What is the initial management for an infant with bronchiolitis?

• A. Nasal suctioning
• B. Nebulized albuterol
• C. Racemic epinephrine
• D. Antibiotics

Answer: (A)

Relieving nasal obstruction is the first priority because in bronchiolitis the nasal passages are often congested, which increases work of breathing and interferes with feeding. Gentle nasal suctioning with a bulb syringe or small suction catheter, sometimes after saline drops to loosen secretions, directly opens the airway and makes breathing and feeding easier. This simple, noninvasive step is safe and effective as the initial management in most infants with bronchiolitis. Antibiotics are not used because bronchiolitis is viral, and while inhaled bronchodilators or epinephrine may be considered in specific situations, they are not routinely used as the initial treatment and do not have strong evidence for universal benefit in bronchiolitis.