Bronchiolitis- No medication in primary care; just monitor and refer when necessary

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Bronchiolitis- No medication in primary care; just monitor and refer when necessary

Bronchiolitis is common in children and for most infants treatment is supportive and the condition is self-limiting. There are no effective pharmacological treatments in primary care and the NICE guideline1 indicates not to use: antibiotics; oral steroids; nebulised adrenalin/saline/salbutamol; inhaled salbutamol/ipratropium/corticosteroids; montelukast or chest physiotherapy. 

The role of primary care is to reassure and give advice on feeding and fluid intake. The decision to refer should take into account other factors such as chronic lung disease (including bronchopulmonary dysplasia), haemodynamically significant congenital heart disease, age in young infants (under 3 months), premature birth, particularly under 32 weeks, neuromuscular disorders and immunodeficiency. 

Red flags indicating hospital referral are increased work of breathing becoming harder or exhaustion, poor fluid intake (<75% normal or no wet nappies for 12 hours) apnoea and cyanosis and an oxygen saturation < 92% on air. 

References:

  1. Bronchiolitis in children: diagnosis and management. NICE Guideline 2015. Click here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

 
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As published in NZ Doctor 12/04/2017