Diagnosis Bronchiolitis: 10 Facts Parents and Caregivers Need to Know
What Is It?
Pediatric bronchiolitis is an acute inflammation of the smallest airways of the lung. This condition is characterized by a thickening of the walls of the tubes that connect directly to the alveoli, the functional units of the lungs. Mucous production also partially blocks bronchioles and compromises the oxygenation and carbon dioxide balance in the blood.
The Human Lung
Respiratory Syncytial Virus (RSV)
Incidence, Causes and Treatment
Bronchiolitis is a common disease of infants and young children from 2 to 24 months of age. Approximately 20 percent of infants in the United States develop bronchiolitis each year, and it is most common in children between 3 and 6 months old. Males are more frequently affected than females. Premature or bottle-fed infants tend to have mild cases. Children exposed to cigarette smoke are more at risk for severe bronchiolitis.
The Respiratory Syncytial Virus (RSV) is the main cause of bronchiolitis (85%) and pneumonia (40%) in children. [It is also of major significance in adult pneumonia with those over 65 years of age at particular risk.]
According to the Centers for Disease and Prevention (CDC), almost all children will have had an RSV infection by their second birthday. The CDC reports that when children are first exposed to RSV 25% to 40 % develop symptoms of bronchiolitis or pneumonia. It is highly contagious among infants.
For the vast majority RSV produces no more than a common cold. Symptoms include rhinitis (nasal congestion and runny nose), cough and fever. The CDC reports that healthy children usually experience these cold-like symptoms 4-6 days after exposure and recover on their own within 10 to 14 days.
Home treatment of this mild upper respiratory infection includes the removal of any sticky nasal fluids with a bulb syringe using saline drops, a cool-mist vaporizer to keep air in the room humidified, fluids throughout the day and non-aspirin fever reducers such as acetaminophen.
If the cold symptoms do not resolve, or if they worsen, medical assessment for possible bronchiolitis (and/or pneumonia) is necessary. Wheezing or difficulty breathing are serious signs of advancing infection.
A child may require hospitalization for a severe episode of bronchiolitis. One to two percent of infants with the condition are admitted to pediatric departments. Bronchiolitis due to respiratory syncytial virus (RSV) is the leading cause of hospitalization in infants younger than one year of age in the US.
Antiviral drugs may be administered in the hospital setting. Supportive care may include supplemental humidified oxygen, intravenous fluid replacement, fever control and, for infants with wheezing, nebulized bronchodilators. The length of stay averages 2-3 days.
The prognosis is good for otherwise healthy children and the condition resolves without complications in 2 to 4 days. However, wheezing may continue for a week or longer. Full recovery can take a month.
Other viruses responsible for bronchiolitis include adenoviruses and rhinoviruses (the most frequent causes of the common cold) and parainfluenza viruses. These microbes are also highly contagious and children and adults with colds should be isolated from infants as much as is reasonably possible. All children and adults who will have contact with infants should practice good hand-washing.
American Family Physician, “Treating Acute Bronchiolitis Associated with RSV,” accessed October 16, 2015, http://www.aafp.org/afp/2004/0115/p325.html.
CDC, “Respiratory Syncytial Virus Infection (RSV), Infection and Incidence,” accessed October 16, 2015, http://www.cdc.gov/rsv/about/infection.html.
CDC, “Respiratory Syncytial Virus Infection (RSV), Trends and Surveillance,” accessed October 16, 2015, http://www.cdc.gov/rsv/research/us-surveillance.html.
Medscape, “Bronchiolitis Treatment & Management,” accessed October 16, 2015, http://emedicine.medscape.com/article/961963-treatment#d8.
UptoDate, “Patient information: Bronchiolitis (and RSV) in infants and children (Beyond the Basics),” accessed October 16, 2015, http://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics.
WebMD, “RSV in Babies,” accessed Oct 16, 2015, http://www.webmd.com/parenting/baby/rsv-in-babies?page=2.
© 2015 M G Del Baglivo