Treatment of<unk>  is usually focused on the hydration and symptoms instead of the infection itself since the infection will run its course and complications are typically from the symptoms themselves. Without active treatment, half of cases will go away in 13 days and 90% in three weeks. Children with severe symptoms, especially poor feeding or dehydration, may be considered for hospital admission. Oxygen saturation under 90%-92% as measured with pulse oximetry is also frequently used as an indicator of need for hospitalization. High-risk infants, apnea, cyanosis, malnutrition, and diagnostic uncertainty are additional indications for hospitalization. Most guidelines recommend sufficient fluids and nutritional support for affected children. Measures for which the recommendations were mixed include nebulized hypertonic saline, nebulized epinephrine, and nasal suctioning. Treatments which the evidence does not support include salbutamol, steroids, antibiotics, antivirals, heliox, continuous positive airway pressure (CPAP), chest physiotherapy, and cool mist or steam inhalation. Diet Maintaining hydration is an important part of management of<unk> . Infants with mild pulmonary symptoms may require only observation if feeding is unaffected. However, oral intake may be affected by nasal secretions and increased work of breathing. Poor feeding or dehydration, defined as less than 50% of usual intake, is often cited as an indication for hospital admission. Guidelines recommend the use of nasogastric or intravenous fluids in children with<unk>  who cannot maintain usual oral intake. The risk of health care caused hyponatremia and fluid retention are minimal with the use of isotonic fluids such as normal saline, breast milk, or formula. Oxygen A newborn wearing a nasal CPAP device. Inadequate oxygen supply to the tissue is one of the main concerns during severe<unk>  and oxygen saturation is often closely associated with both the need for hospitalization and continued length of hospital stay in children with<unk> . However, oxygen saturation is a poor predictor of respiratory distress. Accuracy of pulse oximetry is limited in the 76% to 90% range and there is weak correlation between oxygen saturation and respiratory distress as brief hypoxemia is common in healthy infants. Additionally, pulse oximetry is associated with frequent false alarms and parental stress and fatigue. Clinicians may choose not to given additional oxygen to children with<unk>  if their oxygen saturation is above 90%. Additionally, clinicians may choose not to use continuous pulse oximetry in these people. When choosing to use oxygen therapy for a child with<unk> , there is evidence that home oxygen may reduce hospitalization rate and length of stay although readmission rates and follow-up visits are increased. Also, the use of humidified, heated, high-flow nasal cannula may be a safe initial therapy to decrease work of breathing and need for intubation. However, evidence is lacking regarding the use of high-flow nasal cannula compared to standard oxygen therapy or continuous positive airway pressure. These practices may still be used in severe cases prior to intubation. Blood gas testing is not recommended for people hospitalized with the disease and is not useful in the routine management of<unk> . People with severe worsening respiratory distress or impending respiratory failure may be considered for capillary blood gas testing. Hypertonic saline Guidelines recommend against the use of nebulized hypertonic saline in the emergency department for children with<unk>  but it may be given to children who are hospitalized. Nebulized hypertonic saline (3%) has limited evidence of benefit and previous studies lack consistency and standardization. A 2017 review found tentative evidence that it reduces the risk of hospitalization, duration of hospital stay, and improved the severity of symptoms. The majority of evidence suggests that hypertonic saline is safe and effective at improving respiratory symptoms of mild to moderate<unk>  after 24 hours of use. However, it does not appear effective in reducing the rate of hospitalization when used in the emergency room or other outpatient settings in which length of therapy is brief. Side effects were mild and resolved spontaneously. Bronchodilators Guidelines recommend against the use of bronchodilators in children with<unk>  as evidence does not support a change in outcomes with such use. Additionally, there are adverse effects to the use of bronchodilators in children such as tachycardia and tremors, as well as adding increased financial expenses. Several studies have shown that bronchodilation with β-adrenergic agents such as salbutamol may improve symptoms briefly but do not affect the overall course of the illness or reduce the need for hospitalization. However, there are conflicting recommendations about the use of a trial of a bronchodilator, especially in those with history of previous wheezing, due to the difficulty with assessing an objective improvement in symptoms.