Bronchiolitis

Bronchiolitis is an inflammation of the tiny airways called bronchioles. It is a respiratory infection that typically affects very young children and can lead to severe respiratory problems.

Causes

The most common cause of bronchiolitis is a virus by the name of respiratory syncytial virus (RSV). The virus infects the lungs and breathing passages. Most recover within one to two weeks. RSV can, however, cause severe respiratory problems in certain groups including newborns, young children and the elderly.

The RSV responsible for bronchiolitis is highly contagious and spreads swiftly through direct contact with the eyes, nose or mouth and via a person's hands after they have touched contaminated objects. The germs associated with this infection generally cause outbreaks that last from late fall to early spring.

Other viruses, such as the flu virus, can also cause bronchiolitis.

Persons at risk

RSV bronchiolitis typically affects young children. In fact, by the time they have reached the age of two years, most children have already been exposed to RSV. Some children are more predisposed to developing bronchiolitis:

• Those born prematurely
• Those with a family history of bronchial asthma
• Those with congenital heart disease
• Those with abnormal lung development
• Those with cystic fibrosis
• Those exposed to secondhand smoke
• Those who are in daycare
• Those who live in low income areas
• Those who live in crowded conditions

The elderly and adults with heart or lung problems or weakened immune systems are at risk of developing RSV-related diseases including bronchiolitis.

Smoking also increases the risk of developing bronchiolitis.

Symptoms

The symptoms of RSV are similar to those of the common cold. These include nasal congestion, runny rose, cough, sore throat, low-grade fever and otitis. These symptoms are not serious and should disappear within two weeks.

When a RSV infection worsens and develops into bronchiolitis, symptoms in children include:

• Rapid breathing
• Retraction of the chest muscles
• Rapid heartbeat
• Dry cough that becomes productive (produces phlegm)
• Wheezing
• Bluish nails and lips
• Unusual agitation
• Refusal to eat or drink

If your child presents any of these symptoms, see your doctor.

Diagnosis

Diagnosis is usually based on the observation of symptoms. In rare cases, the doctor may request a chest x-ray. Blood tests may be used to determine the level of oxygen in the bloodstream. A nasal mucus sample may be taken to establish whether the RSV is indeed responsible for the bronchiolitis.

Treatment

Infected children should rest for the first 48 to 72 hours. Contact with others should be kept to a minimum to avoid further contamination.

To ease breathing, a bronchodilator (inhaled medication that opens the airway) may be prescribed. Clearing the nasal passages with a saline solution (Salinex®) or nasal aspirator can also provide some relief. Fever can be treated with acetaminophen. If there is a secondary bacterial infection such as otitis or pneumonia, an antibiotic may be prescribed. On occasion, respiratory physiotherapy treatments are also recommended.

In more severe cases, the child will be hospitalized and will receive supplementary oxygen.

Prevention

Frequent hand washing is the best prevention against RSV. Hand hygiene is even more important in areas heavily frequented by young children such as daycare centres and preschools. Providing a healthy, smoke-free environment and breastfeeding infants will also help prevent RSV.

For more information:

Canadian Lung Association

www.lung.ca