pulmonary disease Bronchiolitis

Bronchiolitis is broadly defined as a clinical syndrome of respiratory distress that occurs in children ۲ years of age. It is characterized by upper respiratory symptoms (eg, rhinorrhea) followed by lower respiratory tract signs (eg, wheezing and/or crackles) Patients with mild bronchiolitis (respiratory severity score [RSS] ۵) can usually be managed in the outpatient setting unless there are concerns about the caregivers' ability to care for them at home. Supportive care and anticipatory guidance are the mainstays of management. Supportive care includes relief of nasal congestion/obstruction, maintenance of adequate hydration, and fever management. Patients with moderate to severe bronchiolitis require evaluation in the emergency department and usually require supportive care in the inpatient setting. Supportive care is the mainstay of management of bronchiolitis in the emergency department and inpatient settings. This includes: •Fluid, nutrition, and fever management Respiratory support - Supplemental oxygen therapy is provided as needed for patients with persistent hypoxemia, targeting an oxygen saturation goal of ≥۹۰ percent Nasal suctioning Limited indications for inhaled bronchodilator: for patients with severe respiratory distress and wheezing, we suggest a trial of bronchodilator therapy. We suggest albuterol (salbutamol) rather than nebulized epinephrine for this purpose.