Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Bronchiolitis in infants and children: Treatment; outcome; and prevention

Pedro A Piedra, MD
Ann R Stark, MD
Section Editors
George B Mallory, MD
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD


Bronchiolitis, part of the spectrum of lower respiratory tract diseases, is a major cause of illness and hospitalization in infants and children younger than two years. The treatment, outcome, and prevention of bronchiolitis will be reviewed here. The epidemiology, clinical features, and diagnosis of bronchiolitis and the treatment of recurrent virus-induced wheezing in young children are discussed separately. (See "Bronchiolitis in infants and children: Clinical features and diagnosis" and "Treatment of recurrent virus-induced wheezing in young children".)


For the purposes of this topic review, bronchiolitis is broadly defined as a clinical syndrome that occurs in children <2 years of age and is characterized by upper respiratory symptoms (eg, rhinorrhea) followed by lower respiratory (eg, small airway/bronchiole) infection with inflammation, which results in wheezing and or crackles (rales). Bronchiolitis typically occurs with primary infection or reinfection with a viral pathogen, but occasionally is caused by bacteria (eg, Mycoplasma pneumoniae). In young children, the clinical syndrome of bronchiolitis may overlap with recurrent virus-induced wheezing and acute viral-triggered asthma. The diagnosis of bronchiolitis, virus-induced wheezing, and acute viral-triggered asthma are discussed separately. (See "Bronchiolitis in infants and children: Clinical features and diagnosis", section on 'Diagnosis' and "Virus-induced wheezing and asthma: An overview" and "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Asthma in children younger than 12 years: Initial evaluation and diagnosis", section on 'Respiratory tract infections'.)


Consensus definitions for severe bronchiolitis are lacking. In general, we consider severe bronchiolitis to be indicated by any of the following:

Persistently increased respiratory effort (tachypnea; nasal flaring; intercostal, subcostal, or suprasternal retractions; accessory muscle use; grunting) as assessed during repeated examinations separated by at least 15 minutes

Hypoxemia (SpO2 <95 percent); SpO2 should be interpreted in the context of other clinical signs, the state of the patient (eg, awake, asleep, coughing, etc), and altitude


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jun 29, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134:e1474.
  2. Adcock PM, Sanders CL, Marshall GS. Standardizing the care of bronchiolitis. Arch Pediatr Adolesc Med 1998; 152:739.
  3. Willson DF, Horn SD, Hendley JO, et al. Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness. Pediatrics 2001; 108:851.
  4. Mallory MD, Shay DK, Garrett J, Bordley WC. Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics 2003; 111:e45.
  5. Scottish Intercollegiate Guidelines Network. Bronchiolitis in children. A national clinical guideline. 2006. www.sign.ac.uk/pdf/sign91.pdf (Accessed on August 25, 2015).
  6. Bronchiolitis Guideline Team, Cincinnati Children's Hospital Medical Center. Bronchiolitis pediatric evidence-based care guidelines, 2010. www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/recommendations/topic/ (Accessed on February 24, 2015).
  7. Tapiainen T, Aittoniemi J, Immonen J, et al. Finnish guidelines for the treatment of laryngitis, wheezing bronchitis and bronchiolitis in children. Acta Paediatr 2016; 105:44.
  8. Shaw KN, Bell LM, Sherman NH. Outpatient assessment of infants with bronchiolitis. Am J Dis Child 1991; 145:151.
  9. Roback MG, Baskin MN. Failure of oxygen saturation and clinical assessment to predict which patients with bronchiolitis discharged from the emergency department will return requiring admission. Pediatr Emerg Care 1997; 13:9.
  10. Schuh S, Freedman S, Coates A, et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA 2014; 312:712.
  11. Cunningham S, Rodriguez A, Adams T, et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet 2015; 386:1041.
  12. Principi T, Coates AL, Parkin PC, et al. Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis. JAMA Pediatr 2016; 170:602.
  13. Hartling L, Bialy LM, Vandermeer B, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev 2011; :CD003123.
  14. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med 2013; 368:2286.
  15. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2014; :CD001266.
