Bronchiolitis

What is Bronchiolitis?

Bronchiolitis is a typical lung infection often found in young people. It is a viral infection that affects the lower part of the respiratory system and can show symptoms ranging from mild to moderate difficulty in breathing. One of the primary causes of bronchiolitis is the Respiratory Syncytial Virus (RSV).

Usually, most children experience bronchiolitis as a mild illness that gets better on its own. However, in certain instances, it can lead to severe respiratory failure in infants. The primary care for bronchiolitis involves keeping the patient hydrated and providing oxygen. Unfortunately, there are no specific medications that cure this infection.

It’s crucial to understand that RSV is not the only cause of Bronchiolitis. This infection can affect people of all ages. However, severe symptoms are usually seen in infants.

What Causes Bronchiolitis?

The respiratory syncytial virus is often the main culprit behind bronchiolitis, which is an infection of the lungs. Despite this, other viruses have also been identified as capable of causing this infection. These include:

• Human rhinovirus
• Coronavirus
• Human metapneumovirus
• Adenovirus
• Parainfluenza virus
• Human bocavirus

The respiratory syncytial virus is responsible for most cases of bronchiolitis. However, it’s worth noting that in about 30% of babies who get the infection, it’s caused by two viruses at the same time.

There are several factors that can make a baby more likely to get bronchiolitis. These include:

• Being premature and having low birth weight
• Being less than 5 months old
• Coming from a low-income household
• Having abnormal airways
• Having an inborn immune system disorder
• Living with parents who smoke
• Living in a crowded environment
• Having a chronic lung disease like bronchopulmonary dysplasia

Risk Factors and Frequency for Bronchiolitis

Bronchiolitis is a condition that mostly affects kids under 2 years old. In their first year of life, around 11% to 15% of kids are likely to get Bronchiolitis. Depending on how serious the infection is, for every 1,000 children under 2, about 5 will need to be hospitalized. It’s a condition that’s usually more common in autumn and winter, but it can happen at any time of the year. There are certain risk factors that make the infection more severe:

• Being born prematurely (before 32 to 34 weeks of pregnancy)
• Being under 3 months old
• Having a neuromuscular disease
• Having a congenital heart disease
• Having a chronic lung disease
• Having a weakened immune system

Signs and Symptoms of Bronchiolitis

RSV, also known as Respiratory Syncytial Virus, is a common virus that can trigger cold-like symptoms. When first contacted, symptoms usually include coughing, fever, and a runny nose. Within two to three days, additional symptoms become noticeable, as the infection spreads to the lower part of the respiratory tract. This can cause issues such as small airway obstruction, which leads to noticeable difficulties in breathing. The physical signs can vary from baby to baby and might include sounds of crackling and wheezing during breathing, alongside rhonchi – a rattling sound in the chest.

The intensity of the breathing problems can differ greatly. While some little ones might experience slightly accelerated breathing (tachypnea), others could have more severe symptoms like grunting, bluish skin color from lack of oxygen (cyanosis), and significant chest retractions (the inward pulling of muscles between the ribs during breathing). The illness usually lasts between a week to 10 days, during which the baby might become fussy and refuse to eat. However, most babies will get better within two to three weeks, provided they remain well-hydrated.

• Initial symptoms: Cough, fever, and runny nose
• Additional symptoms within 2-3 days: Breathing difficulties due to small airway obstruction
• Possible physical signs: Crackling and wheezing sounds during breathing, rhonchi
• Variations in severity: Mild cases may only present accelerated breathing, while severe cases can show grunting, cyanosis, and significant chest retractions
• Typical duration of illness: 7-10 days, with possible irritability and refusal to eat
• Expected recovery timeline: Most infants recover within 14-21 days if they are kept well-hydrated

Testing for Bronchiolitis

If your doctor suspects bronchiolitis, they mainly rely on your symptoms to diagnose it. They only order blood tests and imaging studies in order to eliminate any other possible causes. Doing more in-depth tests to identify the specific virus causing bronchiolitis is usually just for research purposes. Even if the virus is present in the blood, it doesn’t make the symptoms any better or worse. These types of tests are mostly useful just for tracking disease trends and not for treating individual patients.

