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Pulmonology356 papers

Bronchiolitis

Last edited: 4/14/2026

Overview

Bronchiolitis is a common viral respiratory infection in infants and young children, primarily caused by respiratory syncytial virus (RSV), characterized by inflammation of the lower respiratory tract leading to symptoms such as cough, wheezing, and respiratory distress 15.

Diagnosis

  • Clinical Presentation: Cough, wheezing, tachypnea, and signs of respiratory distress 1.
  • Nasopharyngeal Testing: Lactate dehydrogenase levels inversely correlate with severity 21.
  • Imaging: Chest radiographs often show hyperinflation or patchy infiltrates, but their utility varies 34.
  • Grading Severity: Tools incorporating age, work of breathing, dehydration, and tachycardia show reliability in predicting disease severity 26.

    • Management

  • Supportive Care: Oxygen therapy, hydration, and monitoring 113.
  • Avoid Bronchodilators: No proven efficacy in bronchiolitis 15.
  • High-Flow Nasal Cannula (HFNC): Used increasingly for respiratory support, though intubation rates remain variable 1011.
  • Vitamin D Assessment: Evaluate for deficiency, as it may correlate with severity 69.
  • Sedation and Weaning: Use of sedation weaning bundles can aid in extubation 3.

    • Special Populations

  • High-Risk Infants: Palivizumab prophylaxis recommended for premature infants <35 weeks gestation during RSV season 24.
  • Pediatric ICU: Chloral hydrate used for sedation with careful monitoring of adverse reactions 22.

    • Key Recommendations

  • Use Supportive Care: Focus on oxygen therapy, hydration, and monitoring respiratory status (Evidence: Strong 113).
  • Avoid Bronchodilator Use: Do not administer bronchodilators as they lack efficacy (Evidence: Strong 15).
  • Consider HFNC for Severe Cases: Utilize high-flow nasal cannula for respiratory support in severe bronchiolitis (Evidence: Moderate 1011).
  • Evaluate Vitamin D Levels: Assess and address vitamin D deficiency in infants with bronchiolitis (Evidence: Moderate 69).
  • Implement Sedation Weaning Protocols: Employ sedation weaning bundles to facilitate extubation in ICU settings (Evidence: Moderate 3).
  • Palivizumab Prophylaxis: Administer palivizumab to high-risk infants during RSV season (Evidence: Moderate 24).