  16. Patel H, Gouin S, Platt RW. Randomized, double-blind, placebo-controlled trial of oral albuterol in infants with mild-to-moderate acute viral bronchiolitis. J Pediatr 2003; 142:509.
  17. Gadomski AM, Lichenstein R, Horton L, et al. Efficacy of albuterol in the management of bronchiolitis. Pediatrics 1994; 93:907.
  18. Cengizlier R, Saraçlar Y, Adalioğlu G, Tuncer A. Effect of oral and inhaled salbutamol in infants with bronchiolitis. Acta Paediatr Jpn 1997; 39:61.
  19. Quinonez RA, Garber MD, Schroeder AR, et al. Choosing wisely in pediatric hospital medicine: five opportunities for improved healthcare value. J Hosp Med 2013; 8:479.
  20. King VJ, Viswanathan M, Bordley WC, et al. Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Arch Pediatr Adolesc Med 2004; 158:127.
  21. Cade A, Brownlee KG, Conway SP, et al. Randomised placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis. Arch Dis Child 2000; 82:126.
  22. Blom D, Ermers M, Bont L, et al. Inhaled corticosteroids during acute bronchiolitis in the prevention of post-bronchiolitic wheezing. Cochrane Database Syst Rev 2007; :CD004881.
  23. Fernandes RM, Bialy LM, Vandermeer B, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2013; :CD004878.
  24. Jartti T, Vanto T, Heikkinen T, Ruuskanen O. Systemic glucocorticoids in childhood expiratory wheezing: relation between age and viral etiology with efficacy. Pediatr Infect Dis J 2002; 21:873.
  25. Liu F, Ouyang J, Sharma AN, et al. Leukotriene inhibitors for bronchiolitis in infants and young children. Cochrane Database Syst Rev 2015; :CD010636.
  26. National Institute for Health and Care Excellence. Bronchiolitis: diagnosis and management of bronchiolitis in children. Clinical Guideline NG 9. June 2015. https://www.nice.org.uk/guidance/ng9 (Accessed on August 20, 2015).
  27. Plint AC, Johnson DW, Patel H, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med 2009; 360:2079.
  28. Petruzella FD, Gorelick MH. Duration of illness in infants with bronchiolitis evaluated in the emergency department. Pediatrics 2010; 126:285.
  29. Plint AC, Johnson DW, Wiebe N, et al. Practice variation among pediatric emergency departments in the treatment of bronchiolitis. Acad Emerg Med 2004; 11:353.
  30. Thompson M, Vodicka TA, Blair PS, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013; 347:f7027.
  31. Swingler GH, Hussey GD, Zwarenstein M. Duration of illness in ambulatory children diagnosed with bronchiolitis. Arch Pediatr Adolesc Med 2000; 154:997.
  32. O'Donnell K, Mansbach JM, LoVecchio F, et al. Use of Cough and Cold Medications in Severe Bronchiolitis before and after a Health Advisory Warning against Their Use. J Pediatr 2015; 167:196.
  33. Khoshoo V, Edell D. Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis. Pediatrics 1999; 104:1389.
  34. Kugelman A, Raibin K, Dabbah H, et al. Intravenous fluids versus gastric-tube feeding in hospitalized infants with viral bronchiolitis: a randomized, prospective pilot study. J Pediatr 2013; 162:640.
  35. Hanna S, Tibby SM, Durward A, Murdoch IA. Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr 2003; 92:430.
  36. Gozal D, Colin AA, Jaffe M, Hochberg Z. Water, electrolyte, and endocrine homeostasis in infants with bronchiolitis. Pediatr Res 1990; 27:204.
  37. van Steensel-Moll HA, Hazelzet JA, van der Voort E, et al. Excessive secretion of antidiuretic hormone in infections with respiratory syncytial virus. Arch Dis Child 1990; 65:1237.
  38. Mussman GM, Parker MW, Statile A, et al. Suctioning and length of stay in infants hospitalized with bronchiolitis. JAMA Pediatr 2013; 167:414.
