Bronchiolitis

Bronchiolitis is an acute viral infection of the lower respiratory tract, affecting mainly infants under 2 years of age, with a peak between 3-6 months.

It is the most frequent lower respiratory infection in children within this age. It causes an obstruction of the wall of the bronchioles secondary to edema, mucus, and cellular debris; all of them, together with bronchospasm, increase the resistance of the small airways, leading to air trapping, overinflation, and, ultimately, atelectasis.

Respiratory Syncytial Virus (RSV) is the most common etiologic agent accounting for at least half of the cases. Other viruses detected in nasopharyngeal secretions from children hospitalized with bronchiolitis are rhinovirus, parainfluenza, human metapneumovirus (hMPV), bocavirus, coronavirus, influenza, and adenovirus, and coinfection has been described. There are no differences in the clinical presentation depending on the etiologic agent, although there can be some differences in the severity.

RSV is present worldwide, and 90% of the children will be infected in the first 2 years of life. It causes annual epidemics of bronchiolitis; the peak season varies amongst the countries depending on environmental and meteorological factors, but roughly occurs in wintertime and late spring: from November to March in the northern hemisphere, and from May to September in the southern hemisphere.

To date, there is no etiologic treatment that shortens the course of the disease, being the cornerstone of the therapy the optimization of supportive and symptomatic measures.

As bronchiolitis has considerable morbi-mortality, several guidelines from different organisms are periodically published reviewing the best evidence to guide the clinicians in its management.

Runny nose.

Slight fever (under 101 F).

Cough.

Rapid or shallow breathing.

Wheezing. This might be the first time that your child has wheezing. In bronchiolitis, this follows 3 days or so of the first three symptoms.

Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by 2 years of age. Outbreaks of RSV infection occur every winter, and individuals can be reinfected, as previous infection does not appear to cause lasting immunity.

a virus, for example, a cold or flu virus.

a bacterial infection.

exposure to substances that irritate the lungs, such as tobacco smoke, dust, fumes, vapors, and air pollution.

Premature birth.

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.

Complications of severe bronchiolitis may include: Blue lips or skin (cyanosis), caused by lack of oxygen. Pauses in breathing (apnea), which is most likely to occur in premature babies and in babies within the first two months of life. Dehydration.

Bronchiectasis complications include pneumonia, lung abscess, empyema, septicemia, cor pulmonale, respiratory failure, secondary amyloidosis with nephrotic syndrome, and recurrent pleurisy

Can bronchiolitis be prevented? Bronchiolitis can be spread by small children through close contact, saliva and mucus. The best way to prevent infection is to avoid others who are sick, and practice good hand washing. Until your child is better, keep him or her home from daycare and be sure to wash toys between uses.

wash or wipe down toys and clean surfaces regularly. use disposable tissues and throw them away as soon as you've used them. keep newborn babies away from anyone with a cold or the flu – especially if they're under 2 months old or were premature