It’s a contagious viral lung infection that strikes nearly half of all children under two. Bronchiolitis can vary from mild cases similar to a common cold to severe cases needing hospitalization. The latter cases prompted Children’s Medical Center to take part in a two year program to improves its treatment. Dr.Vineeta Mittal, a pediatric hospitalist at Children’s Medical Center and an Associate Professor of Pediatrics with UT Southwestern Medical Center, explains in this edition of Vital Signs.
Cause of Bronchiolitis
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 two. 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 six 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:
- Never having been breast-fed — breast-fed babies receive immune benefits from the mother
- Premature birth
- An underlying heart or lung condition
- A depressed immune system
- Exposure to tobacco smoke
- Contact with multiple children, such as in a child care setting
- Living in a crowded environment
- Having siblings who attend school or child care and bring home the infection
For the first few days, the signs and symptoms of bronchiolitis are similar to those of a common cold:
- Runny nose
- Stuffy nose
- Slight fever (not always present)
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
If it’s difficult to get your child to eat and his or her breathing becomes more rapid or labored, contact your child’s doctor. This is especially true if your child is younger than 12 weeks old or has other risk factors for bronchiolitis – including premature birth or a heart or lung condition.
The following signs and symptoms are reasons to seek prompt medical attention:
- Breathing very fast – more than 60 breaths a minute – and shallowly
- Skin turning blue, especially the lips and fingernails (cyanosis)
- Refusal to drink enough fluids, or breathing too fast to eat or drink
- Audible wheezing sounds
- Ribs seem to suck inward when infant inhales
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.
A tiny percentage of children need hospital care to manage their condition. At the hospital, your child will likely receive humidified oxygen to maintain sufficient oxygen in the blood, and perhaps fluids through a vein (intravenously) to prevent dehydration. In severe cases, a tube may be inserted into the windpipe (trachea) to help the child’s breathing.