Bronchiolitis is an inflammation of the bronchioles (small passages in the lungs) usually caused by a viral infection.
Causes, incidence, and risk factors
The disease usually affects children under the age of 2, with a peak age of 3 to 6 months, and is a common, sometimes severe illness. Respiratory syncytial virus (RSV) is one common cause. Other viruses that can cause bronchiolitis include: parainfluenza, influenza, and adenovirus. The virus is transmitted from person-to-person by direct contact with nasal secretions or by airborne droplets. Although RSV generally causes only mild symptoms in an adult, it can cause a severe illness in an infant. Bronchiolitis begins as a mild upper respiratory infection that, over a period of 2 to 3 days, can develop into a condition of increasing respiratory distress with wheezing and a "tight" wheezy cough . The infant's breathing rate may increase markedly ( tachypnea ), and the infant may become irritable or anxious looking. If the disease is severe enough, the infant may turn bluish (cyanotic), an indication of a critical emergency. As the effort of breathing increases, parents may see the nostrils flaring with each breath and the muscles between the ribs retracting as the child tries to inhale air. This can be exhausting for the child, and very young infants may simply fatigue to an extent that breathing becomes difficult to maintain. Bronchiolitis is seasonal and appears more frequently in the fall and winter months. It is a very common reason for infants to be hospitalized during winter and early spring. Some children have subclinical infections, that is, few or insignificant symptoms. It is estimated that by the first year, more than half of all infants have been exposed to RSV. Risk factors include:
Age (less than 6 months old) No history of being breastfed Prematurity (born before 37 weeks gestation) Exposure to cigarette smoke Crowded living conditions
Signs and tests
Wheezing and crackling sounds are heard by stethoscope examination of chest. Decreased blood oxygen levels Tests often include a chest X-ray and blood gases.
Treatment
Antibiotics are not effective against viral infections. Sometimes, no treatment is necessary. Supportive therapy may include oxygen, humidified air, chest clapping, or postural drainage to remove secretions, rest, and clear fluids. Other medicines used in the hospital may include albuterol (a medication normally used in asthma) or steroids. In extremely ill children, antiviral medications (such as ribavirin) are sometimes used. Antiviral treatment may decrease the severity and duration of the illness. To be effective, it must be administered early in the course of the illness.
Expectations (prognosis)
Usually, the symptoms have resolved within in one week, and difficulty breathing usually improves by the third day. The mortality rate is less than 1%.
Calling your health care provider
Call your health care provider immediately, or go to the emergency room if the person, child, or infant:
Has a cold that suddenly worsens Develops rapid, shallow breathing
Experiences flaring nostrils and/or retracting chest muscles in an effort to breathe Has difficulty breathing Develops a bluish color in the skin, nails or lips
Becomes lethargic
Prevention
Most cases of bronchiolitis are not readily preventable because the viruses that cause this disorder are common in the environment. Careful attention to hand washing, especially around infants, can aid in the prevention or spread of respiratory viruses. Family members with an upper respiratory infection should be especially careful around infants -- hand washing frequently, and certainly, before handling the child. At this date, there is no RSV vaccine available. However, there are two effective prevention products available for infants at high risk for developing severe disease from RSV. You should consult your child's physician to determine whether either of these would be appropriate for your child. The products are RespiGam® (RSV-IGIV) and Synagis® (palivizumab).