A chest x-ray is only necessary if your doctor thinks there could be a complication like pneumothorax (a collapsed lung) or bacterial pneumonia. Also, in some cases where children keep having high temperatures without a clear reason, a urine culture might be done to check for a urinary tract infection. This is because urinary tract infections can sometimes occur alongside bronchiolitis in about 5% to 10% of cases.

Treatment Options for Bronchiolitis

Caring for children with bronchiolitis, a respiratory illness, mainly involves treating the symptoms. Once a child is diagnosed, doctors will assess their hydration level, breathing difficulty, and whether they have low oxygen levels.

Children with mild to moderate symptoms can often be helped with simple remedies like saline for their nose, fever reducers, and a cool-mist humidifier. However, if a child shows severe symptoms such as extreme difficulty breathing, low oxygen levels or dehydration, they should be admitted to the hospital for careful monitoring and treatment. For these children, hydration is very important and if eating is difficult, doctors will ensure they receive enough fluids. They should be provided with humidified oxygen and a special salty solution delivered via a mist to help their breathing. Using standard bronchial treatments like epinephrine or steroids is not effective in these cases. Providing enough oxygen to maintain oxygen saturation just above 90% is recommended.

Children who show signs of extremely difficult breathing may be in danger of respiratory failure. They could require intensive care and mechanical ventilation or non-invasive support to help them breathe. A recently introduced non-invasive support option is a high-flow nasal cannula, which is currently being tested in clinical trials.

Children at a high risk for severe illness from the respiratory syncytial virus (RSV), which often causes bronchiolitis, can be given passive immunization with medicine called palivizumab during RSV season on a monthly basis. However, for many infants, the cost and practicality of this treatment may not be feasible. The American Academy of Pediatrics recommends the use of palivizumab during the first year of life for children born less than 29 weeks into pregnancy, those with symptomatic congenital heart disease, chronic lung disease, certain neuromuscular disorders, airway abnormalities, and immune deficiency. This medicine can also be used into the second year of life for children needing ongoing treatment for chronic lung disease or those with weakened immune systems.

What else can Bronchiolitis be?

• Asthma: a condition that causes the airways in the lungs to become narrow and inflamed
• Bacterial pneumonia: a type of lung infection caused by bacteria
• Gastroesophageal reflux disease (GERD): a digestive disorder that affects the ring of muscle connecting your esophagus and stomach
• Vascular ring: a rare condition where the blood vessels in the chest form a ring, which can constrict the esophagus and trachea
• Croup: an infection that causes the airway just below the vocal cords to become swollen, leading to a barking cough
• Foreign body aspiration: occurs when a person accidentally breathes something into their lungs, like a small piece of food or toy
• Pertussis: also known as whooping cough, it’s a highly contagious respiratory tract infection

What to expect with Bronchiolitis

Bronchiolitis is an infection that generally resolves on its own. Typical treatments include maintaining hydration, managing fever, and ensuring adequate oxygen levels. If detected and dealt with promptly, the outlook is usually very good. Most children bounce back from this condition without any negative effects.

Earlier research hinted that babies who suffered severe bronchiolitis might develop wheezing later in life. However, more recent, long-term studies have not confirmed this.

Around 3% of babies may need to be admitted to the hospital to be treated for bronchiolitis. Death rates due to this condition can vary significantly, ranging from 0.5% to 7%. This large variation is due to different risk factors and the availability, or lack, of intensive care units in some countries.

Possible Complications When Diagnosed with Bronchiolitis

Complications of the condition are:

• Hospital-acquired infections in babies who are admitted
• Lung damage if a ventilator is needed
• Irregular heart rhythms caused by certain medications
• Nutritional issues due to continuous vomiting

Preventing Bronchiolitis

It’s important to ensure that you stay well-hydrated by drinking plenty of water and other non-alcoholic fluids. You should also regularly monitor and regulate your body temperature to stay healthy, especially if you’re not feeling well. Smoke exposure, particularly at home, should be avoided as it can harm your respiratory system.

Additionally, make a habit of washing your hands frequently. This simple act can drastically reduce the chances of infection and the spread of diseases. Remember, these steps are not only about keeping you safe but also about ensuring a healthy environment for everyone around you.