  39. Panitch HB. Respiratory syncytial virus bronchiolitis: supportive care and therapies designed to overcome airway obstruction. Pediatr Infect Dis J 2003; 22:S83.
  40. Ross PA, Newth CJ, Khemani RG. Accuracy of pulse oximetry in children. Pediatrics 2014; 133:22.
  41. Sinha IP, McBride AK, Smith R, Fernandes RM. CPAP and High-Flow Nasal Cannula Oxygen in Bronchiolitis. Chest 2015; 148:810.
  42. Pierce HC, Mansbach JM, Fisher ES, et al. Variability of intensive care management for children with bronchiolitis. Hosp Pediatr 2015; 5:175.
  43. Wing R, James C, Maranda LS, Armsby CC. Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency. Pediatr Emerg Care 2012; 28:1117.
  44. Javouhey E, Barats A, Richard N, et al. Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis. Intensive Care Med 2008; 34:1608.
  45. McKiernan C, Chua LC, Visintainer PF, Allen H. High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr 2010; 156:634.
  46. Schibler A, Pham TM, Dunster KR, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 2011; 37:847.
  47. Kallappa C, Hufton M, Millen G, Ninan TK. Use of high flow nasal cannula oxygen (HFNCO) in infants with bronchiolitis on a paediatric ward: a 3-year experience. Arch Dis Child 2014; 99:790.
  48. Metge P, Grimaldi C, Hassid S, et al. Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit. Eur J Pediatr 2014; 173:953.
  49. Mayfield S, Bogossian F, O'Malley L, Schibler A. High-flow nasal cannula oxygen therapy for infants with bronchiolitis: pilot study. J Paediatr Child Health 2014; 50:373.
  50. de Klerk A. Humidified high-flow nasal cannula: is it the new and improved CPAP? Adv Neonatal Care 2008; 8:98.
  51. Lee JH, Rehder KJ, Williford L, et al. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med 2013; 39:247.
  52. Hutchings FA, Hilliard TN, Davis PJ. Heated humidified high-flow nasal cannula therapy in children. Arch Dis Child 2015; 100:571.
  53. Hilliard TN, Archer N, Laura H, et al. Pilot study of vapotherm oxygen delivery in moderately severe bronchiolitis. Arch Dis Child 2012; 97:182.
  54. Wing R, Armsby CC. Noninvasive ventilation in pediatric acute respiratory illness (in press). Clin Pediatr Emerg Med 2015.
  55. Abboud PA, Roth PJ, Skiles CL, et al. Predictors of failure in infants with viral bronchiolitis treated with high-flow, high-humidity nasal cannula therapy*. Pediatr Crit Care Med 2012; 13:e343.
  56. Beggs S, Wong ZH, Kaul S, et al. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev 2014; :CD009609.
  57. Franklin D, Dalziel S, Schlapbach LJ, et al. Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A Paediatric Acute Respiratory Intervention Study (PARIS). BMC Pediatr 2015; 15:183.
  58. Arora B, Mahajan P, Zidan MA, Sethuraman U. Nasopharyngeal airway pressures in bronchiolitis patients treated with high-flow nasal cannula oxygen therapy. Pediatr Emerg Care 2012; 28:1179.
  59. Milési C, Baleine J, Matecki S, et al. Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Med 2013; 39:1088.
  60. Bressan S, Balzani M, Krauss B, et al. High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. Eur J Pediatr 2013; 172:1649.
  61. Hough JL, Pham TM, Schibler A. Physiologic effect of high-flow nasal cannula in infants with bronchiolitis. Pediatr Crit Care Med 2014; 15:e214.
  62. Schuh S. Update on management of bronchiolitis. Curr Opin Pediatr 2011; 23:110.
  63. Campion A, Huvenne H, Leteurtre S, et al. [Non-invasive ventilation in infants with severe infection presumably due to respiratory syncytial virus: feasibility and failure criteria]. Arch Pediatr 2006; 13:1404.
  64. Thia LP, McKenzie SA, Blyth TP, et al. Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child 2008; 93:45.
  65. Cambonie G, Milési C, Jaber S, et al. Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis. Intensive Care Med 2008; 34:1865.