    • References

    1 Borland ML, Loveys K, Babl FE, Cotterell E, Haskell L, O'Brien S et al.. Australasian Bronchiolitis Guideline: 2025 Update. Journal of paediatrics and child health 2025. link 2 Agossah C, Marie J, Bendoukha Y, Vallet C, Brouard J, Brossier D. The severity of the first occurrence of bronchiolitis increased the risk of developing asthma symptoms. Acta paediatrica (Oslo, Norway : 1992) 2025. link 3 Mitting RB, McDowell C, Blackwood B, Ray S. Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2025. link 4 Corcoran A, Shore D, Boesch RP, Chopra M, Das S, DiBardino D et al.. Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States. Pediatric pulmonology 2024. link 5 Makrinioti H, Hasegawa K, Lakoumentas J, Xepapadaki P, Tsolia M, Castro-Rodriguez JA et al.. The role of respiratory syncytial virus- and rhinovirus-induced bronchiolitis in recurrent wheeze and asthma-A systematic review and meta-analysis. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2022. link 6 Estalella-Mendoza A, Castellano-Martínez A, Flores-González JC, Estepa-Pedregosa L, Rodríguez-Campoy P, Rodríguez-González M. Vitamin D Levels and Cardiopulmonary Status in Infants with Acute Bronchiolitis. Indian pediatrics 2022. link 7 Rosenberg K. Intermittent vs. Continuous Pulse Oximetry in Infants Hospitalized with Bronchiolitis. The American journal of nursing 2021. link 8 Alharbi AS, Alzahrani M, Alodayani AN, Alhindi MY, Alharbi S, Alnemri A. Saudi experts' recommendation for RSV prophylaxis in the era of COVID-19: Consensus from the Saudi Pediatric Pulmonology Association. Saudi medical journal 2021. link 9 Alakaş Y, Celiloğlu C, Tolunay O, Matyar S. The Relationship between Bronchiolitis Severity and Vitamin D Status. Journal of tropical pediatrics 2021. link 10 Kalburgi S, Halley T. High-Flow Nasal Cannula Use Outside of the ICU Setting. Pediatrics 2020. link 11 Suessman A, Gray LL, Cavenaugh S, Camp EA, Shi Y, Meskill SD. Clinical factors associated with intubation in the high flow nasal cannula era. The American journal of emergency medicine 2020. link 12 Simone L, Lyttle MD, Roland D, Stephens D, Schuh S. Canadian and UK/Ireland practice patterns in lumbar puncture performance in febrile neonates with bronchiolitis. Emergency medicine journal : EMJ 2019. link 13 Kou M, Hwang V, Ramkellawan N. Bronchiolitis: From Practice Guideline to Clinical Practice. Emergency medicine clinics of North America 2018. link 14 Cordier JF, Cottin V, Lazor R, Thivolet-Béjui F. Many Faces of Bronchiolitis and Organizing Pneumonia. Seminars in respiratory and critical care medicine 2016. link 15 . Bronchiolitis in infants: do not use bronchodilators. Prescrire international 2016. link 16 Green CA, Yeates D, Goldacre A, Sande C, Parslow RC, McShane P et al.. Admission to hospital for bronchiolitis in England: trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma. Archives of disease in childhood 2016. link 17 Brown LK. What is BOOP? Lessons learned in silence. Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship 2015. link 18 Ho SW, Huang KY, Teng YH, Ku MS, Chiou JY. Practice Variations between Emergency Physicians and Pediatricians in Treating Acute Bronchiolitis in the Emergency Department: A Nationwide Study. The Journal of emergency medicine 2015. link 19 Lee LT, Ho CH, Putti TC. Bronchiolitis obliterans organizing pneumonia following nitric acid fume exposure. Occupational medicine (Oxford, England) 2014. link 20 Vogl UM, Nagayama K, Bojic M, Hoda MA, Klepetko W, Jaksch P et al.. Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: a single-center experience. Transplantation 2013. link 21 Mansbach JM, Piedra PA, Laham FR, McAdam AJ, Clark S, Sullivan AF et al.. Nasopharyngeal lactate dehydrogenase concentrations predict bronchiolitis severity in a prospective multicenter emergency department study. The Pediatric infectious disease journal 2012. link 22 Martinbiancho JK, Carvalho PR, Trotta Ede A, Schweiger AP, Rau R, Moreira LB. Evidence of safety of chloral hydrate for prolonged sedation in PICU in a tertiary teaching hospital in southern Brazil. European journal of clinical pharmacology 2009. link 23 Fenton ME, Kanthan R, Cockcroft DW. Nitrofurantoin-associated bronchiolitis obliterans organizing pneumonia: report of a case. Canadian respiratory journal 2008. link 24 Mansbach J, Kunz S, Acholonu U, Clark S, Camargo CA. Evaluation of compliance with palivizumab recommendations in a multicenter study of young children presenting to the emergency department with bronchiolitis. Pediatric emergency care 2007. link 25 Smith KJ, Fan LL. Insights into post-infectious bronchiolitis obliterans in children. Thorax 2006. link 26 Walsh P, Gonzales A, Satar A, Rothenberg SJ. The interrater reliability of a validated bronchiolitis severity assessment tool. Pediatric emergency care 2006. link 27 Madsen P, Shah SA, Rubin BK. Plastic bronchitis: new insights and a classification scheme. Paediatric respiratory reviews 2005. link 28 Hooi LN. Bronchiolitis obliterans organising pneumonia: a treatable condition. The Medical journal of Malaysia 2005. link 29 Mansbach JM, Emond JA, Camargo CA. Bronchiolitis in US emergency departments 1992 to 2000: epidemiology and practice variation. Pediatric emergency care 2005. link 30 Epler GR. Bronchiolitis obliterans organizing pneumonia. Archives of internal medicine 2001. link 31 Srivastava S, Haddad R, Kleinman G, Manthous CA. Erythema nodosum after smoke inhalation-induced bronchiolitis obliterans organizing pneumonia. Critical care medicine 1999. link 32 Possamai C, Corbanese U. Slow-resolving pneumonia secondary to bronchiolitis obliterans organizing pneumonia. Acta anaesthesiologica Scandinavica 1999. link 33 Gupta PR, Joshi N, Khangarot S. BOOP presenting as pseudo-lymphadenopathy. The Indian journal of chest diseases & allied sciences 1999. link 34 Roback MG, Dreitlein DA. Chest radiograph in the evaluation of first time wheezing episodes: review of current clinical practice and efficacy. Pediatric emergency care 1998. link 35 Mroz BJ, Sexauer WP, Meade A, Balsara G. Hemoptysis as the presenting symptom in bronchiolitis obliterans organizing pneumonia. Chest 1997. link 36 Amarasekera N, Chandani MH. Idiopathic bronchiolitis obliterans. The Ceylon medical journal 1995. link 37 Froudarakis M, Bouros D, Loire R, Valasiadou K, Tsiftsis D, Siafakas NM. BOOP presenting with haemoptysis and multiple cavitary nodules. The European respiratory journal 1995. link 38 Valle JM, Alvarez D, Antúnez J, Valdés L. Bronchiolitis obliterans organizing pneumonia secondary to amiodarone: a rare aetiology. The European respiratory journal 1995. link 39 Piperno D, Donné C, Loire R, Cordier JF. Bronchiolitis obliterans organizing pneumonia associated with minocycline therapy: a possible cause. The European respiratory journal 1995. link 40 Rutledge M, Davis J, Bixby L. Why another leaflet?. Health visitor 1994. link 41 Patel H, Karetzky MS. Idiopathic unilateral hyperlucent lung. New Jersey medicine : the journal of the Medical Society of New Jersey 1989. link 42 Miki Y, Hatabu H, Takahashi M, Sadatoh N, Kuroda Y. Computed tomography of bronchiolitis obliterans. Journal of computer assisted tomography 1988. link 43 Iannuzzi MC, Farhi DC, Bostrom PD, Petty TL, Fisher JH. Fulminant respiratory failure and death in a patient with idiopathic bronchiolitis obliterans. Archives of internal medicine 1985. link 44 Rosenberg ME, Vercellotti GM, Snover DC, Hurd D, McGlave P. Bronchiolitis obliterans after bone marrow transplantation. American journal of hematology 1985. link

