Bronchiolitis

• Based on good evidence, the diagnosis of bronchiolitis should be based on clinical evaluation without supportive laboratory or radiologic studies. • Based on good evidence, the mainstay of therapy is supportive care and involves oxygen, hydration, and nutrition support. • Based on good evidence, many current therapeutic interventions have not demonstrated efficacious improvement in the clinical course or subsequent outcomes. A trial of bronchodilator therapy is optional but should be continued only if a clinical response is documented. Corticosteroids should not be used to treat bronchiolitis, and ribavirin therapy should be reserved for special situations. • Based on good evidence, effective measures to prevent bronchiolitis include administration of palivizumab, encouragement of breastfeeding, avoidance of tobacco smoke, and strict handwashing as well as adherence to other institutional infection control policies. • Future areas of research include defining the roles of pulse oximetry and oxygen therapy in bronchiolitis, developing a robust clinical scoring tool for assessing respiratory distress in patients who have bronchiolitis, delineating the relationship between early clinical bronchiolitis and recurrent wheezing episodes, and developing cost-effective immunoprophylaxis and ultimately vaccination against RSV.