  66. Martinón-Torres F, Rodríguez-Núñez A, Martinón-Sánchez JM. Nasal continuous positive airway pressure with heliox versus air oxygen in infants with acute bronchiolitis: a crossover study. Pediatrics 2008; 121:e1190.
  67. Martinón-Torres F, Rodríguez-Núñez A, Martinón-Sánchez JM. Nasal continuous positive airway pressure with heliox in infants with acute bronchiolitis. Respir Med 2006; 100:1458.
  68. Mayordomo-Colunga J, Medina A, Rey C, et al. Helmet-delivered continuous positive airway pressure with heliox in respiratory syncytial virus bronchiolitis. Acta Paediatr 2010; 99:308.
  69. Ganu SS, Gautam A, Wilkins B, Egan J. Increase in use of non-invasive ventilation for infants with severe bronchiolitis is associated with decline in intubation rates over a decade. Intensive Care Med 2012; 38:1177.
  70. Lazner MR, Basu AP, Klonin H. Non-invasive ventilation for severe bronchiolitis: analysis and evidence. Pediatr Pulmonol 2012; 47:909.
  71. Cavari Y, Sofer S, Rozovski U, Lazar I. Non invasive positive pressure ventilation in infants with respiratory failure. Pediatr Pulmonol 2012; 47:1019.
  72. Jat KR, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database Syst Rev 2015; 1:CD010473.
  73. Donlan M, Fontela PS, Puligandla PS. Use of continuous positive airway pressure (CPAP) in acute viral bronchiolitis: a systematic review. Pediatr Pulmonol 2011; 46:736.
  74. Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev 2012; :CD004873.
  75. Davison C, Ventre KM, Luchetti M, Randolph AG. Efficacy of interventions for bronchiolitis in critically ill infants: a systematic review and meta-analysis. Pediatr Crit Care Med 2004; 5:482.
  76. Tibby SM, Hatherill M, Wright SM, et al. Exogenous surfactant supplementation in infants with respiratory syncytial virus bronchiolitis. Am J Respir Crit Care Med 2000; 162:1251.
  77. Luchetti M, Casiraghi G, Valsecchi R, et al. Porcine-derived surfactant treatment of severe bronchiolitis. Acta Anaesthesiol Scand 1998; 42:805.
  78. Vos GD, Rijtema MN, Blanco CE. Treatment of respiratory failure due to respiratory syncytial virus pneumonia with natural surfactant. Pediatr Pulmonol 1996; 22:412.
  79. Jat KR, Chawla D. Surfactant therapy for bronchiolitis in critically ill infants. Cochrane Database Syst Rev 2015; :CD009194.
  80. Conway E, Schoettker PJ, Moore A, et al. Empowering respiratory therapists to take a more active role in delivering quality care for infants with bronchiolitis. Respir Care 2004; 49:589.
  81. 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; 169:898.
  82. Wang EE, Law BJ, Stephens D. Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr 1995; 126:212.
  83. Schroeder AR, Marmor AK, Pantell RH, Newman TB. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Arch Pediatr Adolesc Med 2004; 158:527.
  84. Brooks AM, McBride JT, McConnochie KM, et al. Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection. Pediatrics 1999; 104:463.
  85. Wainwright CE, Kapur N. Oxygen saturation targets in infants with bronchiolitis. Lancet 2015; 386:1016.
  86. Mansbach JM, Piedra PA, Teach SJ, et al. Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med 2012; 166:700.
  87. Shay DK, Holman RC, Newman RD, et al. Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA 1999; 282:1440.
  88. Jartti T, Aakula M, Mansbach JM, et al. Hospital length-of-stay is associated with rhinovirus etiology of bronchiolitis. Pediatr Infect Dis J 2014; 33:829.
  89. McMillan JA, Tristram DA, Weiner LB, et al. Prediction of the duration of hospitalization in patients with respiratory syncytial virus infection: use of clinical parameters. Pediatrics 1988; 81:22.
  90. Green M, Brayer AF, Schenkman KA, Wald ER. Duration of hospitalization in previously well infants with respiratory syncytial virus infection. Pediatr Infect Dis J 1989; 8:601.