    Original source

    1. [1]
      Australasian Bronchiolitis Guideline: 2025 Update. — Borland ML, Loveys K, Babl FE, Cotterell E, Haskell L, O'Brien S et al. Journal of paediatrics and child health (2025)
    2. [2]
      The severity of the first occurrence of bronchiolitis increased the risk of developing asthma symptoms. — Agossah C, Marie J, Bendoukha Y, Vallet C, Brouard J, Brossier D Acta paediatrica (Oslo, Norway : 1992) (2025)
    3. [3]
      Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial. — Mitting RB, McDowell C, Blackwood B, Ray S Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (2025)
    4. [4]
      Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States. — Corcoran A, Shore D, Boesch RP, Chopra M, Das S, DiBardino D et al. Pediatric pulmonology (2024)
    5. [5]
      The role of respiratory syncytial virus- and rhinovirus-induced bronchiolitis in recurrent wheeze and asthma-A systematic review and meta-analysis. — Makrinioti H, Hasegawa K, Lakoumentas J, Xepapadaki P, Tsolia M, Castro-Rodriguez JA et al. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2022)
    6. [6]
      Vitamin D Levels and Cardiopulmonary Status in Infants with Acute Bronchiolitis. — Estalella-Mendoza A, Castellano-Martínez A, Flores-González JC, Estepa-Pedregosa L, Rodríguez-Campoy P, Rodríguez-González M Indian pediatrics (2022)
    7. [7]
      Intermittent vs. Continuous Pulse Oximetry in Infants Hospitalized with Bronchiolitis. — Rosenberg K The American journal of nursing (2021)
    8. [8]
      Saudi experts' recommendation for RSV prophylaxis in the era of COVID-19: Consensus from the Saudi Pediatric Pulmonology Association. — Alharbi AS, Alzahrani M, Alodayani AN, Alhindi MY, Alharbi S, Alnemri A Saudi medical journal (2021)
    9. [9]
      The Relationship between Bronchiolitis Severity and Vitamin D Status. — Alakaş Y, Celiloğlu C, Tolunay O, Matyar S Journal of tropical pediatrics (2021)
    10. [10]
      High-Flow Nasal Cannula Use Outside of the ICU Setting. — Kalburgi S, Halley T Pediatrics (2020)
    11. [11]
      Clinical factors associated with intubation in the high flow nasal cannula era. — Suessman A, Gray LL, Cavenaugh S, Camp EA, Shi Y, Meskill SD The American journal of emergency medicine (2020)
    12. [12]
      Canadian and UK/Ireland practice patterns in lumbar puncture performance in febrile neonates with bronchiolitis. — Simone L, Lyttle MD, Roland D, Stephens D, Schuh S Emergency medicine journal : EMJ (2019)
    13. [13]
      Bronchiolitis: From Practice Guideline to Clinical Practice. — Kou M, Hwang V, Ramkellawan N Emergency medicine clinics of North America (2018)
    14. [14]
      Many Faces of Bronchiolitis and Organizing Pneumonia. — Cordier JF, Cottin V, Lazor R, Thivolet-Béjui F Seminars in respiratory and critical care medicine (2016)
    15. [15]
      Bronchiolitis in infants: do not use bronchodilators. Prescrire international (2016)
    16. [16]
      Admission to hospital for bronchiolitis in England: trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma. — Green CA, Yeates D, Goldacre A, Sande C, Parslow RC, McShane P et al. Archives of disease in childhood (2016)
    17. [17]
      What is BOOP? Lessons learned in silence. — Brown LK Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship (2015)
    18. [18]
      Practice Variations between Emergency Physicians and Pediatricians in Treating Acute Bronchiolitis in the Emergency Department: A Nationwide Study. — Ho SW, Huang KY, Teng YH, Ku MS, Chiou JY The Journal of emergency medicine (2015)
    19. [19]
      Bronchiolitis obliterans organizing pneumonia following nitric acid fume exposure. — Lee LT, Ho CH, Putti TC Occupational medicine (Oxford, England) (2014)
    20. [20]
      Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: a single-center experience. — Vogl UM, Nagayama K, Bojic M, Hoda MA, Klepetko W, Jaksch P et al. Transplantation (2013)
    21. [21]
      Nasopharyngeal lactate dehydrogenase concentrations predict bronchiolitis severity in a prospective multicenter emergency department study. — Mansbach JM, Piedra PA, Laham FR, McAdam AJ, Clark S, Sullivan AF et al. The Pediatric infectious disease journal (2012)
