Introduction
Bronchiolitis is a common respiratory infection that affects the small airways (bronchioles) in the lungs, primarily in infants and young children under two years of age. It is often referred to as obstructive bronchitis in this age group due to the inflammation and narrowing of the bronchioles, which can lead to breathing difficulties. Bronchiolitis is typically caused by a viral infection and is most prevalent during the fall and winter months.
Causes
Bronchiolitis is most commonly caused by the respiratory syncytial virus (RSV). Other viruses, such as rhinovirus, adenovirus, and influenza virus, can also cause bronchiolitis. The virus spreads through respiratory droplets when an infected person coughs, sneezes, or talks. Young children are particularly susceptible to bronchiolitis because their airways are smaller and more easily blocked by inflammation and mucus.
Symptoms
Symptoms of bronchiolitis typically begin with mild cold-like symptoms, such as a runny nose, cough, and low-grade fever. As the infection progresses, the child may develop more severe symptoms, including:
- Wheezing
- Rapid breathing
- Difficulty breathing
- Nasal flaring
- Retractions (pulling in of the skin between the ribs or above the collarbone)
- Irritability
- Poor feeding
- Apnea (pauses in breathing), especially in infants
Diagnosis
Diagnosis of bronchiolitis is usually based on a clinical evaluation by a healthcare provider. The provider will assess the child’s symptoms, listen to their lungs, and check for signs of respiratory distress. In most cases, no specific testing is required. However, in severe cases or when the diagnosis is uncertain, a nasal swab may be taken to test for RSV or other viruses. Chest X-rays are generally not recommended unless there is suspicion of pneumonia or another underlying condition.
Treatment Options
Treatment for bronchiolitis focuses on relieving symptoms and supporting the child’s breathing. Most cases can be managed at home with supportive care, including:
- Nasal suctioning to clear nasal passages
- Ensuring adequate hydration with breast milk or formula
- Monitoring for signs of respiratory distress
- Fever management with acetaminophen or ibuprofen (as directed by a healthcare provider)
In severe cases, hospitalization may be necessary for:
- Oxygen therapy to improve oxygen levels
- Intravenous fluids to prevent dehydration
- Assisted ventilation in cases of respiratory failure
Bronchodilators (such as albuterol) and corticosteroids are generally not recommended for routine use in bronchiolitis, as they have not been shown to be consistently effective.
Prevention
Preventing bronchiolitis involves reducing exposure to respiratory viruses. Strategies include:
- Frequent handwashing
- Avoiding close contact with sick individuals
- Cleaning and disinfecting surfaces
- Breastfeeding (which provides antibodies to protect against infections)
- Avoiding exposure to tobacco smoke
Palivizumab, a monoclonal antibody, can be given to high-risk infants (such as premature infants or those with certain heart or lung conditions) to help prevent severe RSV infection.
When to Seek Medical Care
Seek medical attention promptly if your child experiences:
- Difficulty breathing or rapid breathing
- Nasal flaring or retractions
- Bluish skin or lips
- Poor feeding or signs of dehydration
- Lethargy or decreased responsiveness
- Apnea (pauses in breathing)
Takeaway
Bronchiolitis is a common respiratory infection in young children that can cause breathing difficulties. Most cases can be managed at home with supportive care, but severe cases may require hospitalization. Prevention strategies, such as frequent handwashing and avoiding exposure to sick individuals, can help reduce the risk of infection.