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Bronchiolitis

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
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Last reviewed: 9 Apr 2025
Last updated: 10 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • tachypnea
  • wheezing
  • retractions, grunting, and nasal flaring
Full details

Other diagnostic factors

  • rhinitis
  • fluctuating clinical findings
  • irritability, malaise, and poor feeding
  • fever <104°F (<40°C)
  • crackles
  • apnea
  • thoracoabdominal asynchrony
Full details

Risk factors

  • infants <3 years
  • winter months
  • prematurity or bronchopulmonary dysplasia
  • passive tobacco smoke exposure and air pollution
  • impaired airway clearance and function
  • congenital heart disease
  • immunodeficiency
Full details

Diagnostic tests

1st tests to order

  • pulse oximetry
Full details

Tests to avoid

  • broad respiratory pathogen panels
Full details

Tests to consider

  • enzyme-linked immunosorbent assay (ELISA) rapid antigen detection
  • chest x-ray
  • reverse transcriptase polymerase chain reaction (RT-PCR)
Full details

Treatment algorithm

ACUTE

confirmed bronchiolitis

Contributors

Authors

Howard B. Panitch, MD

Professor

Division of Pulmonary Medicine

Children's Hospital of Philadelphia

Philadelphia

PA

Disclosures

HBP is a member of the American Thoracic Society's Guideline Committee, Long-Term Oxygen Therapy for Infants and Children, past Chair of the American College of Chest Physicians' Home Based Mechanical Ventilation and Neuromuscular Disease NetWork, a member of the ATS guideline committee on bronchopulmonary dysplasia (BPD), and a member of the current new guideline committee updating the BPD Statement. He is a member of the planning committee of the Pediatric Assembly of the American Thoracic Society, and receives royalties from Up-To-Date for the review of two topics (Spirometry in Children and Bronchopulmonary Dysplasia).

Acknowledgements

Professor Panitch would like to gratefully acknowledge Dr Isaac Desheng Liu, Dr Woon Li Seo, Dr Jennifer L. Nayak, Dr Caroline B. Hall, and Dr Clement L. Ren, previous contributors to this topic.

Disclosures

IDL, WLS, JLN, and CLR declare that they have no competing interests. CBH is an author of a number of references cited in this topic.

Peer reviewers

Robert Welliver, MD

Professor of Pediatrics

Women and Children's Hospital

Buffalo

NY

Disclosures

RW declares that he has no competing interests.

Giovanni Piedimonte, MD

Wyeth Research Scholar Professor and Chair

Department of Pediatrics

WVU School of Medicine

Physician-in-Chief

WVU Children's Hospital

Morgantown

WV

Disclosures

GP declares that he has no competing interests.

H. Cody Meissner, MD

Professor of Pediatrics

Infectious Disease

Department of Pediatrics

Tufts-New England Medical Center

Boston

MA

Disclosures

HCM is an author of a number of references cited in this topic.

John Henderson, MBBS

Professor of Paediatric Respiratory Medicine

University of Bristol

Bristol

UK

Disclosures

JH declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

McCulloh R, Koster M, Ralston S, et al. Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2015 Oct;169(10):898-904.Full text  Abstract

Cunningham S, Rodriguez A, Adams T, et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet. 2015 Sep 12;386(9998):1041-8.Full text  Abstract

Lin J, Zhang Y, Xiong L, et al. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child. 2019 Jun;104(6):564-76. Abstract

Farley R, Spurling GK, Eriksson L, et al. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014 Oct 9;(10):CD005189.Full text  Abstract

Zhang L, Mendoza-Sassi RA, Wainwright CE, et al. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2023 Apr 4;4(4):CD006458.Full text  Abstract

Liet JM, Ducruet T, Gupta V, et al. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2015 Sep 18;(9):CD006915.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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