Adult bronchiolitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
The optimal medical therapy for adult bronchiolitis is unknown. Therapy is mainly the cessation of exposure to irritant agent. Bronchiolitis is treated based on severity, however, the disease is progressive and inevitably, leads to respiratory failure. Therefore, supportive therapy includes supplemental oxygen, bronchodilators, cough suppressant, anti-reflux therapy, macrolides, immunosuppressants and glucocorticoids. Bronchodilators and glucocorticoids have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.
Medical Therapy
- Therapy is mainly the cessation of exposure to irritant agent.
- Bronchiolitis is treated based on severity, however, the disease is progressive and inevitably, leads to respiratory failure.
- Therefore, supportive therapy includes supplemental oxygen, bronchodilators, cough suppressant, anti-reflux therapy, macrolides, immunosuppressants and glucocorticoids.
- Bronchodilators and glucocorticoids have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.
Adult bronchiolitis
- 1 Stage 1 - Respiratory compromise
- 1.1 Supplemental oxygen
- 1.1.1 Adult
- Preferred regimen (1): maintain oxygen saturation at higher than 90% for 24 hours on standard flow rate
- Preferred regimen (2): maintain oxygen saturation at higher than 90% for 20 hours on high flow humidified oxygen
- Preferred regimen (3): maintain oxygen saturation at higher than 90% for 24 hours using Heliox (20 - 30% oxygen and 70 - 80% helium)
- 1.1.1 Adult
- 1.2 Antibiotic macrolide
- 1.1.2 Adult
- Preferred regimen (1): Erythromycin 200 - 600mg PO per day
- Preferred regimen (2): Clarithromycin 250 - 500mg PO per day
- 1.1.3 Bronchiolitis obliterans syndrome
- Preferred regimen (1): Azithromycin 250 mg daily for 5 days followed by 250 mg 3 times a week
- 1.1.2 Adult
- 1.1 Supplemental oxygen
References
- ↑ Azuma A, Kudoh S (March 2005). "Securing the safety and efficacy of macrolide therapy for chronic small airway diseases". Intern. Med. 44 (3): 167–8. PMID 15805698.
- ↑ Parambil JG, Yi ES, Ryu JH (April 2009). "Obstructive bronchiolar disease identified by CT in the non-transplant population: analysis of 29 consecutive cases". Respirology. 14 (3): 443–8. doi:10.1111/j.1440-1843.2008.01445.x. PMID 19210653.
- ↑ Akpinar-Elci M, Travis WD, Lynch DA, Kreiss K (August 2004). "Bronchiolitis obliterans syndrome in popcorn production plant workers". Eur. Respir. J. 24 (2): 298–302. PMID 15332401.