blockage of airways
with mucous, rather than airway narrowing, therefore bronchodilators have little benefit. They do not improve oxygen saturation,
reduce the need for hospitalisation or shorten the duration of the illness.8 Small, short-term improvements
in respiratory score following bronchodilation may occur, however, adverse effects include tachycardia and tremor.8
There is no evidence to support the use of oral or inhaled corticosteroids or ipratropium for
the treatment of bronchiolitis in primary care.
Hospital treatment is also supportive and includes nasal suction, supplemental oxygen, rehydration and maintenance of
A smoke-free home with a room that is at a comfortable temperature for a lightly clothed adult should
be provided for the infant to sleep in. Where possible the infant should avoid close contact with other children to prevent
transmission of the disease. Other family members with respiratory symptoms should also avoid close contact in order to
reduce the risk of the infant developing a secondary infection. Re-infection is common and hand washing is the best way
to prevent RSV transmission.
Passive smoking increases risk of bronchiolitis
Infants in a household where both parents smoke have a risk of developing bronchiolitis three times greater than infants
in a household where neither parent smokes.10 In 2009, approximately 20% of people in New Zealand aged 15
- 64 years were current smokers.11 However, in the same age range, almost 50% of Māori females, over
40% of Māori males and approximately 30% of Pacific adults were current smokers.11
It is recommended that smoking cessation advice be given (using the "ABC" method - Ask, Brief Advice, Cessation support)
to any family member who is a smoker.12 If family members must smoke, stress the importance of doing so outside,
away from children and never in a car.
For further information see: "Update
on smoking cessation" BPJ 33 (Dec, 2010).
Post-bronchiolitic wheeze after hospitalisation
Persistent wheeze is experienced by approximately 40% of infants who are hospitalised due to bronchiolitis, continuing
up to age five years.9 Approximately 10% will continue to have wheezing episodes after age five years, but
by age 13 years, wheeze will have resolved in most children.9
For further information see: "Bronchiolitis
update", BPJ 20 (Apr, 2009).