BRONCHIOLITIS

By Union Avenue Pediatrics

Bronchiolitis is an infection of the small breathing tubes (bronchioles) of the lungs, which primarily occurs in infants under one year of age. Bronchiolitis should not be confused with bronchitis, which is an infection of larger airways.

The virus known as RSV usually causes Bronchiolitis. This stands for respiratory syncytial virus. Other viruses known to cause bronchiolitis are parainfluenza, influenza and adenovirus. RSV infection usually occurs during the late fall and winter months. During the other months bronchiolitis is usually caused by one of the other viruses. A hospital laboratory using special cultures of nasal secretions can readily test for these viruses.

When one of these viruses infects the bronchioles it causes inflammation and swelling within the center of the small airway, which results in a blockage of airflow. Because the bronchioles in infants are so much smaller than in older children and adults, even a small amount of narrowing of the air passageway can create a significant obstruction to moving air in and out of the lungs.

Infants with RSV can have a very serious respiratory illness, especially if they are premature infants, have heart disease, or other chronic illnesses. In the older child or adult RSV may be no more serious than the common cold caused by the rhinovirus. At first, even in the infant, RSV bronchiolitis may begin as a simple cold with symptoms of a runny nose, mild cough and sometimes fever. However, the infant with bronchiolitis will begin to show more serious signs of illness after a day or two into the illness.

Cigarette smoke exposure to an infant after an episode of RSV bronchiolitis increases the odds of hospitalization nearly five times in the next year. This is why parent must be sure their infants who have had bronchiolitis (and all infants for that matter) are not subjected to the harmful effects of cigarette smoke.

• Rapid breathing (especially if more than 60 times in a minute)
• Difficulty breathing
• Dilating nostrils or using all the muscles of the rib cage with each breath
• Ribs or sternum pull in deeply with each breath
• Grunting or wheezing noises
• Poor feeding
• Fewer wet diapers
• Blue fingers or lips - call 911 if your child is blue.

Home treatment for mild cases:

• Humidified air
• Saline nose drops with a nasal aspirator (suction bulb device)
• Drink fluids.
• Home nebulizers or similar medications given by mouth may be prescribed by your doctor
• No smoking in the house

Hospital treatment for sicker children:

Some of these may be used to treat a hospitalized child. Many of these mimic milder episodes of bronchiolitis and frequently respond to nebulizers.

• Oxygen
• Nebulizers may help
• Fluids - may require an IV
• Other medications
• Antibiotics - these are only used if the child develops a complication like pneumonia. Antibiotics will not work against RSV or any of the other viruses.
• Extremely sick children sometimes require breathing tube and machine.

• There is no prevention or vaccine right now for normal healthy babies or children
• Common sense would recommend keeping babies away from other people with respiratory illnesses
• Good hand washing and preventing contact with nasal or oral secretions of caretakers is important

For premature infants and other selected high-risk groups a new form of prevention is now available. Respiratory Syncytial Virus Immune Globulin can be injected monthly into the muscle of the susceptible infant to protect him or her from infection. Unfortunately, the protection is far from complete and the treatment is extremely expensive costing nearly $5,000 for a five month time period of protection using five injections thirty days apart. Your pediatrician can discuss this further with you if you have an infant that was born premature or has other risk factors.

Most infants recover completely from bronchiolitis but many are prone to repeated episodes of wheezing following simple colds in the next few years to come. Some children who get RSV bronchiolitis as infants are more likely to have asthma as they grow up.

Last Update: 02/16/2003