  91. Dawson KP, Mogridge N. Acute bronchiolitis: a three year study. N Z Med J 1989; 102:528.
  92. Walsh EE, McConnochie KM, Long CE, Hall CB. Severity of respiratory syncytial virus infection is related to virus strain. J Infect Dis 1997; 175:814.
  93. Martinello RA, Chen MD, Weibel C, Kahn JS. Correlation between respiratory syncytial virus genotype and severity of illness. J Infect Dis 2002; 186:839.
  94. Wright PF, Gruber WC, Peters M, et al. Illness severity, viral shedding, and antibody responses in infants hospitalized with bronchiolitis caused by respiratory syncytial virus. J Infect Dis 2002; 185:1011.
  95. Mansbach JM, Clark S, Piedra PA, et al. Hospital course and discharge criteria for children hospitalized with bronchiolitis. J Hosp Med 2015; 10:205.
  96. Hartling L, Fernandes RM, Bialy L, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ 2011; 342:d1714.
  97. Hasegawa K, Tsugawa Y, Brown DF, et al. Trends in bronchiolitis hospitalizations in the United States, 2000-2009. Pediatrics 2013; 132:28.
  98. Shay DK, Holman RC, Roosevelt GE, et al. Bronchiolitis-associated mortality and estimates of respiratory syncytial virus-associated deaths among US children, 1979-1997. J Infect Dis 2001; 183:16.
  99. Holman RC, Shay DK, Curns AT, et al. Risk factors for bronchiolitis-associated deaths among infants in the United States. Pediatr Infect Dis J 2003; 22:483.
  100. Fjaerli HO, Farstad T, Rød G, et al. Acute bronchiolitis in infancy as risk factor for wheezing and reduced pulmonary function by seven years in Akershus County, Norway. BMC Pediatr 2005; 5:31.
  101. Hyvärinen M, Piippo-Savolainen E, Korhonen K, Korppi M. Teenage asthma after severe infantile bronchiolitis or pneumonia. Acta Paediatr 2005; 94:1378.
  102. Sigurs N, Gustafsson PM, Bjarnason R, et al. Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13. Am J Respir Crit Care Med 2005; 171:137.
  103. Piippo-Savolainen E, Korppi M, Korhonen K, Remes S. Adult asthma after non-respiratory syncytial virus bronchiolitis in infancy: subgroup analysis of the 20-year prospective follow-up study. Pediatr Int 2007; 49:190.
  104. Midulla F, Nicolai A, Ferrara M, et al. Recurrent wheezing 36 months after bronchiolitis is associated with rhinovirus infections and blood eosinophilia. Acta Paediatr 2014; 103:1094.
  105. Bergroth E, Aakula M, Korppi M, et al. Post-bronchiolitis Use of Asthma Medication: A Prospective 1-year Follow-up Study. Pediatr Infect Dis J 2016; 35:363.
  106. Stein RT, Sherrill D, Morgan WJ, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999; 354:541.
  107. Takeyama A, Hashimoto K, Sato M, et al. Clinical and epidemiologic factors related to subsequent wheezing after virus-induced lower respiratory tract infections in hospitalized pediatric patients younger than 3 years. Eur J Pediatr 2014; 173:959.
  108. Proesmans M, Sauer K, Govaere E, et al. Montelukast does not prevent reactive airway disease in young children hospitalized for RSV bronchiolitis. Acta Paediatr 2009; 98:1830.
  109. Bisgaard H, Flores-Nunez A, Goh A, et al. Study of montelukast for the treatment of respiratory symptoms of post-respiratory syncytial virus bronchiolitis in children. Am J Respir Crit Care Med 2008; 178:854.
  110. Kim CK, Choi J, Kim HB, et al. A randomized intervention of montelukast for post-bronchiolitis: effect on eosinophil degranulation. J Pediatr 2010; 156:749.
  111. Mukherjee S, Rutter K, Watson L, Eisenhut M. Adverse effects of bronchodilators in infants with bronchiolitis. J Pediatr Pharmacol Ther 2015; 20:70.
