Bronchiolitis

What is it?

Bronchiolitis is the leading cause of hospitalization for infants in the United States with over 100,000 admissions annually. It is usually seen from December through April. It is a viral infection that begins as an upper-respiratory infection and then progresses to involve the lower small airways of the lung, known as the bronchioles. These tiny airways become swollen and filled with mucus, making it very difficult to breathe. Small infants and babies are more susceptible to severe disease secondary to the very small diameter of these airways. 

The most common cause of bronchiolitis is respiratory synctial virus, or RSV. This is a common wintertime virus in the Northern Hemisphere. Other viruses such as influenza (flu), rhinovirus, and human metapneumovirus (HMPV) can also cause bronchiolitis. 

Infants with a history of prematurity, congenital disorders (problems they are born with) such as congenital heart or lung disease, or live in homes with smokers are higher risk of severe bronchiolitis.

What are the Signs and Symptoms?

Bronchiolitis often begins as a typical cold with runny nose, congestion, cough, sneezing, and fever. It then progresses to involve the lower airways. The child may have difficulty breathing, fast breathing, wheezing, nostril flaring and/or chest in-drawing or “retractions.” Young infants may stop breathing for a period, which is known as “apnea” and may appear dusky or blue in the lips and nail beds (“cyanosis”). This is a sign that the infant may require medical evaluation and/or supplemental oxygen. Some infants can become dehydrated from vomiting or refusal to drink because of nasal blockage. The illness can be prolonged, lasting 2-3 weeks. 

How is it Treated?

The primary treatment for bronchiolitis is “supportive.” This includes keeping the nasal passages open with saline (salt water) drops and a suction bulb. It is important to try to keep the baby hydrated, and this may include using electrolyte solutions such as Pedialyte. Offering infants smaller volumes of fluid more frequently is often more helpful while they are ill. It is important that infants and babies avoid being exposed to smoke.  This will further irritate the airways and make it more difficult for the child to breathe. The use of a cool-mist vaporizer can also be helpful in keeping the air moist and loosening up secretions. Fever can be treated with appropriate dosing of acetaminophen and/or ibuprofen. Hospitalization may be required if the infant needs frequent intensive nasal suctioning, intravenous fluids, and/or supplemental oxygen. Supplemental oxygen may be delivered at home in infants who are otherwise doing well. A few infants require assisted breathing support with a ventilator until they are improved.

Unfortunately, there are no treatments that have been shown to shorten the duration of bronchiolitis. Children are often given “breathing treatments” of medicines such as albuterol or epinephrine. These may help a very small percentage of infants breath easier, but the effects may also be detrimental, so they are usually reserved for more severe cases. Antibiotics have no role since bronchiolitis is a viral disease, not a bacterial disease. Other treatments such as over-the-counter cold remedies are not recommended, and infant preparations have recently been withdrawn from the market.

When Should I Seek Medical Attention?

If the baby stops breathing (“apnea”) or you are concerned that the child’s lips, mouth, or nail beds are dusky or blue, please seek medical attention immediately. Other warning signs include rapid breathing, chest in-drawing or retractions, poor level of responsiveness, or concern for dehydration, signified by a dry mouth or less than one wet diaper every 8 hours. 

How Can I Prevent My Child From Getting Bronchiolitis?

The primary way to prevent your child from becoming ill is to practice good hand washing, as the viruses that cause bronchiolitis are commonly transmitted from person to person via close contact with infected secretions on the hands. Infants who live in homes with exposure to cigarette smoke have been shown to have higher rates of bronchiolitis and are more likely to be hospitalized. Synagis (palivizumab), which is an injection that is given monthly during the winter, has been shown to decrease the likelihood of hospitalization in infants with severe prematurity, history of chronic lung disease or congenital heart disease. This should be discussed with your medical provider.