Bronchiolitis is a common lung infection in young children and infants. It causes congestion in the small airways (bronchioles) of the lung. Bronchiolitis is almost always caused by a virus. Typically, the peak time for bronchiolitis is during the winter months.
Bronchiolitis starts out with symptoms similar to those of a common cold but then progresses to coughing, wheezing and sometimes difficulty breathing. Symptoms of bronchiolitis can last for several days to weeks, even a month.
Most children get better with supportive care at home. A very small percentage of children require hospitalization.
Bronchioles and alveoli
Within your lungs, the main airways (bronchi) branch off into smaller and smaller passageways, the smallest of which are called bronchioles. At the end of the bronchioles are tiny air sacs (alveoli). ...
For the first few days, the signs and symptoms of bronchiolitis are similar to those of a common cold:
After this, there may be a week or more of breathing difficulty or a whistling noise when breathing out (wheezing).
Many infants will also have an ear infection (otitis media).
When to see a doctor
The following signs and symptoms are reasons to seek prompt medical attention:
Bronchiolitis occurs when a virus infects the bronchioles, which are the smallest of the airways branching off the main breathing tubes (bronchi) within your lungs. The viral infection makes the bronchioles swell and become inflamed. Mucus collects in these airways, which can make it difficult for air to flow freely into and out from the lungs.
Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus which infects just about every child by the age of 2. Seasonal outbreaks of RSV infection occur every winter. Bronchiolitis can also be caused by a variety of other viruses, including those that cause the flu or the common cold.
Bronchiolitis is a contagious condition. You contract the virus just as you would a cold or the flu — through droplets in the air when someone who is sick coughs, sneezes or talks. You can also contract bronchiolitis by touching shared objects — such as utensils, towels or toys — and then touching your eyes, nose or mouth.
One of the greatest risk factors for getting bronchiolitis is being younger than 6 months old, because the lungs and immune system aren't yet fully developed.
Other factors that have been associated with an increased risk of bronchiolitis in infants, or more severe illness due to bronchiolitis, include:
Complications of severe bronchiolitis may include:
If these occur, your child may need hospitalization. Severe respiratory failure may require that a tube be inserted into the trachea to help the child's breathing until the infection has run its course.
If your infant was born prematurely, has a heart or lung condition, or has a compromised immune system, watch closely for beginning signs of bronchiolitis. The infection may rapidly become severe, and signs and symptoms of the underlying condition may become worse. In such cases, your child will usually need hospitalization.
RSV can also cause pneumonia. Sometimes a second infection, such as bacterial pneumonia, can occur at the same time, but this is not common. Reinfections with RSV after the initial episode may occur but typically aren't as severe.
Preparing for your appointment
You're likely to start by seeing your family doctor or your child's doctor. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Questions to ask your doctor
Don't hesitate to ask questions during your appointment anytime that you don't understand something.
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
Tests and X-rays are not usually needed to diagnose bronchiolitis. The doctor can usually identify the problem by observing your child and listening to his or her lungs with a stethoscope. It may take several visits to distinguish the condition from a cold or flu.
If your child is at greater risk of severe bronchiolitis, if symptoms are worsening or if another problem is suspected, your doctor may order tests, including:
Your doctor may also ask you about signs of dehydration, especially if your child has been refusing to drink or eat or has been vomiting. Signs of dehydration include sunken eyes, dry mouth and skin, sluggishness, and little or no urinary output.
Treatments and drugs
The vast majority of cases of bronchiolitis can be cared for at home with supportive care. Make sure your child is getting adequate liquids. Consider saline nose drops or suctioning with a bulb to relieve nasal congestion. Be alert for changes in breathing difficulty. Expect the condition to last for a week to a month.
Drugs that open the airways (bronchodilators) haven't been found to be routinely helpful. But your doctor may elect to try a nebulized albuterol treatment to see if it helps.
Because viruses cause bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — aren't effective against it. If your child has an associated bacterial infection, such as pneumonia, your doctor may prescribe an antibiotic for that.
Use of corticosteroid medications, the antiviral drug ribavirin and pounding on the chest to loosen mucus (chest physiotherapy) have not been shown to be effective treatments for bronchiolitis and are not recommended.
Lifestyle and home remedies
Although it may not be possible to shorten the duration of your child's illness, you may be able to relieve some of the symptoms and make your child more comfortable. Here are some tips to consider:
Because bronchiolitis spreads from person to person, one of the best ways to prevent it is to wash your hands frequently — especially before touching your baby when you have a cold. Wearing a face mask at this time is appropriate. If your child has bronchiolitis, keep him or her at home until the illness is past to avoid spreading it to others.
Other effective ways that can help curb spread of the infection include:
No vaccine available
Palivizumab doesn't interfere with childhood vaccines. Its expense generally limits its use to infants at particularly high risk of RSV infection, such as those born very prematurely or with a heart-lung condition or a depressed immune system.
Last Updated: 2013-05-07
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