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Bronchiolitis
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Definition
Bronchiolitis is a type of chest infection that commonly affects
children under 12 months of age. It occurs when the very small
airways in the lungs, called the bronchioles, become inflamed
and swell up.

The bronchioles are the smallest air passages within the lungs.
When they are compromised, usually by a virus, these air
passages become swollen and are filled with mucus. The
inflammation can be enough to cause partial or complete
blockages of the airways. In children especially, this can lead to
wheezing, a high-pitched noise that can be heard when the child
is breathing out. Although it is not always the case, airways that
are seriously blocked can lead to lower levels of oxygen within
the blood.

This condition is a common illness among infants and children. In

fact, it is the most frequent cause of hospitalization for patients
in this age group. This is a seasonal illness that generally peaks
during the winter months, although it can occur at other times
during the year.

Epidemiology
⏪⏪⏪⏪⏪⏪⏪⏪◀
Approximately 75% of cases of bronchiolitis occur in children
under the age of 1 and 95% in those under the age of 2.
Although children can usually be managed at home,
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approximately 3% of affected children require hospital admission,

with 1.3 per 1000 infants aged less than 1 year requiring
paediatric intensive care input. The condition most commonly
occurs during the winter months.

Types of Bronchiolitis
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There are two main types of bronchiolitis:

Viral Bronchiolitis

Viral bronchiolitis appears in infants. Most cases of viral

bronchiolitis are due to respiratory syncytial virus (RSV). Viral
outbreaks occur every winter and affect children under the age of
one.

Bronchiolitis Obliterans

Bronchiolitis obliterans is a rare and dangerous condition seen in

adults. This disease causes scarring in the bronchioles. This blocks
the air passages creating an airway obstruction that can’t be
reversed.

Risk factors
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Bronchiolitis typically affects children under the age of 2 years.
Infants younger than 3 months of age are at greatest risk of

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getting bronchiolitis because their lungs and immune systems

aren’t yet fully developed.

Other factors that are linked with an increased risk of

bronchiolitis in infants and with more-severe cases include:

Premature birth
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Underlying heart or lung condition
Depressed immune system
Exposure to tobacco smoke
Never having been breast-fed (breast-fed babies receive immune
benefits from the mother)
Contact with multiple children, such as in a child care setting
Spending time in crowded environments
Having siblings who attend school or get child care services and
bring home the infection

Causes of Bronchiolitis

🔵🔵🔵🔵🔵🔵🔵🔵🔵
The most common cause of bronchiolitis is a virus. At first, the
virus causes an infection in the upper respiratory tract. This
includes the nose, mouth, and throat. It then spreads downward
into the windpipe (trachea) and lungs (lower respiratory tract).
The virus causes inflammation and even death of the cells inside
the respiratory tract. This blocks airflow in and out of the child’s
lungs.
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Bronchiolitis ❗❗❗is most often caused by the respiratory syncytial

virus (RSV). But these other viruses can also cause it:

Rhinovirus
Parainfluenza virus
Adenovirus
Influenza
Human metapneumo virus⭕➕➕⭕⭕
In rare cases, bronchiolitis may be caused by bacteria.

Bronchiolitis symptoms
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The early symptoms of bronchiolitis are similar to those of a

common cold. The first symptom is usually a blocked or runny
nose and your child may also have a slight cough or fever (high
temperature). A normal temperature is 36C-36.8C (96.8F-98.2F).

Bronchiolitis begins as a mild upper respiratory infection. Within

2 to 3 days, the child develops more breathing problems,
including wheezing and a cough.

Symptoms include:🟤🟤🟤🟤

Wheezing is the main symptom that helps with diagnosis.

Wheezing is a high-pitched purring or whistling sound.

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You can hear it best when your child is breathing out.

Rapid breathing at a rate of over 40 breaths per minute.
Tight breathing (having to work hard to push air out).
Coughing (may cough up very sticky mucus).
Fever and a runny nose often start before the breathing
problems.
The average age for getting bronchiolitis is 6 months (range:
birth to 2 years).
Symptoms are like asthma.
About 30% of children with bronchiolitis later do develop asthma.
This is more likely if they have close family members with
asthma. Also likely if they have bronchiolitis more than 2 times.

