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Bronchiolitis

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Definition

Bronchiolitis is a childhood disease that affects the lungs. It occurs when a virus enters the breathing system. The virus causes the tiny airways in the lungs to become swollen. As a result, a thick fluid called mucus collects in the airways. This makes it hard for air to flow freely in the lungs.
The infection will usually go away after 7-10 days. Some may show very mild symptoms. In others, the disease can be severe. Younger children are more likely to have severe symptoms because they have smaller airways.
Bronchioles
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Causes

Bronchiolitis is caused by a virus. There are several different types of virus that may cause it. The viruses are easily spread from person to person like a common cold . It spreads most often through coughs or sneezes which release droplets of moisture into the air. Breathing in the air can cause the infection in a noninfected person.

Risk Factors

Bronchiolitis can affect anyone. Some factors that may increase your risk of infection include:
  • Age—most likely in children under the age of two, especially between 3-6 months old
  • Season—winter months have highest risk
  • Factors that increase risk in adults include:
    • Immunocompromised
    • Exposure to toxic fumes
  • Children most at risk are those who:
    • Were never breastfed
    • Were born prematurely
    • Are exposed to tobacco smoke
    • Are often in groups of children (as in day care) or live in crowded conditions

Symptoms

Symptoms of bronchiolitis occur in two stages:
During the first 2-3 days the child will probably have a:
  • Runny or stuffy nose
  • Slight fever
During the next 2-3 days, the symptoms increase to include:
  • Cough (dry)
  • Fever
  • Sneezing
  • Rash
  • Red eyes
  • Fast rate of breathing
  • Difficulty breathing
  • Wheezing (a whistling noise that is louder when breathing out)
  • Bluish color in the skin, especially around the lips or nails
  • Poor feeding
  • Restlessness
More serious symptoms may require care from your doctor. Call the doctor if your child:
  • Is vomiting and can’t keep liquids down
  • Is breathing very fast (more than 40 breaths in one minute)
  • Has bluish skin, especially around the lips or on the fingertips
  • Has to sit up to breathe
  • Was born prematurely or has a history of heart disease
  • Appears dehydrated

Diagnosis

To diagnose bronchiolitis, your doctor may do one or more of the following:
  • Listen to the child’s lungs to check for abnormal breathing sounds, such as wheezing
  • Sample mucus from nose or throat to test for the virus that may be causing the infection
Your doctor may also order:
  • Chest x-ray —to check for swelling in the airways and signs of pneumonia (severe case)
  • Blood test—to determine the level of oxygen in the blood
  • Blood test—for complete blood count to look for infections in the blood

Treatment

There is no medication to cure viral infections. The infection will usually clear on its own after a week to 10 days.
Treatment steps will focus on making your child more comfortable. These steps include:
  • Have the child drink clear liquids.
  • Use a vaporizer in the bedroom.
  • If your child is coughing and very congested, consider sitting in a steamy bathroom. Run hot water from the shower. Sit in the bathroom with your child until the coughing eases.
  • Do not smoke around your child. Keep your child away from smoke.
  • Consider acetaminophen (eg, Children’s or Infant’s Tylenol) if a fever is present. Note : Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome . Ask your doctor which other medicines are safe for your child.
  • Your doctor may also recommend or give your child an inhaled medication. This may include a bronchodilator or hypertonic saline. These medications can help open airways and ease breathing.
In severe cases, medical treatment may be needed. The doctor will check for dehydration and pneumonia. The doctor will also make sure the child is getting enough oxygen. Your child may need to be admitted to the hospital.

Prevention

There is no vaccine to prevent bronchiolitis. There are some medications that may lessen the risk of bronchiolitis by respiratory syncytial virus (RSV) . RSV is a virus which causes more than half of all cases of bronchiolitis. This preventative medication is usually given to high-risk babies. It is given monthly during high risk RSV season.
Proper handwashing habits can help to prevent the spread of illness. Make sure to wash your hands before touching your child. Also wash your hands after being in contact with an infected person.
Bronchiolitis can spread easily from one person to another. Children should be kept home until they are well. Teach your children to cover their mouth and nose with a tissue or upper sleeve when they cough or sneeze.

RESOURCES

American Academy of Family Physicians http://www.familydoctor.org/

Kids Health http://kidshealth.org/

CANADIAN RESOURCES

The Canadian Lung Association http://www.lung.ca/

The Canadian Paediatric Society http://www.caringforkids.cps.ca/

References

Bronchiolitis and your child. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/bronchiolitis.html . Updated January 2010. Accessed July 19, 2012.

Respiratory syncytial virus (RSV) infection in infants and children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 7, 2012. Accessed July 19, 2012.

Gadomski AM, Bhasale aL: Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2006 :CD001266.

Smyth RL, Openshaw PJ. Bronchiolitis. Lancet. 2006;368:312-322.

Steiner RWP. Treating acute bronchiolitis associated with RSV. Am Fam Physician. 2004;69:325-330.

8/10/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Corneli HM, Zorc JJ, Majahan P, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007;357:331-339.

2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Panickar J, Lakhanpaul M, Lambert PC, et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med. 2009;360:329-338.

Revision Information

  • Reviewer: Michael Woods
  • Review Date: 09/2012 -
  • Update Date: 00/92/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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