When it comes to treating bronchiolitis in children from 1 through 23 months of age,
the 2014 AAP clinical practice guideline has an extensive list of don’ts. Clinicians
should not administer albuterol or epinephrine. They should not administer systemic
corticosteroids. They should not administer antibacterial medications unless there
is a concomitant bacterial infection or a strong suspicion of one.
“I think people underestimate how difficult it is to care for a child in respiratory
distress and not do anything to try to help the child feel better. But to date, we
really haven’t found anything that has been shown to consistently improve outcomes
for these kids,” said Jonathan M. Mansbach, M.D., M.P.H., a pediatric hospitalist
at Children’s Hospital Boston and associate professor of pediatrics, Harvard Medical
School. “For now, the care is as the AAP guideline states, which is to provide supportive
care, but I think in the future that may change.”
Dr. Mansbach and Colette C. Mull, M.D., M.A., FAAP, will discuss what the evidence
shows and changes that may be on the horizon during the point-counterpoint session
“Clearing the Air on Bronchiolitis (D1115)” from 4-5 p.m. Saturday, Nov. 3 in room
W304AB of the convention center.
“One thing that is near and dear to my heart is the practice of evidence-based medicine
and teaching house staff how to practice evidence-based medicine in this particular
disease,” said Dr. Mull, a pediatric emergency medicine attending physician at Nemours/A.I.
DuPont Hospital for Children in Wilmington, Del., and associate clinical professor
of pediatrics, Sidney Kimmel College of Medicine at Jefferson University in Philadelphia.
“Unfortunately, appropriate treatment of bronchiolitis is a bit like ‘tie your hands
behind your back.’ But there seems to be some hope of new treatment approaches on
the horizon, and we plan on ending our discussion by leaving attendees with some hope
based on new data.”
Dr. Mull developed an interest in bronchiolitis during her pediatric emergency medicine
fellowship, when she conducted a research trial comparing the use of nebulized epinephrine
with albuterol in the management of infants with bronchiolitis presenting to the emergency
“My current interest in this field is based on the longtime observation that there’s
a significant discrepancy between how patients with bronchiolitis are treated in their
primary care physician’s office and community hospital EDs vs. how the scientific
evidence suggests they be treated,” said Dr. Mull, a member of the AAP Section on
Emergency Medicine Executive Committee.
Dr. Mansbach’s interest was sparked after his son developed the disease.
“My son was hospitalized with bronchiolitis, and when I started looking at the data
more carefully after this event, I was flummoxed by the fact that there were no really
good data on this common illness,” said Dr. Mansbach, who has been doing research
on bronchiolitis and respiratory viruses with the Emergency Medicine Network for more
than a decade.
“Research on bronchiolitis is coming along nicely,” he said, “and I think the newer
results provide some hope.”