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Bronchiolitis

Definition


Disease: Bronchiolitis Bronchiolitis
Category: Respiratory diseases
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Disease Definition:

Bronchiolitis, usually caused by a virus, is a common infection of the lungs’ airways. This condition typically occurs during the fall and winter months, and it most frequently occurs in infants between the ages of 3 and 6 months.

Although this condition starts with symptoms that are similar to those of a common cold, it later progresses to wheezing and coughing.

The symptoms of bronchiolitis usually last about a week and then go away, despite the fact that it may be scary, especially for parents. In the meantime, in order to make the child more comfortable, the parent can take a few self-help measures. Sometimes, bronchiolitis could become severe and require hospitalization in case the child has an underlying health problem.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Usually, the signs and symptoms of bronchiolitis are similar to those of a common cold, especially in the first two or three days. These may include:

 

  • Stuffy nose
  • Slight fever (sometimes, it may not occur)
  • Runny nose


In the next two or three days the child will experience:

 

  • Rapid heartbeat
  • Wheezing, because breathing seems more difficult or noisy when breathing out
  • Rapid or difficult breathing


Usually, the infection goes away on its own in 7 to 10 days in case the infant is otherwise healthy. However, the infection could be more severe and the child may need to be hospitalized if:

 

  • The child was born prematurely
  • He/she has underlying health problems, such as a lung or heart condition, or a weakened immune system.


Severe bronchiolitis requires emergency medical care, because it may cause the child to have difficulty breathing, or develop bluish-looking skin (cyanosis), which is a sign that the child isn’t getting enough oxygen.

A parent should contact the doctor in case:

 

  • The child has more than minor breathing problems
  • He/she has other risk factors for bronchiolitis, such as a heart-lung condition, or a premature birth
  • He/she is younger than 12 weeks old.


Parents should seek immediate medical care in case their child experiences any of these signs and symptoms:

 

  • Lethargy
  • Vomiting
  • The need to sit up in order to breathe, or exhaustion from trying to breathe
  • Breathing very shallowly and fast, more than 40 breaths a minute
  • Breathing too fast to eat or drink or refusal to drink enough fluids
  • Turning the skin into blue, particularly around the lips and fingernails (cyanosis).

Causes:

The main airway to the lungs is the windpipe (trachea), which branches off into two main breathing tubes called bronchi, one into the right lung, and one into the left. The bronchi within each lung branch off into smaller and smaller air-tube passageways that distribute air throughout the lungs. Bronchioles are the smallest of these airways.

When a virus enters the respiratory system and makes its way to the bronchioles and causes them to become swollen and inflamed, bronchiolitis occurs, the result of which is the collection of mucus in these airways, making it difficult for air to flow freely through the lungs.

Although the signs and symptoms in older children and adults are generally mild, they are more severe and can result in difficulty breathing in infants, because infants’ bronchioles are much narrower than are adults’ and so more easily blocked.

Most cases of childhood bronchiolitis are due to the common respiratory syncytial virus (RSV). However, the rest of the cases are due to other infectious agents, including viruses that cause the common cold or flu. Multiple infections, such as a combination of RSV and metapneumovirus could cause severe cases of bronchiolitis.

There is no vaccine for bronchiolitis, which is a contagious condition. A person can catch this infectious virus the same way they would catch a cold or the flu; by touching contaminated objects and then touching their eyes or the inside of their nose or mouth, or inhaling airborne droplets of infected mucus or other respiratory secretions.

Complications

Complications:

Some of the complications that are associated with severe bronchiolitits are:

 

  • Dehydration
  • Severe respiratory failure
  • Increasingly labored breathing
  • Fatigue
  • Cyanosis, which is when the skin appears blue or ashen due to lack of oxygen, particularly around the lips and fingernails.


When these occur, a child might need hospitalization. Insertion of a tube into the trachea (intubation) may be required in case of a severe respiratory failure; in order to assist the child’s breathing until the infection can be brought under control. This condition could be fatal if it is left untreated.

Because the infection could rapidly become severe and the signs and symptoms of the underlying condition might become worse, parents should watch their infants closely for beginning signs and symptoms of bronchiolitis, especially if the infant was born prematurely, has a compromised immune system, or has a heart or lung condition. In this case, in order to monitor the child’s health and provide any necessary care, he/she will probably need to be hospitalized.

In some cases, another lung infection, such as bacterial pneumonia, can accompany bronchiolitis, in which case the two diseases are treated separately. Usually, when reinfections with RSV occur after the initial episode, they aren’t as severe. The development of asthma later in life could be preceded with repeated episodes of bronchiolitis. However, the relationship between these two diseases is not clear yet.
 

Treatments:

Most cases of bronchiolitis could be treated at home with self-care steps. The child may be prescribed antibiotics in case he/she has an associated bacterial infection, such as pneumonia. However, antibiotics aren’t effective in treating bronchiolitis, because this condition is caused by viruses, and antibiotics are used to treat infections caused by bacteria.

A bronchodilator could be prescribed in some severe cases, which is a medication that opens up the airways in the lungs, such as albuterol or albuterol inhalers. Although not as effective as desired, but inhaled antiviral drugs could also be used, such as ribavirin.

Staying at the hospital may be necessary in some cases, especially if the child has complications from bronchiolitis. While at the hospital, in order to prevent dehydration, the child will be given fluids intravenously (through a vein) and in order to maintain sufficient oxygen in the blood, the child will receive humidified oxygen.

Prognosis:

Not Available

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