Bronchiolitis

Definition
Bronchiolitis is a common infection of the lungs' airways, often caused by a virus. It
most frequently occurs in infants, commonly between 3 and 6 months of age.
Typically, bronchiolitis occurs during the fall and winter months.

Bronchiolitis starts out with symptoms similar to those of a common cold but then
progresses to coughing and wheezing.

Although a child's bout of bronchiolitis may be scary, particularly for parents,

symptoms typically last for about a week and then go away. In the meantime, you can
take a number of self-help measures to make your child more comfortable. In some
cases, especially if your child has an underlying health problem, bronchiolitis can
become severe and require hospitalization.

Symptoms
For the first two or three days, the signs and symptoms of bronchiolitis are similar to
those of a common cold:

 Runny nose
 Stuffy nose
 Slight fever (may or may not occur)

After this, there may be two or three days of:

 Wheezing — breathing seems more difficult or noisy when breathing out

 Rapid or difficult breathing
 Rapid heartbeat

In otherwise healthy infants, the infection generally goes away by itself in seven to 10
days. If your child was born prematurely or has underlying health problems, such as a
heart or lung condition or a weakened immune system, the infection may be more
severe and your child may need to be hospitalized.

Severe bronchiolitis may cause your child to have difficulty breathing or develop
bluish-looking skin (cyanosis) — a sign that he or she isn't getting enough oxygen.
This requires emergency medical care.

When to see a doctor

If your child has more than minor breathing problems, is younger than 12 weeks old
or has other risk factors for bronchiolitis — including premature birth or a heart-lung
condition — contact your child's doctor.
If your child experiences any of the following signs and symptoms, seek prompt
medical attention:

 Vomiting
 Breathing very fast — more than 40 breaths a minute — and shallowly
 Skin turning blue, especially around the lips and fingernails (cyanosis)
 Exhaustion from trying to breathe or the need to sit up in order to breathe
 Lethargy
 Refusal to drink enough fluids, or breathing too fast to eat or drink

Causes

The windpipe (trachea) is the main airway to your lungs. Within your lungs, the
trachea branches off into two main breathing tubes called bronchi, one into your left
lung and one into your right. Within each lung, the bronchi branch off into smaller
and smaller air-tube passageways, distributing air throughout your lungs. The smallest
of these airways are called bronchioles.

Bronchiolitis occurs when a virus enters the respiratory system and makes its way to
the bronchioles, causing them to become inflamed and swollen. As a result, mucus
often collects in these airways, which can make it difficult for air to flow freely
through your lungs.

In older children and adults, the resulting signs and symptoms are generally mild. But
an infant's bronchioles are much narrower than are an adult's and are more easily
blocked, leading to greater difficulty breathing.

The respiratory syncytial virus (RSV), a common virus, causes most childhood
bronchiolitis cases. The rest are caused by other infectious agents, including viruses
that cause the flu or the common cold. Severe cases of bronchiolitis may reflect
multiple infections, such as a combination of RSV and metapneumovirus.
Bronchiolitis is a contagious condition. You contract the infectious virus just like you
would a cold or the flu — by inhaling airborne droplets of infected mucus or other
respiratory secretions or by touching objects contaminated by these secretions and
then touching your eyes or the inside of your nose or mouth. There is no vaccine for
most of these viruses.

Risk factors
One of the greatest risk factors for getting bronchiolitis is being younger than 6
months old, because the lungs and immune system aren't yet fully developed. Boys
tend to get bronchiolitis more frequently than girls do. Other factors that have been
associated with an increased risk of bronchiolitis in children include:

 Never having been breast-fed — breast-fed babies receive immune benefits

from the mother
 Premature birth
 An underlying heart-lung condition
 A depressed immune system
 Exposure to tobacco smoke
 Contact with multiple children, such as in a child care setting
 Having siblings who attend school or child care and bring home the infection

Complications
Complications of severe bronchiolitis may include:

 Increasingly labored breathing

 Cyanosis, a condition in which the skin appears blue or ashen, especially
around the lips, caused by lack of oxygen
 Dehydration
 Fatigue
 Severe respiratory failure

If these occur, your child may need hospitalization. Severe respiratory failure may
require insertion of a tube into the trachea (intubation) to assist the child's breathing
until the infection is brought under control. Untreated, this can be fatal.

