Bronchiolitis – Trouble in Little Airways
It is fully winter now, which means there are certain illnesses we see more often than in other seasons. Colds, influenza, pneumonia are all common illnesses that are more prevalent in the winter months. For our infant and toddler population, this list must also include bronchiolitis.
What is bronchiolitis?
Bronchiolitis is a respiratory illness that occurs in children under the age of 2 years. It can cause significant trouble breathing, which is often scary for parents and families.
Think of the lungs like an upside-down tree. The trunk of the tree represents the trachea, or large breathing tube in the throat. The larger branches are the the bronchi, or larger tubes of the airways in the lungs. The smaller branches are the bronchioles, which are smaller airways. The leaves are the alveolae, which are the small sacs in the lungs where oxygen is exchanged.
Adults commonly get bronchitis, which is infection and inflammation of the large airways. Infants and toddlers, however, get bronchiolitis, which is an infection of the smaller airways. The bronchioles and the alveolae fill up with mucous and fluid, causing the characteristic lung sounds of the disease.
Symptoms of bronchiolitis begin with fever and typical cold symptoms, but progress to commonly include wheezing, a high-pitched whistling sound produced during expiration. The wheezing is caused by narrowing of the bronchioles as a result of inflammation or swelling. This inflammation, if severe, can lead to difficulty breathing and decreased oxygenation of the blood.
What causes bronchiolitis?
Bronchiolitis is caused by a number of common viruses that infect the respiratory tract, including influenza, human metapnuemovirus, and respiratory syncytial virus (RSV). These viruses affect the younger children more severely because their bronchioles are already smaller. Viruses are found in nasal secretions of infected individuals and are spread by sneezing or coughing or by hand-to-nose or hand-to-eye contact. People usually do not develop permanent immunity to the viruses.
Expected course of illness
Bronchiolitis usually starts with upper respiratory symptoms that progresses to coughing, wheezing, and tight breathing. These symptoms may continue to worsen for up to 5 days before stabilizing, but the wheezing may last approximately 7-10 days before subsiding. However, coughing may go on for another week or so. Since bronchiolitis is mostly caused by a virus, no antibiotic is usually needed unless a secondary infection occurs (most commonly ear infections). See your child’s Pediatrician if fever persists longer than 3-5 days or if fever returns after a few days without one. Your Pediatrician will need to rule out any secondary infections that may require additional treatments.
Rarely, infants will have such severe illness that they require hospitalization. Usually this is for oxygen needs, but infants must also be monitored closely for dehydration since they may not be able to drink fluids adequately when they are working so hard to breathe. Monitor your baby closely for worsening of symptoms and do not hesitate to visit the doctor if you are worried.
Can you prevent or treat it?
Prevention of bronchiolitis is similar to any other other respiratory illness. Avoid friends and family who may be sick, wash hands frequently, keep your baby home as much as possible (especially very young infants).
For a certain at-risk population of infants, there is a vaccine available. It is given once per month for the duration of the RSV season. This vaccine is only given to infants with certain congenital heart conditions and chronic lung diseases. If your infant qualifies for this vaccine your Pediatrician or other specialist will let you know.
Treatment of bronchiolitis is symptomatic. There are no medications – such as antibiotics or steroids – the have been proven to help treat the infection. Using nasal saline to flush out mucous, a humidifier in the child’s room, and giving adequate fluids can all help your child feel somewhat better.
Call your doctor’s office or 911 if:
- breathing becomes labored or difficult – this includes wheezing that is severe or sounds tight, breathing rate that is faster than 40-60 breaths/minute at rest, or increasing retractions (tugging in between the ribs with inhaled breaths)
- lips become bluish
- your child starts acting very sick or is not drinking well
- persistent fever for 3-5 days or if recurrent fever
- cough lasts more than 2-3 weeks.
Bronchiolitis can be very scary for parents and families, especially with younger infants. Most children recover very well from bronchiolitis infections.
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