  112. Mansbach JM, Clark S, Teach SJ, et al. Children Hospitalized with Rhinovirus Bronchiolitis Have Asthma-Like Characteristics. J Pediatr 2016; 172:202.
  113. Panickar J, Lakhanpaul M, Lambert PC, et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med 2009; 360:329.
  114. Frey U, von Mutius E. The challenge of managing wheezing in infants. N Engl J Med 2009; 360:2130.
  115. Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C. Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review. Pediatrics 2015; 136:687.
  116. Badgett RG, Vindhyal M, Stirnaman JT, et al. A Living Systematic Review of Nebulized Hypertonic Saline for Acute Bronchiolitis in Infants. JAMA Pediatr 2015; 169:788.
  117. Brooks CG, Harrison WN, Ralston SL. Association Between Hypertonic Saline and Hospital Length of Stay in Acute Viral Bronchiolitis: A Reanalysis of 2 Meta-analyses. JAMA Pediatr 2016; 170:577.
  118. Silver AH, Esteban-Cruciani N, Azzarone G, et al. 3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial. Pediatrics 2015; 136:1036.
  119. Everard ML, Hind D, Ugonna K, et al. Saline in acute bronchiolitis RCT and economic evaluation: hypertonic saline in acute bronchiolitis - randomised controlled trial and systematic review. Health Technol Assess 2015; 19:1.
  120. Jacobs JD, Foster M, Wan J, Pershad J. 7% Hypertonic saline in acute bronchiolitis: a randomized controlled trial. Pediatrics 2014; 133:e8.
  121. Flores P, Mendes AL, Neto AS. A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants. Pediatr Pulmonol 2016; 51:418.
  122. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2013; :CD006458.
  123. Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, et al. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev 2016; 2:CD004873.
  124. Davies HD, Matlow A, Petric M, et al. Prospective comparative study of viral, bacterial and atypical organisms identified in pneumonia and bronchiolitis in hospitalized Canadian infants. Pediatr Infect Dis J 1996; 15:371.
  125. Kabir AR, Mollah AH, Anwar KS, et al. Management of bronchiolitis without antibiotics: a multicentre randomized control trial in Bangladesh. Acta Paediatr 2009; 98:1593.
  126. Farley R, Spurling GK, Eriksson L, Del Mar CB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev 2014; :CD005189.
  127. Hemming VG, Rodriguez W, Kim HW, et al. Intravenous immunoglobulin treatment of respiratory syncytial virus infections in infants and young children. Antimicrob Agents Chemother 1987; 31:1882.
  128. Rodriguez WJ, Gruber WC, Welliver RC, et al. Respiratory syncytial virus (RSV) immune globulin intravenous therapy for RSV lower respiratory tract infection in infants and young children at high risk for severe RSV infections: Respiratory Syncytial Virus Immune Globulin Study Group. Pediatrics 1997; 99:454.
  129. Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev 2015; :CD006915.
  130. Dimova-Yaneva D, Russell D, Main M, et al. Eosinophil activation and cysteinyl leukotriene production in infants with respiratory syncytial virus bronchiolitis. Clin Exp Allergy 2004; 34:555.
  131. Da Dalt L, Callegaro S, Carraro S, et al. Nasal lavage leukotrienes in infants with RSV bronchiolitis. Pediatr Allergy Immunol 2007; 18:100.
  132. Volovitz B, Welliver RC, De Castro G, et al. The release of leukotrienes in the respiratory tract during infection with respiratory syncytial virus: role in obstructive airway disease. Pediatr Res 1988; 24:504.
  133. Fullmer JJ, Khan AM, Elidemir O, et al. Role of cysteinyl leukotrienes in airway inflammation and responsiveness following RSV infection in BALB/c mice. Pediatr Allergy Immunol 2005; 16:593.
  134. Szefler SJ, Simoes EA. Montelukast for respiratory syncytial virus bronchiolitis: significant effect or provocative findings? Am J Respir Crit Care Med 2003; 167:290.
  135. Bisgaard H. Montelukast in RSV-bronchiolitis. Am J Respir Crit Care Med 2004; 169:542.