If your infant was born prematurely, has a heart or lung condition, or has a
compromised immune system, watch closely for beginning signs of bronchiolitis. The
infection may rapidly become severe, and signs and symptoms of the underlying
condition may become worse. In such cases, your child will usually need
hospitalization to monitor his or her health and provide any necessary care.

Infrequently, bronchiolitis is accompanied by another lung infection such as bacterial

pneumonia, which is treated separately. Reinfections with RSV after the initial
episode may occur but typically aren't as severe. Repeated episodes of bronchiolitis
may precede the development of asthma later in life, but the relationship between the
two conditions is unclear.
Preparing for your appointment
You're likely to start by first seeing your family doctor or your child's doctor. Here's
some information to help you get ready for your appointment, and what to expect
from your doctor.

What you can do

 Write down any symptoms your child is experiencing, including any that
may seem unrelated to an upper respiratory infection, and when they started.
 Write down key personal information, such as if your child was born
prematurely or if he or she has a heart or lung problem.
 Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time
will help you make the most of your time together. List your questions from most
important to least important in case time runs out. For bronchiolitis, some basic
questions to ask your doctor include:

 What is likely causing my child's symptoms? Are there other possible causes?
 Does my child need any tests?
 How long do symptoms usually last?
 What is the best course of action?
 What are the alternatives to the primary approach that you're suggesting?
 Does my child need medication? If so, is there a generic alternative to the
medicine you're prescribing me?
 What can I do to make my child feel better?
 Are there any brochures or other printed material that I can take home with
me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to
ask questions during your appointment at any time that you don't understand
something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them
may reserve time to go over any points you want to spend more time on. Your doctor
may ask:

 When did your child first begin experiencing symptoms?

 Have your child's symptoms been continuous, or occasional?
 How severe are your child's symptoms?
 What, if anything, seems to improve your child's symptoms?
 What, if anything, appears to worsen your child's symptoms?

What you can do in the meantime

If your child has a fever, you can give him or her acetaminophen (Tylenol, others).
Have your child drink plenty of fluids to prevent dehydration. Keeping your child
upright and the air moist with a humidifier also may help ease congestion.
Tests and diagnosis
The doctor will likely listen to your child's lungs with a stethoscope to check for
wheezing and prolonged breathing out (exhaling). These may indicate obstructed
airflow in the bronchioles. The doctor may consider specific risk factors for
bronchiolitis as well.

Sometimes other tests are recommended, including:

 Chest X-ray. In severe or uncertain cases, your doctor may request that a
chest X-ray be taken to visually check for any signs of pneumonia. Your
doctor may also check for the presence of a foreign object, such as a peanut or
small piece of plastic, that your baby or toddler may have inhaled.
 Mucus sample test. In addition, your doctor may collect a sample of mucus
from your child — using a nasal pharyngeal swab or a suction catheter that's
gently inserted into the nose — to test for the virus that may be causing the
bronchiolitis.
 Blood tests. Occasionally, blood tests might be used to check your child's
white blood cell count. An increase in white blood cells is usually a sign that
your body is fighting an infection. A blood test can also determine whether the
level of oxygen has decreased in your child's bloodstream. An alternative test
for oxygen levels is an oximeter that fits over the finger. Oxygen is necessary
to the functioning of the body's organs, including the brain.

Your doctor may also ask you about signs of dehydration, especially if your child has
been refusing to drink or eat or has been vomiting. Signs of dehydration include
sunken eyes, dry mouth and skin, sluggishness, and little or no urinary output.

Treatments and drugs

You can treat most cases of bronchiolitis at home with self-care steps. 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 antibiotics for that.

In more severe cases, doctors may prescribe a bronchodilator, a medication to open up

the airways in the lungs, such as albuterol or albuterol inhalers (Proventil, Ventolin,
others). Inhaled antiviral drugs, such as ribavirin (Rebetol), also may be used,
although they may not always be as effective as desired.

