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Bronchiolitis is a viral infection that causes the bronchioles or airways in the lungs to swell, making breathing difficult. This is a frequent lung infection in infants and young children. The infection causes swelling, inflammation, and mucus buildup in the lung’s small airways.
Bronchiolitis symptoms typically last 1 to 2 weeks but can possibly continue longer. Children may experience breathing difficulties. Bronchiolitis usually begins with symptoms similar to a regular cold. However, it progresses and becomes more severe, resulting in coughing and a high-pitched whistling sound known as wheezing when exhaling.
Small children can spread bronchiolitis through personal contact, saliva, and mucous. The easiest method to avoid infection is to avoid people who are unwell and to wash their hands frequently.
Most children with bronchiolitis improve with home care. A small number of children require hospitalization.
Symptoms
Bronchiolitis symptoms are similar to those of a cold or flu. It may include:
- Nasal congestion or runny nose
- Cough
- Mild fever (less than 101 F)
- Breathing that is too fast or too shallow
- Wheezing, which may occur 3 days or so after the onset first other symptoms
Many infants suffering from bronchiolitis also has an ear infection known as otitis media.
Some children may exhibit more severe symptoms, such as:
- Making a grunting sound
- Attempting to breathe so hard that their chest retracts
- Having difficulty sucking and swallowing
- Poor appetite and difficulty feeding
- Lips, fingertips, or toes becoming blue or gray
- Being sluggish
If any of these signs and symptoms are observed in children, it is essential to promptly contact a healthcare provider or take the child to an emergency room. This is especially critical if the baby is less than 12 weeks old or has additional risk factors for bronchiolitis, such as being born prematurely or having a heart disease.
This also applies especially if the child displays indications of dehydration, such as a parched mouth, infrequent urination, and crying without tears. Dehydration poses a significant risk to young children and should be treated as a serious matter.
Causes
Many bronchiolitis cases are caused by the respiratory syncytial virus (RSV), rhinovirus, and influenza (flu) virus. RSV is a common virus that affects nearly every child by the age of two. RSV outbreaks are common during the colder months of the year in some areas and the rainy season in others.
These viruses are highly infectious and are transmitted through direct contact with oral or nasal secretions, as well as through respiratory droplets in the air. When someone sneezes or coughs, these droplets are released into the atmosphere, facilitating their spread from person to person. Children can also get them by touching shared items like dishes, doorknobs, towels, or toys and then touching their eyes, nose, or mouth.
Risk factors
Bronchiolitis rarely affects adults. Infants younger than 3 months face the greatest susceptibility to bronchiolitis due to their underdeveloped lungs and limited immune defenses against infections. More often it affects children who are under 2 years old. Certain factors may also increase a child’s risk for bronchiolitis, such as:
- Born prematurely.
- Having a compromised immune system
- Having a heart or lung disease
- Exposure to many other children such as in a childcare facility
- Spending time in congested areas
- Being exposed to tobacco smoke
- Having other people in the household who bring the virus home with them.
Diagnosis
The process of diagnosing bronchiolitis typically starts with inquiring about the duration of the child’s illness, the presence of a fever, and potential exposure to a sick individual. The healthcare provider will then carefully observe the child’s symptoms and conduct a thorough examination of the lungs.
The lungs are typically assessed by using a stethoscope during the examination. To measure the oxygen levels in the child’s blood, a painless electronic device called a pulse oximeter may be placed on the fingertips or toes. Further diagnostic tests are typically reserved for situations where there is a risk of severe bronchiolitis, worsening symptoms, or if the doctor suspects an other condition.
In addition, the healthcare provider may assess for signs of dehydration, especially if the child has exhibited refusal to drink or eat, or has experienced vomiting. Symptoms of dehydration can include dry mouth and skin, excessive fatigue, and decreased or no urine output.
Additional tests to further assess bronchiolitis may include:
- Chest X-ray: The presence of pneumonia can be ruled out through a chest X-ray.
- Virus detection: This is performed by gently inserting a swab into the nose. A sample of mucus is obtained for testing. The virus causing the condition can be identified through this.
- Blood tests: A blood test can detect low oxygen levels in the child’s circulation. A blood test can check if there is a rise in white blood cells which is usually indicative of the body’s battle against infection.
Treatment
Usually, bronchiolitis does not require treatment. Instead, adequate hydration for the child is advised. The most painful uncomfortable stage of bronchiolitis may last seven to ten days. Days three to five are frequently the most difficult. It is critical to be on the lookout for worsening breathing issues.
Antibiotics are ineffective against this viral infection. Bacterial infections, such as pneumonia or ear infections, can occur in conjunction with bronchiolitis. In this scenario, the child’s pediatrician may prescribe an antibiotic to treat the bacterial illness.
Most children with bronchiolitis can be treated at home using comfort measures. To thin mucus, people can use saline nasal drops, which the doctor or pharmacy may recommend. If the baby is 6 months or younger, one can use a suction bulb to remove mucus from his or her nose. For fever, children can take the appropriate acetaminophen dose for their age. They may also have a reduced appetite, so offering smaller portions of food or liquid at a time and increasing the frequency of feeding can be beneficial.
In severe circumstances, the healthcare provider may administer a nebulized albuterol medication to see if it helps manage the condition. During this treatment, a machine sprays a thin mist of medicine into the child’s lungs.
There is no substantial evidence supporting the effectiveness of oral corticosteroid medicines and chest pounding (chest physiotherapy) for treating bronchiolitis. As a result, these treatments are not recommended for managing this condition.
Hospital care
Hospitalization may be necessary for a small percentage of children who require oxygen therapy or intravenous (IV) fluids. To ensure sufficient oxygen levels in the blood, children may be required to wear a face mask. In order to prevent dehydration, fluids may be administered through a vein to keep the child adequately hydrated. In severe cases of bronchiolitis, a medical professional may recommend the use of a tube inserted into the windpipe to assist with breathing.
Although bronchiolitis is generally a treatable condition, it can, in rare cases, lead to respiratory failure and potentially be fatal.
