Acute bronchiolitis is the most frequent respiratory infection in children <2 years old. The severity of bronchiolitis can vary from mild symptoms that can be managed at home to acute respiratory failure requiring mechanical ventilation. Approximately 250 000 children are evaluated for bronchiolitis annually in the emergency department (ED) and 100 000 of those children are hospitalized,2,3  making it the leading cause of hospitalizations in children <1 year old in the United States, at a cost exceeding $1.7 billion.

The management of bronchiolitis is largely supportive. The 2014 American Academy of Pediatrics (AAP) clinical practice guideline recommends against the routine use of albuterol, nebulized epinephrine, and corticosteroids because each is associated with an unfavorable benefit/harm ratio. However, there continues to be substantial variation in the use of these medications across hospitals and countries.6,7  There is also wide variability in rates of...

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