Definition

Bronchiolitis is a viral disease of the lungs most common in young children. The virus causes swelling airways in the small airways of the lungs, called bronchioles, and a buildup of mucus in the airways. This can make breathing more difficult and lead to coughing and wheezing.

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Causes

Bronchiolitis is caused by one of several different types of viruses. These viruses are easily spread from person to person like the common cold. It is passed most easily through droplets of moisture that are released into the air with coughs or sneezing. These droplets may be inhaled by others or land on common surfaces like counters and doorknobs. A healthy person can pick up the virus by inhaling it in the air or coming in contact with the virus on surfaces then touching their face.

Risk Factors

Bronchiolitis can affect anyone, but is most common in children under the age of 2 years old. It is also most common during the winter season.

Factors that may increase a child's risk include:

• Premature birth
• Exposure to environmental pollution including second hand smoke
• Weak immune systems
• Child care attendance or older siblings that attend childcare or schools
• Congenital abnormalities of the heart or lungs
• Severe neuromuscular disease

Factors that increase a child's risk of bronchiolitis include:

Symptoms

At first bronchiolitis will have the same symptoms as a common cold. This may include stuffy or runny nose, cough, and mild fever. After a few days, the cough will worsen and breathing rate will increase.

Symptoms may include:

• Wheezing or crackling noises when exhaling
• Abnormal breathing patterns, such as using abdominal muscles to help move air, widening nostrils, or grunting while breathing
• Rapid breathing
• Sunken chest
• Lack of interest or difficulty in eating or drinking which may lead to dehydration (tearless cries, less urinating or fewer wet diapers, dry mouth)
• Fever
• Bluish tint around lips or fingertips

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done. The doctor will most likely be able to diagnose bronchiolitis based on the history and physical exam.

Lab tests of the blood or mucus or chest x-ray may be done if there is a concern about a secondary infection.

The doctor may also assess the risk of a severe infection based on health history.

Treatment

Viral infections cannot be cured with medication. The virus needs to run its course. Bronchiolitis will usually clear completely on its own by 2-3 weeks.

Treatment will help manage symptoms during more intense periods of the infection.

Management of less severe symptoms includes:

• Encouraging liquids to prevent dehydration.
• Avoiding environmental pollutants such as cigarette smoke. Irritants can make symptoms worse.
• Acetaminophen may be recommended if a fever is present.

If breathing becomes difficult, hospitalization may be needed. Care may include:

• Oxygen therapy
• Inhaled therapy to widen the airway and help loosen mucus
• IV tubes or tubes passed through the nose and into the stomach to provide nutrition and fluids

Prevention

There is no vaccine to prevent bronchiolitis itself. There are some medications that may lessen the risk of bronchiolitis by respiratory syncytial virus (RSV):

• This preventative medication is usually given to high-risk babies.
• It is given monthly during high-risk RSV season.
• If your child is considered high risk, talk to your doctor about prevention.

To help decrease the risk of bronchiolitis or any respiratory infection:

• Avoid close contact with people who have respiratory infections. Do not share utensils or cups with people who have colds.
• Wash your hands often, encourage children to wash their hands. Caretakers should especially their hands while caring for sick children.
• Prevent or limit exposure to second-hand smoke.
• Consider exclusive breastfeeding for the first 6 month of life. Exclusive breastfeeding may reduce the risk of pulmonary infections in children.