RSV/Bronchiolitis and Ventolin

Great question and one that comes up frequently, particularly as the RSV season approaches! Bronchiolitis is inflammation of the bronchioles usually caused by an acute viral illness. It is the most common lower respiratory tract infection in children younger than two years of age. The most common infectious agent causing acute bronchiolitis in children is the respiratory syncytial virus (RSV). Bronchiolitis is a clinical diagnosis based on history and physical examination. It can present various symptoms and severity, from a mild upper respiratory tract infection (URTI) to impending respiratory failure (grunting, nasal flaring, indrawing, retractions or abdominal breathing). Management of bronchiolitis generally requires only supportive care (oxygenation (Sats< 93%), hydration, nasal suctioning). It is recommended to avoid activities that may agitate the child as they can worsen the clinical presentation, allowing the child to remain comforted by a parent and avoiding any unnecessary application of monitors and devices. Evidence does not support the routine use of salbutamol, nebulized epinephrine, or corticosteroids, given the possible side effects weighed against any clinical improvement. Suppose a child has persistent issues with oxygenation despite supplemental oxygen, increased work of breathing that is interfering with hydration or oxygenation, or a family history of asthma. In that case, it is not uncommon for a trial of salbutamol and/or nebulized epinephrine to be used to see if there is any clinical improvement.  In summary, bronchiolitis is a common lower respiratory tract infection in children < 2 years of age that is usually best managed by supportive care.