Bronchiolitis

Overview

Bronchiolitis is a common lung infection in young children and infants, characterized by swelling and irritation of the small airways in the lungs, known as bronchioles. It is usually caused by a virus, with the respiratory syncytial virus (RSV) being the most common culprit. Symptoms of bronchiolitis resemble those of a common cold at first but then progress to include coughing, wheezing, and difficulty breathing, which can last for about 1 to 2 weeks. While most children recover with home care, a small number may require hospitalization. Prevention measures include frequent hand washing, avoiding contact with sick individuals, and disinfecting surfaces.

Understanding the disease

Symptoms

The symptoms of bronchiolitis are similar to those of a common cold in the early stages, but they can worsen over time. Symptoms include a runny nose, stuffy nose, cough, and sometimes a slight fever. Later symptoms may include wheezing, difficulty breathing, and chest tightness. Infants with bronchiolitis may also develop an ear infection called otitis media. If symptoms become serious or if your child is younger than 12 weeks old or has other risk factors, it is important to contact their healthcare provider. In cases where the child is struggling to breathe, showing signs of low oxygen levels, or experiencing rapid breathing, immediate medical attention is required.

Risk Factors

Risk factors for developing bronchiolitis include:

1. Age: Children under 2 years old are more susceptible to bronchiolitis, particularly infants younger than 3 months.
2. Premature birth: Infants born prematurely have a higher risk of developing bronchiolitis due to underdeveloped lungs and immune systems.
3. Heart or lung conditions: Children with pre-existing heart or lung conditions are at an increased risk of contracting bronchiolitis.
4. Weakened immune system: Children with weakened immune systems, such as those with HIV or undergoing chemotherapy, are more prone to bronchiolitis.
5. Exposure to tobacco smoke: Being around tobacco smoke increases the risk of developing bronchiolitis.
6. Contact with multiple children: Children in childcare settings or those with siblings who attend school or daycare have a higher risk of contracting bronchiolitis.
7. Crowded places: Spending time in crowded places or being in close contact with individuals increases the risk of bronchiolitis transmission.
8. Exposure to environmental factors: Prolonged exposure to air pollution, such as cigarette smoke, can increase the risk of developing bronchiolitis.

Development

Bronchiolitis develops as a result of a viral infection that affects the small airways in the lungs called bronchioles. The most common cause of bronchiolitis is the respiratory syncytial virus (RSV), which affects almost every child by the age of 2. Other viruses, such as those causing the flu or the common cold, can also cause bronchiolitis. The viruses that cause bronchiolitis are easily spread through droplets in the air when an infected person coughs, sneezes, or talks, or through contact with shared items, such as dishes, doorknobs, towels, or toys. Risk factors for bronchiolitis include being under 2 years old, being born prematurely, having a heart or lung condition, having a weakened immune system, being around tobacco smoke, spending time in crowded places, or having siblings who attend school or child care services.

Assessment and Diagnosis

Triage

You should see a doctor if bronchiolitis is suspected when your child's symptoms become serious or if they experience any of the following:

1. Blue or gray skin, lips, and fingernails due to low oxygen levels.
2. Struggling to breathe and being unable to speak or cry.
3. Refusing to drink enough or breathing too fast to eat or drink.
4. Breathing very fast (in infants, more than 60 breaths per minute) with short, shallow breaths.
5. Having difficulty breathing and the ribs appearing to suck inward when breathing in. If your child exhibits any of these symptoms, it is important to get medical attention right away.

Diagnosis

A health care provider can usually diagnose bronchiolitis by the symptoms and listening to the child's lungs with a stethoscope. Tests and X-rays are not usually needed to diagnose bronchiolitis, but they may be recommended if the child is at risk of severe bronchiolitis, if symptoms are getting worse, or if the provider thinks there may be another problem. Tests may include a chest X-ray, viral testing, or blood tests.

Management and Treatment

Complications

Complications of severe bronchiolitis may include low oxygen in the body, pauses in breathing, and respiratory failure. If these complications occur, a child may need to be hospitalized. Severe respiratory failure may require inserting a tube into the windpipe to help the child breathe until the infection improves.

Home Remedies

Home remedies are an important aspect of managing bronchiolitis. Here are some suggestions:

1. Wash hands often: Frequently wash your hands and your child's hands with soap and water for at least 20 seconds. Keep an alcohol-based hand sanitizer handy to use when you're away from home.
2. Cover coughs and sneezes: Use a tissue to cover your mouth and nose when coughing or sneezing. Throw away the tissue, then wash your hands. If soap and water aren't available, use a hand sanitizer.
3. Use your own drinking glass: Avoid sharing glasses with others, especially if someone in your family is ill.
4. Clean and disinfect surfaces: Regularly clean and disinfect surfaces and items that people often touch, such as toys and doorknobs. This is especially important if a family member is sick.
5. Breastfeed, when possible: Breastfeeding can help prevent respiratory infections in infants, so it is advised to do so when possible. Please note that while these home remedies can help prevent the spread of bronchiolitis, they do not treat the actual infection. If your child is experiencing severe symptoms, such as difficulty breathing, it's important to consult with a healthcare professional for appropriate medical treatment.

Treatment

Treatments for bronchiolitis primarily focus on easing symptoms and supporting the child's overall health. Most cases of bronchiolitis can be managed at home under a doctor's guidance. Here are some general treatments for bronchiolitis:

1. Fluids: Encourage your child to drink plenty of fluids, such as water, clear broths, frozen water or ice pops, and clear juices. This helps prevent dehydration.
2. Rest: Ensure your child gets enough rest. Extra fluids and rest can help ease breathing difficulties.
3. Medications: Over-the-counter pain relievers like acetaminophen or ibuprofen can help reduce fever and ease discomfort. However, always consult your doctor before giving any medication to a child.
4. Humidifier: Using a cool-mist humidifier or taking a steamy shower can help relieve congestion and make breathing easier.
5. Saline nasal spray: A saline nasal spray can help loosen mucus and ease nasal congestion.
6. Monitoring: Closely monitor your child's breathing, and watch for any signs of worsening symptoms or difficulty breathing. In severe cases or if the child is at high risk for complications, hospitalization may be necessary. In the hospital, oxygen therapy and other treatments may be provided. It's essential to consult with a healthcare professional for personalized advice on treating bronchiolitis, as specific treatments may vary based on the child's age, overall health, and the severity of the condition.

Preparing for medical consultation