Complications
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These complications can occur following bronchiolitis:

Hypoxia
Dehydration
Fatigue
Respiratory failure
Persistent cough or wheeze (very common and parents should be
counselled that their child may cough for several weeks)
Bronchiolitis obliterans – Airways become permanently damaged
due to inflammation and fibrosis
Diagnosis and test

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Doctors usually diagnose bronchiolitis solely through physical

examination and taking the history of your child, but they may
order additional tests to rule out other diseases, such as
pneumonia or asthma. To confirm the diagnosis, the doctor may
also order:

Chest x-rays- A diagnostic test which uses invisible

electromagnetic energy beams to produce images of internal
tissues, bones and organs onto film.
Blood tests
Pulse oximetry- An oximeter is a small machine that measures
the amount of oxygen in the blood. To obtain this measurement,
a small sensor (like a Band-Aid) is taped onto your child’s finger
or toe. When the machine is on, a small red light can be seen in
the sensor. The sensor is painless and the red light does not get
hot.
Nasopharyngeal swab- 🟦🟦🟦🟦These tests quickly indicate
the presence of RSV and other viruses.
Treatment and medications
Bronchiolitis is a viral infection, which the body can clear on its
own with antibodies. There is no specific treatment for the
disease nor can it be cured with antibiotics that only work against
bacteria. The doctor will prescribe medicines only to alleviate the
symptoms. The baby may have to be hospitalized only in severe
cases of illness.
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The following are the standard treatment methods for
bronchiolitis in babies:

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Medicines for fever: ⭕⭕⭕⭕⭕⭕

The doctor may prescribe medicines like acetaminophen
(paracetamol) to bring down the fever and make the baby a little
comfortable.
Intravenous fluids: ⭕⭕⭕⭕⭕⭕
Babies with bronchiolitis have a hard time eating and drinking
and may need intravenous fluids. This usually happens in severe
cases of infection, when the baby has to be hospitalized for
bronchiolitis.
Oxygen: ⭕⭕⭕⭕⭕⭕⭕⭕⭕
Oxygen can help the baby in respiration and improve oxygen
levels in the blood.
Nebulization: ⭕⭕⭕⭕⭕⭕⭕⭕⭕
Use of nebulization with hypertonic saline or bronchodilators
may be of benefit in some children.
Using a cool mist humidifier
Using a bulb syringe to clear the nose

In most cases, the baby gets better without any treatment, with
the symptoms improving within a week. Just like any other viral
infection, managing the illness at home is the best way to make
the baby feel better and recover faster, unless more dangerous
symptoms develop as explained above.

Medical Treatment
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Viral bronchiolitis in children can usually be treated at home but
sometimes requires medical intervention including

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hospitalization. Treatment depends on the severity of the

condition and the overall health of the child. It can include:

Intravenous fluids to re-hydrate

Supplemental oxygen
Inhaled medications to open airways
Antibiotics in the presence of a bacterial infection
Medical treatment for bronchiolitis obliterans is a little different
and depends on the underlying cause. Some ways this condition
is treated is through:
✳✳✳✳✳✳
Macrolide antibiotics
Corticosteroids
Immunosuppressant drugs
Lung transplant
Bronchiolitis prevention
RSV and other viruses that lead to bronchiolitis are common and
spread easily. Older children and adults get the viruses, too. But
they usually don’t get as sick as younger children. The best way
to prevent bronchiolitis is to keep your child from catching a
virus.

Keep your child away from other children or people with colds or
other illnesses.
Stay away from crowded areas where viruses can spread easily.
This could include elevators or shopping malls.
Wash your hands and your child’s hands frequently.
Regularly disinfect surfaces, toys, and objects in your home.
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If your child has bronchiolitis, keep them home until the cough is
almost gone. Make sure to wash your hands after you take care
of your sick child.

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