Bronchodilators in bronchiolitis: should we reassess their selective use?

Authors’ conclusions: compared to guidelines‐guided strategy, treating infants with viral bronchiolitis using the phenotypic‐guided bronchodilator therapy strategy is a more cost‐effective strategy, because it involves a lower probability of hospital admission at lower total treatment costs. Randomized controlled trials using biomarkers to stratify patients most likely to respond to bronchodilators are necessary.

Reviewers’ commentary: the available information does not seem sufficient to make changes to the current recommendations in acute bronchiolitis management. There is still need for a predictive model that allows to identify potential responders to bronchodilators, as well as a clinical trial with a sufficient sample size to estimate the effectiveness of the strategy of its selective use.