If your child has complications from bronchiolitis, a stay at the hospital may be
necessary. 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.

Lifestyle and home remedies

Although it may not be possible to shorten the duration of your child's illness, you
may be able to relieve some of the symptoms and make your child more comfortable.
Here are some tips to consider:

 Humidify the air. If the air in your child's room is dry, a cool-mist humidifier
or vaporizer can moisten the air and help ease congestion and coughing. Be
sure to keep the humidifier clean to prevent the growth of bacteria and molds.
Keep the room warm but not overheated — too much heat can make the air
drier. Another way to humidify the air is to run a hot shower or bath in the
bathroom and let it steam up the room. Sitting in the room holding your child
for about 15 minutes may help ease a fit of coughing.
 Keep your child upright. Being in an upright position usually makes
breathing easier. Placing your infant in a car seat may help. If you plan to
leave your child in a car seat for an extended period of time, such as for a nap,
make sure your child's head won't fall forward, which can prevent proper
breathing. To do this, place foam wedges or a rolled up blanket on each side of
your child's head to keep it safely in place. Also check that the seat has an
appropriate slope. This varies with the child's size and age.
 Have your child drink clear fluids. To prevent dehydration, give your child
plenty of clear fluids to drink, such as water, juice or gelatin water. Your child
may drink more slowly than usual, due to congestion.
 Try saline nasal drops to ease congestion. You can purchase these drops
over-the-counter (OTC). They're effective, safe and nonirritating, even for
children. To use them, instill several drops into one nostril, then immediately
bulb suction that nostril (but don't push the bulb too far in). Repeat the process
in the other nostril. If your child is old enough, you might teach your child
how to blow his or her nose.
 Use OTC pain relievers. OTC pain relievers such as acetaminophen (Tylenol,
others) may help relieve a sore throat and improve your child's ability to drink
fluids. Don't offer your child aspirin. It's associated with a rare but serious
illness called Reye's syndrome. OTC cold preparations aren't appropriate for
bronchiolitis, either.
 Maintain a smoke-free environment. Smoke can aggravate symptoms of
respiratory infections. If a family member smokes, ask him or her to smoke
outside of the house and outside of the car.

Prevention
Because bronchiolitis spreads from person to person, one of the best ways to prevent
it is to wash your hands frequently — especially before touching your baby when you
have a cold. Wearing a face mask at this time is appropriate. If your child has
bronchiolitis, keep him or her at home until the illness is past to avoid spreading it to
others.

These other simple but effective ways can help curb spread of the infection:

 Limit your child's contact with people who have a fever or cold. If your
child is a newborn, especially a premature newborn, avoid exposure to people
with colds in the first two months of life.
  Keep bathroom and kitchen countertops in your home clean. Be especially
careful if another family member has a cold. To disinfect the area, you can use
a solution of bleach and water made with a tablespoon of bleach per gallon of
cool water. Don't mix in any other chemicals, as this can create a toxic
chemical reaction. Always store homemade mixtures in a labeled container out
of the reach of young children.
 Use a tissue only once. Discard used tissues promptly, then wash your hands
or use alcohol hand sanitizer.
 Use your own drinking glass. Don't share glasses with others.
 Be prepared away from home. Keep a waterless hand sanitizer handy for
yourself and for your child when you're away from home.
 Wash hands. Frequently wash your own hands and those of your child.

No vaccine available
There's no vaccine for bronchiolitis. But the medication palivizumab (Synagis) can
help decrease the likelihood of RSV infections in infants with high risk of severe
disease, as well as decrease the need for hospitalization and limit severity of the
illness. Palivizumab is typically given through a single injection into a large muscle,
such as the thigh, once a month during the peak RSV season — from November
through March.

Palivizumab doesn't interfere with childhood vaccines. The expense generally limits
its use to infants at particularly high risk of RSV infection, such as those born very
prematurely or with a heart-lung condition or a depressed immune system.