Bronchiolitis Treatment? (When supportive is not the answer)

[hsk013]

A 14-month-old male presents to the emergency department with fever, cough, and increasing difficulty breathing over the past 2 days. On physical examination, the child is in moderate respiratory distress with grunting and retractions. Auscultation of the lungs reveals diffuse expiratory wheezing. The most beneficial treatment for this child's respiratory difficulty is

- amoxicillin
- dexamethasone
- diphenhydramine
- prednisolone
- albuterol

This sounds like bronchiolitis to me (< 2y/o, fever, respiratory distress, grunting, retraction). I thought you normally provide supportive therapy but that was not one of the answer choices. Since the child is in the ED and requires additional treatment, I went with dexamethasone (more potent than prednisolone), but I couldn't find any articles that support dexamethasone or steroid for bronchiolitis. Anyone can tell me whether bronchiolitis is the right diagnosis and you would pick dexamethasone in this case?

I briefly thought of asthma but asthma would not present with fever and worsening symptoms for 2 days. And no other history of atopy or anything like that. So I didn't think albuterol would be an appropriate choice here.

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[Captain_Falcon]

Asthma - most commonly exacerbated by an URI. Treat with Albuterol. Keys in the stem is the diffuse bilateral wheezing and respiratory distress