Nebulized epinephrine decreases oxygen requirements, respiratory rate, wheezing, and retractions and may lower hospitalization rates and length of stay (Grade of Recommendation: A, based on consistent randomized controlled trials [RCTs] and systematic reviews). At best, other beta-2 agonists provide modest short-term improvement in mild to moderate bronchiolitis (Grade of Recommendation: A, consistent RCTs and systematic reviews), and may be indicated in patients with preexisting asthma. Discontinue bronchodilators if patients do not respond quickly, because the bronchodilators may cause respiratory deterioration (Grade of Recommendation: D, expert opinion). Supplemental oxygen for low oxygen saturation and suctioning may improve respiratory status (Grade of Recommendation: D, expert opinion). Chest physiotherapy (Grade of Recommendation: D, expert opinion), cool mist (Grade of Recommendation: D, expert opinion), and aerosolized saline (Grade of Recommendation: A, based on RCTs) are not recommended. Steroids, routine antibiotics, ribavirin, and pooled immunoglobulins play no role in previously healthy children (Grade of Recommendation: A, systematic review, RCT and meta-analysis). See the Table for a summary of therapeutic interventions for bronchiolitis
