Every winter season, pediatric hospitals witness a surge in cases of bronchiolitis, a viral infection that primarily affects infants and young children. The most common culprit is the Respiratory Syncytial Virus (RSV), a highly contagious virus that causes inflammation of the small airways (bronchioles) in the lungs.
Bronchiolitis often starts as a simple cold but can progress to serious breathing difficulties, especially in infants under 12 months of age. While most children can be managed at home, some may require hospitalization if symptoms become severe.
What is Bronchiolitis?
Bronchiolitis is an acute viral infection that leads to inflammation and congestion in the bronchioles, the smallest branches of the lung’s airway system. As these airways swell and fill with mucus, airflow becomes restricted, making it difficult for the child to breathe.
Key Facts:
- Most often caused by Respiratory Syncytial Virus (RSV).
- Common in infants and young children under 2 years, especially those 3–6 months old.
- Highly contagious, spreading through droplets from coughing, sneezing, or direct contact with contaminated surfaces.
- Typically seasonal, peaking in late fall and winter.
Causes of Bronchiolitis
The leading cause is Respiratory Syncytial Virus (RSV), but other viruses such as rhinovirus, influenza, parainfluenza, and adenovirus may also be responsible.
How it Spreads
- Droplet transmission: Coughing and sneezing.
- Direct contact: Touching contaminated surfaces (toys, clothing, hands).
- Close contact: Particularly in daycares, nurseries, or crowded households.
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Pathophysiology
1. RSV infects the upper respiratory tract (nose, throat).- Airway narrowing.
- Air trapping and difficulty exhaling.
- Impaired gas exchange, leading to low oxygen (hypoxemia).
Signs and Symptoms of Bronchiolitis
Early (Initial) Symptoms
- Nasal congestion
- Runny nose
- Mild cough
- Sneezing
- Fever (may be present)
Continued (Progressive) Symptoms
- Tachypnea (rapid breathing)
- Worsening cough
- Wheezing (whistling sound while breathing)
Severe or Emergent Symptoms
- Grunting (a sign of struggling to breathe)
- Nasal flaring (widening of nostrils)
- Cyanosis (bluish skin/lips due to lack of oxygen)
- Hypoxia (low oxygen levels)
- Apnea (pauses in breathing)
- Respiratory failure in critical cases
Risk Factors
Certain infants and children are at higher risk of severe bronchiolitis:
- Age less than 6 months.
- Premature infants.
- Infants with congenital heart disease or chronic lung disease.
- Immunocompromised children.
- Exposure to secondhand smoke.
- Crowded living conditions or daycare attendance.
Treatment of Bronchiolitis
General Principles
- Bronchiolitis is usually a self-limiting illness, meaning it resolves on its own.
- Supportive care is the mainstay of treatment.
Airway Maintenance
- Oxygen therapy: For children with hypoxia (low oxygen saturation).
- Suctioning: Using saline nose drops followed by gentle suction with a bulb syringe to clear mucus before feeding or sleep.
- Positioning: Keep the child at a 30–40° angle to ease breathing.
Hydration
- Encourage oral fluids to prevent dehydration.
- If unable to drink, provide IV fluids in hospital.
Hospitalization
Indicated if:
- Child shows severe breathing difficulty.
- Oxygen saturation is persistently low.
- Episodes of apnea occur.
- Feeding is inadequate due to respiratory distress.
Medications
- Antibiotics are NOT recommended since bronchiolitis is viral.
- Bronchodilators, steroids, or antivirals are not routinely used except in special cases.
Prevention of Bronchiolitis
1. Hand hygiene: Frequent handwashing for caregivers and siblings.Home Care Tips for Parents
- Keep the child hydrated with small, frequent feeds.
- Use saline drops and suction to clear nasal passages.
- Monitor breathing—look for chest retractions, fast breathing, or bluish lips.
- Do not give over-the-counter cough/cold medicines to infants.
- Keep the room air moist with a humidifier.
- Seek immediate medical attention if symptoms worsen.
Prognosis
- Most children recover fully within 1–2 weeks.
- Some may develop recurrent wheezing or asthma-like symptoms later in childhood.
- Severe cases can lead to hospitalization or ICU care, especially in high-risk infants.
Comparison: Bronchiolitis vs. Other Childhood Respiratory Illnesses
| Feature | Bronchiolitis (RSV) | Pneumonia | Asthma | Common Cold |
|---|---|---|---|---|
| Cause | Viral (RSV) | Viral or bacterial | Chronic inflammatory condition | Viral |
| Age group | Infants < 2 yrs | All ages | School-age children, adolescents | All ages |
| Symptoms onset | Cold-like, then wheezing | Fever, cough, chest pain | Wheezing, recurrent | Sneezing, runny nose |
| Treatment | Supportive care | Antibiotics (if bacterial) | Inhalers, steroids | Supportive |
| Contagious | Highly contagious | Variable | Not contagious | Highly contagious |
Frequently Asked Questions (FAQ)
Q1. Is bronchiolitis the same as bronchitis?
No. Bronchiolitis affects small airways (bronchioles) in infants, while bronchitis affects larger airways (bronchi) in older children and adults.
Q2. Can bronchiolitis be treated at home?
Yes, most children with mild symptoms can be managed at home with hydration, suctioning, and monitoring. Severe cases need hospitalization.
Q3. How long does bronchiolitis last?
Symptoms usually last 7–14 days, though cough may persist longer.
Q4. Is RSV dangerous for all children?
Most children recover well, but premature infants and those with chronic conditions are at higher risk of severe complications.
Q5. Can bronchiolitis lead to asthma?
Children who have had severe RSV bronchiolitis may develop recurrent wheezing or asthma-like symptoms later in life.
