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Bronchiolitis

  • Lungs and bronchial tree

Definition

Bronchiolitis is an inflammation in the bronchioles, the small airways in the lungs. It is characterized by wheezing and usually affects children under 2 years of age.

What is going on in the body?

Bronchiolitis is a common condition in which an infection, such as a cold or the flu, causes the bronchioles (small airways in the lungs) to swell. Along with the swelling, an increased amount of mucus is produced.
Bronchiolitis is a common illness in children under the age of 2, although it may sometimes affect older people. It can be more serious in infants and young children, because their airways are much narrower than in older children or adults.

Risks

What are the causes and risks of the disease?

The most common cause of bronchiolitis is a virus called respiratory syncytial virus (RSV). Other viruses and certain types of bacterial infections can also cause bronchiolitis.
Bronchiolitis can occur in a child when someone who has a cold or the flu spreads the virus to the child.
Bronchiolitis occurs most often in the winter and early spring. Most children with bronchiolitis have mild symptoms and recover without incident in 7 to10 days. However, about 5% of children with this illness have to be hospitalized. Whether this is necessary depends on:
  • how young the child is
  • how much trouble the child has breathing
  • whether the child is getting enough oxygen
  • whether the child is able to eat well enough during the illness
  • whether the child is dehydrated

Prevention

What can be done to prevent the disease?

It can be difficult to prevent bronchiolitis. It may help to keep a young child away from others who have a cold or flu. If someone in the household is coughing or sneezing, they should wash their hands frequently.
Also, any person who handles children should wash his or her hands frequently. Persons should cough, sneeze, or blow their noses into tissues and discard them. They should not cough or sneeze near others.
A vaccine exists for RSV, but it is used only in very premature infants--those at highest risks for getting sick enough to end up in the hospital.

Diagnosed

How is the disease diagnosed?

A healthcare professional usually takes a history of how symptoms started and then does a physical exam.
Usually, the illness starts with 1 to 2 days of nasal congestion. Then breathing gradually becomes more difficult. The child may start to breathe more rapidly and may exhale more forcefully.
The healthcare professional will listen for wheezing and look for trouble breathing or rapid breathing. X-rays of the chest may be taken as well. It usually will show that extra air gets trapped in the lungs (known as hyperinflation).

Long Term Effects

What are the long-term effects of the disease?

Some children who have had an episode of bronchiolitis may be prone to further episodes of wheezing. This is especially true for children who needed to be hospitalized for a bout with bronchiolitis. These children may also develop allergy symptoms.

Other Risks

What are the risks to others?

Viral and bacterial infections are contagious.

Treatments

What are the treatments for the disease?

Treatment for bronchiolitis consists of providing warm, moist air. Parents should check with the healthcare professional about using a vaporizer or humidifier to moisten the air. A humidifier is a machine that moistens the air with a cool mist. A vaporizer is a machine that turns water into steam to moisten the air.
Young infants who have cyanosis, or bluish lips and nail beds, may need to be hospitalized. Infants who have had repeated attacks of bronchiolitis, or those who are breathing very rapidly and shallowly, may need to be hospitalized as well.
The medications used will depend on the cause and severity of the bronchiolitis.
Sometimes breathing treatments with a nebulizer are needed. Breathing treatments involve a machine that sprays out a light mist of medicine through a mask. Children who are having an extremely hard time breathing may need a ventilator, or artificial breathing machine.

Side Effects

What are the side effects of the treatments?

Side effects vary, depending on the treatment used.
  • Medications, such as antibiotics, can cause stomach upset and allergic reactions.
  • Vaporizers can cause burns.
  • A child may become jittery or have a rapid heart beat from the medications used with breathing treatments.
  • There may be more significant side effects if a child needs to be put on a ventilator.
Antibiotics usually have no place in treating bronchiolitis because the cause of the infection is almost always viral.

After Treatment

What happens after treatment for the disease?

After a child recovers from bronchiolitis, no further treatment is usually needed, unless the child had significant difficulty breathing and needed aggressive treatment.

Monitor

How is the disease monitored?

A healthcare professional may have a child return for several visits to make sure that the symptoms are improving. If a child needs to stay in the hospital, he or she will often have the level of oxygen in the blood checked frequently. Most children with bronchiolitis recover without much intervention.

Sources

Mayo Clinic Family Health Book, David E. Larson, 1996.

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