BRONCHIOLITIS

Description

• Wheezing: A high-pitched whistling sound while breathing out.
• Rapid breathing (over 40 / minute).
• Tight breathing (pushing air out).
• Coughing, often with sticky mucous.
• Often preceded by fever and profuse nasal discharge.
• Usually between 6 months and 2 years old.

Cause

The wheezing is caused by narrowing of the smallest airways in the lungs. The narrowing results from inflammation caused by viruses, usually respiratory syncytial virus (RSV). RSV epidemics occur most often in the months between September and April. Whereas infants with RSV may develop wheezing, children over age 2 years and adults usually just develop cold symptoms. The virus is found in nasal secretions of infected individuals. It is spread by sneezing or coughing at a range of less than 6 feet, or by hand-to-nose or hand-to-eye contact. People do not develop permanent immunity.

Expected Course

Wheezing and difficulty breathing out usually worsens for 2 or 3 days and then begins to improve. Overall, the wheezing lasts 7 to 10 days and the cough may last 3-6 weeks. It is common for bronchiolitis to re-occur after the first episode. The most common complication of bronchiolitis is an ear infection (20%). Bacterial pneumonia is an uncommon complication. About 1% or 2% of infants and children will be hospitalized because they need oxygen or IV fluids. In the long run, approximately 30% of the children who develop bronchiolitis will go on to develop asthma. Current research suggests that bronchiolitis does not actually cause the asthma.

Prevention

Infants who are at the greatest risk for contracting severe cases of RSV infection are encouraged to receive monoclonal antibody injections (Synagis) each month during the peak season in an effort to prevent getting the disease. This would usually include the following:

• Premature birth at less than 28 weeks gestation with age less than 12 months in September.
• Premature birth at 29-32 weeks gestation with age less than 6 months in September.
• Premature birth at 33-35 weeks gestation only with additional risk factors; school age siblings, day care attendance, passive smoke exposure, expected cardiac surgery, multiple births, and apnea.
• Under 2 years of age with chronic lung disease of prematurity that has required medical treatment of the lung disease within the last 6 months.
• Severe immune deficiency

Minimizing exposure to other children, frequent hand washing, and avoidance of smoke exposure will help prevent all infants and children from contracting RSV.

Treatment

There is no definitive cure for bronchiolitis. At home we can try to use nasal saline washes with gentle suctioning to open the airways. We should encourage fluids. “Cold medications” often provide little relief. Oral or inhaled steroids, which are a mainstay of the treatment of asthma, seem to have little positive effect. Bronchodilators like albuterol or Xopenex are frequently used, but their overall effectiveness is limited. Antibiotics have no role in the treatment of bronchiolitis, and are reserved for the treatment of any secondary bacterial infections that may arise, mainly otitis media (ear infection). Call our office if your child seems to be dehydrated, has labored or difficult breathing, is breathing at 60 or more times per minute, has fever of 103 or greater, or if fever above 101 lasts > 3 days.