Bronchiolitis - Treatments

Palivizumab injections to prevent bronchiolitis

If your baby is at high risk of life-threatening bronchiolitis, injections of a medicine called palivizumab (brand name Synagis) each month during the winter might mean they don't have to go to hospital.

Doctors only use these medicines to prevent bronchiolitis. They aren't used to treat babies and children who already have the illness.

Palivizumab is an antibody that can protect your baby against respiratory syncytial virus (RSV), the main cause of bronchiolitis. Your body naturally produces antibodies to defend it against viruses or bacteria. But if your baby has serious heart problems or lung problems, they might need the extra protection of antibody injections.

Doctors used to give babies another medicine called an immunoglobulin (brand name RespiGam). This medicine also fights the respiratory syncytial virus (RSV). But this drug has to be fed into a vein by a drip for four hours. Palivizumab is a newer drug and much easier to give to your baby. Your baby needs only one injection of palivizumab a month into the muscle of their thigh. Doctors usually prescribe palivizumab to babies at a high risk of getting bronchiolitis.

Usually, children will only have this sort of treatment if they:[2]

• Were born prematurely (before 35 weeks)
• Are under 2 years of age and have a serious lung disease, which means they need extra oxygen
• Are under 2 years of age and have a serious heart disease.

There is plenty of research to show this medicine works. We found five good-quality studies (randomised controlled trials) including nearly 5,000 children with serious lung disease or heart disease. Children at high risk from bronchiolitis were half as likely to have to go to hospital if they had palivizumab or immunoglobulin through a drip.[3] [4]

This treatment has side effects but they aren't common. There's a small chance that your baby will get a fever or a skin reaction where they are injected with palivizumab.[4] One study also found that babies who were given this drug were slightly more likely to get serious breathing difficulties.

About 3 in 100 children who were put on an immunoglobulin drip had complications. They breathed faster, had a fever, a skin reaction where they were injected, and a slight decrease in oxygen in their blood.[3] The immunoglobulin shouldn't be given to babies with serious heart disease.[2]

Taking care to prevent bronchiolitis from spreading

If nurses and doctors wash their hands between patients this helps a lot to prevent infection, including bronchiolitis, spreading to other children.[5] Separating babies with bronchiolitis from children who don't have it may also help, as may getting nurses and other hospital staff to wear gowns, masks and gloves.[6]

But more research into different nursing practices is needed to be sure of the best way of preventing the spread of bronchiolitis to other babies and young children in hospital.

Bronchodilators

Bronchodilators are drugs that are used to make your airways (bronchioles) open up (dilate). They are normally used to quickly help people with asthma. Examples include salbutamol (Ventolin, Airomir), orciprenaline (Alupent), adrenaline, ipratropium bromide (Atrovent) and aminophylline.

Sometimes babies are given this drug if they have problems breathing because of bronchiolitis. They are usually breathed in (inhaled), although they can also be given as injections.

We found quite a few studies (called randomised controlled trials) of these medicines for bronchiolitis. These found that, for children with mild to moderate symptoms, bronchodilators might help with breathing. But they won't help children who have more severe bronchiolitis and need to be treated in hospital.[7] [8] [9] [10] For example, there's no evidence that bronchodilators can prevent your child having to go into hospital or reduce the time they need to spend in hospital. More good research is needed to know for certain whether or not these drugs help with bronchioloitis.

There's a risk of side effects from bronchodilators. A child who takes them may get a fast heartbeat, increased blood pressure, less oxygen in their blood, flushing, hyperactivity, cough and tremor (muscle movements that can't be controlled) after using a bronchodilator.[7]

Physiotherapy

A physiotherapist may sometimes work with a child to try to remove the phlegm from their lungs. The idea is that this will help them breathe more easily. Physiotherapists can do this in various ways. For example, they may put your child in a position that helps their lungs drain. Or they might pat your child's chest to help the fluids move from their lungs into their throat. But there's no evidence from the three studies we found that chest physiotherapy helps children with bronchiolitis who are treated in hospital go home sooner.[11] More research is needed to know whether or not this treatment works.

There's no evidence from these studies that chest physiotherapy is harmful.

Montelukast

Montelukast (brand name Singulair) is a drug that's sometimes used to treat asthma. It's used to help calm down the airways to prevent children getting asthma symptoms. We haven't found any good studies to show whether or not this treatment works for children with bronchiolitis.

Ribavirin

Ribavirin (brand name Virazole) is a medicine that attacks viruses. It isn't usually given to babies with bronchiolitis. There's no clear evidence that this drug will help your baby get better.

One summary of the research (called a systematic review) found that children given ribavirin were just as likely to get worse, die or need to stay in hospital as children given a dummy treatment (a placebo).[12] But there is some evidence that ribavirin may reduce the length of time a child needs to stay on a ventilating machine to help with breathing.[12]

Treatment with ribavirin probably won't help in the long term either. Two studies (randomised controlled trials) found that children treated with ribavirin for bronchiolitis were just as likely to have a wheezing illness and need hospital treatment the following year as those who had a dummy treatment (a placebo).[13] [14]

Ribavirin can have side effects. The lungs of some children go into a spasm after treatment. People looking after children who are taking ribavirin can get headaches and problems with contact lenses.[15]

Surfactants

Surfactants are drugs that are usually used to help premature babies breathe more easily. They are similar to the natural fluid in your lungs. They are put into your lungs through a tube in your windpipe. Beractant (brand name Survanta) and poractant (Curosurf) are two products available in the UK.

Some small studies have looked at surfactants in children with bronchiolitis who have to go on a ventilator. The studies found that the children needed to spend less time in the hospital intensive care units of their hospitalsl.[16] But we need more studies to know whether or not this treatment works.

The studies we found did not report any problems with this treatment. But, in premature babies, surfactants can sometimes create more mucus in the lungs, which can make breathing more difficult. They can also make the lungs bleed. But this is very rare.

Treatments that are unlikely to work

Steroids

Steroids are medicines that reduce inflammation. They are often used to help control asthma. Doctors are unlikely to give steroids to a baby with bronchiolitis.

Lots of studies have found that steroids are unlikely to help children who have bronchiolitis avoid going into hospital or make their stay in hospital any shorter.[17] [18] [19]

Steroids have side effects. Sometimes, blood sugar levels get too high. This is called hyperglycaemia. And the drugs can affect a child's immune system and make them less able to fight infections.[20] A few children in the studies got muscle movements (tremors) after breathing in steroids.[21]