What is Acute Bronchiolitis?
Acute bronchiolitis is a common respiratory tract infection involving the smallest breathing tubes in the lungs called the bronchioles.
How common is Acute Bronchiolitis?
Children under 2 years are especially prone to bronchiolitis. It is most common in males between 2 and 6 months old and in children who have not been breastfed. Please discuss with your doctor for further information.
What are the symptoms of Acute Bronchiolitis?
The disease starts out as an upper respiratory infection (URI) such as a common cold. The child will have a runny, stuffy nose and sneezing, but then, after a few days, fever and a harsh, tight cough appear.
The child will develop rapid breathing, and may use extra breathing muscles, especially in the neck, between the ribs and below the rib cage. The child will usually have difficulty with breathing out (exhalation) and wheezing may occur.
Very young children who develop bronchiolitis may have problems sleeping and eating. Large amounts of thick secretions in the airway may lead to vomiting or mucous in the stool.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
You should contact your doctor if you have any of the following:
- Audible wheezing sounds
- Breathing very fast — more than 60 breaths a minute (tachypnea) — and shallowly
- Labored breathing — the ribs seem to suck inward when infant inhales
- Sluggish or lethargic appearance
- Refusal to drink enough, or breathing too fast to eat or drink
- Skin turning blue, especially the lips and fingernails (cyanosis)
If it’s difficult to get your child to eat or drink and his or her breathing becomes more rapid or labored, call your child’s doctor. This is especially important if your child is younger than 12 weeks old or has other risk factors for bronchiolitis — including premature birth or a heart or lung condition.
What causes Acute Bronchiolitis?
A virus usually causes the illness. Respiratory syncytial virus (RSV) is most common, but parainfluenza virus and adenovirus can also do it.
The viruses are spread from person to person by sneezing and coughing, and by direct hand-to-hand contact.
What increases my risk for Acute Bronchiolitis?
There are many risk factors for Acute Bronchiolitis, such as:
- Male gender,
- A history of prematurity,
- Young age,
- Being born in relation to the RSV season,
- Pre-existing disease such as bronchopulmonary dysplasia,
- Underlying chronic lung disease, neuromuscular disease, congenital heart disease,
- Exposure to environmental tobacco smoke,
- High parity,
- Young maternal age,
- Short duration/no breastfeeding,
- Maternal asthma
- Poor socioeconomic factors.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is Acute Bronchiolitis diagnosed?
The diagnosis of bronchiolitis is based on clinical presentation, the patient’s age, seasonal occurrence, and findings from the physical examination, which may reveal the following:
- Fever (38-39°C)
- Fine rales (47%); diffuse, fine wheezing
- Otitis media
When the clinical presentation, patient’s age, seasonal occurrence, and findings from the physical examination are consistent with the expected diagnosis of bronchiolitis, few laboratory studies are necessary. Diagnostic testing is controversial but is typically used to exclude other diagnoses (eg, bacterial pneumonia, sepsis, or congestive heart failure) or to confirm a viral etiology and determine required infection control for patients admitted to the hospital.
Commonly used tests in the evaluation of patients with bronchiolitis include the following:
- Rapid viral antigen or nucleic acid amplification testing of nasopharyngeal secretions for respiratory syncytial virus
- Arterial blood gas analysis
- White blood cell count with differential
- C-reactive protein level
- Pulse oximetry
- Blood cultures
- Urine analysis, specific gravity, and culture
- Cerebrospinal fluid analysis and culture
- Serum chemistries
Electrocardiography or echocardiography should be reserved for those few children who display arrhythmias or cardiomegaly.
Chest radiographs are not routinely necessary. A practical approach is to obtain a chest radiograph in children who appear ill, are experiencing clinical deterioration, or are at high risk (eg, those with underlying cardiac or pulmonary disease).
This imaging modality is most useful in excluding unexpected congenital anomalies or other conditions; it may also yield evidence of alternative diagnoses (eg, lobar pneumonia, congestive heart failure, or foreign body aspiration).
In rare situations (eg, severe immunodeficiency, strong history of possible foreign body aspiration), bronchoscopy may be indicated for diagnostic bronchoalveolar lavage or therapeutic foreign body removal.
How is Acute Bronchiolitis treated?
Among numerous medications and interventions used to treat bronchiolitis, thus far, only oxygen appreciably improves the condition of young children.  Therefore, therapy is directed toward symptomatic relief and maintenance of hydration and oxygenation.
Supportive care for patients with bronchiolitis may include the following:
- Supplemental humidified oxygen
- Maintenance of hydration
- Mechanical ventilation
- Nasal and oral suctioning
- Apnea and cardiorespiratory monitoring
- Temperature regulation in small infants
Medications have a limited role in the treatment of bronchiolitis. Otherwise-healthy children with bronchiolitis usually have limited disease and do well with supportive care only.
The following medications are used in selected patients with bronchiolitis:
- Alpha/beta agonists (eg, albuterol, racemic epinephrine)
- Monoclonal antibodies (eg, palivizumab)
- Antibiotics (eg, ampicillin, cefotaxime, ceftriaxone)
- Antiviral agents (eg, ribavirin)
- Intranasal decongestants (eg, oxymetazoline)
- Corticosteroids (eg, dexamethasone, prednisone, methylprednisolone)
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage Acute Bronchiolitis?
The following lifestyles and home remedies might help you cope with Acute Bronchiolitis:
- Limit contact with people who have a fever or cold. If your child is a newborn, especially a premature newborn, avoid exposure to people with colds in the first two months of life.
- Clean and disinfect surfaces. Clean and disinfect surfaces and objects that people frequently touch, such as toys and doorknobs. This is especially important if a family member is sick.
- Cover coughs and sneezes. Cover your mouth and nose with a tissue. Then throw away the tissue and wash your hands or use alcohol hand sanitizer.
- Use your own drinking glass. Don’t share glasses with others, especially if someone in your family is ill.
- Wash hands often. Frequently wash your own hands and those of your child. Keep an alcohol-based hand sanitizer handy for yourself and your child when you’re away from home.
- Breast-feed. Respiratory infections are significantly less common in breast-fed babies.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
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Acute bronchiolitis in infants, a review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230018/. Accessed May 8, 2018.
Acute bronchiolitis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078613/. Accessed May 8, 2018.
Bronchiolitis. https://emedicine.medscape.com/article/961963-overview. Accessed May 8, 2018.
Bronchitis. https://www.parents.com/health/cough/bronchitis/. Accessed May 8, 2018.
Review Date: May 10, 2018 | Last Modified: May 10, 2018