Acute viral bronchiolitis in South Africa: Strategies for management and prevention

Management of acute viral bronchiolitis is largely supportive. There is currently no proven effective therapy other than oxygen for hypoxicchildren. The evidence indicates that there is no routine benefit from inhaled, rapid short-acting bronchodilators, adrenaline or ipratropiumbromide for children with acute viral bronchiolitis. Likewise, there is no demonstrated benefit from routine use of inhaled or oral corticosteroids,inhaled hypertonic saline nebulisation, montelukast or antibiotics. The last should be reserved for children with severe disease, when bacterialco-infection is suspected.Prevention of respiratory syncytial virus (RSV) disease remains a challenge. A specific RSV monoclonal antibody, palivizumab,administered as an intramuscular injection, is available for children at risk of severe bronchiolitis, including premature infants, youngchildren with chronic lung disease, immunodeficiency, or haemodynamically significant congenital heart disease. Prophylaxis should becommenced at the start of the RSV season and given monthly during the season. The development of an RSV vaccine may offer a moreeffective alternative to prevent disease, for which the results of clinical trials are awaited.Education of parents or caregivers and healthcare workers about diagnostic and management strategies should include the following:bronchiolitisis caused by a virus; it is seasonal; it may start as an upper respiratory tract infection with low-grade fever; symptoms arecough and wheeze, often with fast breathing; antibiotics are generally not needed; and the condition is usually self limiting, althoughsymptoms may occur for up to four weeks in some children