    22. [22]
      Evidence of safety of chloral hydrate for prolonged sedation in PICU in a tertiary teaching hospital in southern Brazil. — Martinbiancho JK, Carvalho PR, Trotta Ede A, Schweiger AP, Rau R, Moreira LB European journal of clinical pharmacology (2009)
    23. [23]
      Nitrofurantoin-associated bronchiolitis obliterans organizing pneumonia: report of a case. — Fenton ME, Kanthan R, Cockcroft DW Canadian respiratory journal (2008)
    24. [24]
      Evaluation of compliance with palivizumab recommendations in a multicenter study of young children presenting to the emergency department with bronchiolitis. — Mansbach J, Kunz S, Acholonu U, Clark S, Camargo CA Pediatric emergency care (2007)
    25. [25]
      Insights into post-infectious bronchiolitis obliterans in children. — Smith KJ, Fan LL Thorax (2006)
    26. [26]
      The interrater reliability of a validated bronchiolitis severity assessment tool. — Walsh P, Gonzales A, Satar A, Rothenberg SJ Pediatric emergency care (2006)
    27. [27]
      Plastic bronchitis: new insights and a classification scheme. — Madsen P, Shah SA, Rubin BK Paediatric respiratory reviews (2005)
    28. [28]
      Bronchiolitis obliterans organising pneumonia: a treatable condition. — Hooi LN The Medical journal of Malaysia (2005)
    29. [29]
      Bronchiolitis in US emergency departments 1992 to 2000: epidemiology and practice variation. — Mansbach JM, Emond JA, Camargo CA Pediatric emergency care (2005)
    30. [30]
      Bronchiolitis obliterans organizing pneumonia. — Epler GR Archives of internal medicine (2001)
    31. [31]
      Erythema nodosum after smoke inhalation-induced bronchiolitis obliterans organizing pneumonia. — Srivastava S, Haddad R, Kleinman G, Manthous CA Critical care medicine (1999)
    32. [32]
      Slow-resolving pneumonia secondary to bronchiolitis obliterans organizing pneumonia. — Possamai C, Corbanese U Acta anaesthesiologica Scandinavica (1999)
    33. [33]
      BOOP presenting as pseudo-lymphadenopathy. — Gupta PR, Joshi N, Khangarot S The Indian journal of chest diseases & allied sciences (1999)
    34. [34]
      Chest radiograph in the evaluation of first time wheezing episodes: review of current clinical practice and efficacy. — Roback MG, Dreitlein DA Pediatric emergency care (1998)
    35. [35]
      Hemoptysis as the presenting symptom in bronchiolitis obliterans organizing pneumonia. — Mroz BJ, Sexauer WP, Meade A, Balsara G Chest (1997)
    36. [36]
      Idiopathic bronchiolitis obliterans. — Amarasekera N, Chandani MH The Ceylon medical journal (1995)
    37. [37]
      BOOP presenting with haemoptysis and multiple cavitary nodules. — Froudarakis M, Bouros D, Loire R, Valasiadou K, Tsiftsis D, Siafakas NM The European respiratory journal (1995)
    38. [38]
      Bronchiolitis obliterans organizing pneumonia secondary to amiodarone: a rare aetiology. — Valle JM, Alvarez D, Antúnez J, Valdés L The European respiratory journal (1995)
    39. [39]
      Bronchiolitis obliterans organizing pneumonia associated with minocycline therapy: a possible cause. — Piperno D, Donné C, Loire R, Cordier JF The European respiratory journal (1995)
    40. [40]
      Why another leaflet? — Rutledge M, Davis J, Bixby L Health visitor (1994)
    41. [41]
      Idiopathic unilateral hyperlucent lung. — Patel H, Karetzky MS New Jersey medicine : the journal of the Medical Society of New Jersey (1989)
    42. [42]
      Computed tomography of bronchiolitis obliterans. — Miki Y, Hatabu H, Takahashi M, Sadatoh N, Kuroda Y Journal of computer assisted tomography (1988)
    43. [43]
      Fulminant respiratory failure and death in a patient with idiopathic bronchiolitis obliterans. — Iannuzzi MC, Farhi DC, Bostrom PD, Petty TL, Fisher JH Archives of internal medicine (1985)
    44. [44]
      Bronchiolitis obliterans after bone marrow transplantation. — Rosenberg ME, Vercellotti GM, Snover DC, Hurd D, McGlave P American journal of hematology (1985)
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