<unk> -associated wheezing is likely not effectively alleviated by bronchodilators anyway as it is caused by airway obstruction and plugging of the small airway diameters by luminal debris, not bronchospasm as in asthma-associated wheezing that bronchodilators usually treat well. Anticholinergic inhalers, such as ipratropium bromide, have a modest short-term effect at best and are not recommended for treatment. Epinephrine The current state of evidence suggests that nebulized epinephrine is not indicated for children with<unk>  except as a trial of rescue therapy for severe cases. Epinephrine is an α and β adrenergic agonist that has been used to treat other upper respiratory tract illnesses, such as croup, as a nebulized solution. A Cochrane meta-analysis in 2011 found no benefit to the use of epinephrine in the inpatient setting and suggested that there may be utility in the outpatient setting in reducing the rate of hospitalization. However, current guidelines do not support the outpatient use of epinephrine given the lack of substantial sustained benefit. A 2017 review found inhaled epinephrine with corticosteroids did not change the need for hospitalization or the time spent in hospital. Other studies suggest a synergistic effect of epinephrine with corticosteroids but have not consistently demonstrated benefits in clinical trials. Guidelines recommend against its use currently. Unclear evidence Currently other medications do not yet have evidence to support their use, although they have been studied for use in<unk> . Experimental trials with novel antiviral medications in adults are promising but it remains unclear if the same benefit will be present. * Surfactant had favorable effects for severely critical infants on duration of mechanical ventilation and ICU stay however studies were few and small. *Chest physiotherapy, such as vibration or percussion, to promote airway clearance may slightly reduce duration of oxygen therapy but there is a lack of evidence that demonstrates any other benefits. People with difficulty clearing secretions due to underlying disorders such as spinal muscle atrophy or severe tracheomalacia may be considered for chest physiotherapy. *Suctioning of the nares may provide temporarily relief of nasal congestion but deep suctioning of the nasopharynx has been shown prolong length of hospital stay in infants. Upper airway suctioning may be considered in people with respiratory distress, feeding difficulties, or infants presenting with apnea. *Heliox, a mixture of oxygen and the inert gas helium, may be beneficial in infants with severe acute RSV<unk>  who require CPAP but overall evidence is lacking. * DNAse has not been found to be effective but might play a role in severe<unk>  complicated by atelectasis. *There are no systematic reviews or controlled trials on the effectiveness of nasal decongestants, such as xylometazoline, for the treatment of<unk> s. * Overall evidence is insufficient to support the use of alternative medicine. There is tentative evidence for Chinese herbal medicine, vitamin D, N-acetylcysteine, and magnesium but this is insufficient to recommend their use. Non-effective treatments * Ribavirin is an antiviral drug which does not appear to be effective for<unk> . * Antibiotics are often given in case of a bacterial infection complicating<unk> , but have no effect on the underlying viral infection and their benefit is not clear. The risks of<unk>  with a concomitant serious bacterial infection among hospitalized febrile infants is minimal and work-up and antibiotics are not justified. Azithromycin adjuvant therapy may reduce the duration of wheezing and coughing in children with<unk>  but has not effect on length of hospital stay or duration of oxygen therapy. * Corticosteroids, although useful in other respiratory disease such as asthma and croup, have no proven benefit in<unk>  treatment and are not advised. Additionally, corticosteroid therapy in children with<unk>  may prolong viral shedding and transmissibility. The overall safety of corticosteroids is questionable. * Leukotriene inhibitors, such as montelukast, have not been found to be beneficial and may increase adverse effects. * Immunoglobulins are of unclear benefit.
Bronchiolitis
Heart failure
Bronchitis
Asthma
Bronchitis kettle
Pneumonia
Croup
Cystic fibrosis