Table 1.

Non-specific approaches to treating acute RSV bronchiolitis.

Product Name	Mode of Administration/Mechanism of Action	Recommendation
Mucus therapies
Deoxyribonuclease (hrDNase)	Nebulized solution Mucolytic compound Cleaves extracellular DNA	Not recommended [35] May be considered as a therapeutic option for atelectasis in severe cases, when conventional therapy is unsuccessful [36]
N-acetylcysteine	Nebulized solution Poor bioavailability of oral preparation [37] Mucolytic compound Hydrolyzes disulfide bonds of mucus proteins Antioxidant properties [38]	Insufficient data—further studies needed Not recommended
3% hypertonic saline	Nebulized solution Creates osmotic gradient and pulls water into the mucus layer Improves ciliary activity Stimulates cough May reduce airway edema [39]	May reduce the risk of hospitalization in the ED setting [40] Not recommended for inpatient management May modestly reduce the duration of admission for infants admitted >72 h—further studies needed [40,41]
Bronchodilators
Salbutamol, albuterol, etc.	Nebulized solution β-2 adrenergic receptor agonist, relaxes smooth muscle and opens airways	Not recommended [33] Can be trialled to assess the response in certain cases and given where a benefit is seen
Epinephrine	Nebulized solution Some β-2 adrenergic effects Vasoconstriction due to α-1 adrenergic receptor effects also decrease airway edema	May reduce risk of hospitalization in the ED setting [42] Not recommended [43]
Therapies targeting inflammation
Glucocorticoids (dexamethasone, prednisolone, budesonide, etc.)	Oral solution, inhaled or nebulized preparations Broad spectrum anti-inflammatory Repress the expression of pro-inflammatory cytokines	Not recommended [44,45] Could be considered where reactive airway disease is strongly suspected (asthma, bronchopulmonary dysplasia, etc.), but no good evidence
Leukotriene inhibitors (montelukast, etc.)	Oral solution Inhibit leukotrienes, which are endogenous mediators of inflammation [46]	Poor evidence, not recommended [47]
Manual therapies
Chest physiotherapy	Chest percussion, suction Aids in the clearance of secretions Thought to decrease ventilatory effort for infants on the severe end of the disease spectrum	Not routinely recommended [48] Can be considered when relevant comorbidities are present (neuromuscular conditions, etc.) [49]