Overview

What is bronchiolitis?

Bronchiolitis is a viral infection that causes the airways (bronchioles) in the lungs to become narrow, which makes breathing difficult. It occurs most often in children under age 2 during winter and early spring. Very rarely, adults can get bronchiolitis.

For instance, there is a condition called bronchiolitis obliterans, which is sometimes known as “popcorn lung.” This condition is usually caused by breathing in irritating chemicals or other substances.

What’s the difference between bronchiolitis and bronchitis?

These two conditions not only sound similar, but they are similar in some ways. Both can be caused by a virus. Both affect the airways in the lungs, but bronchitis affects the larger airways (the bronchi). Bronchiolitis affects the smaller airways (bronchioles). Bronchitis usually affects older children and adults, while bronchiolitis is more common in younger children.

Symptoms and Causes

What causes bronchiolitis?

The viruses that cause most cases of bronchiolitis are the respiratory syncytial virus (RSV), the rhinovirus and the influenza (flu) virus. These viruses are very contagious and are spread from person to person by touching secretions from the mouth or nose or by respiratory droplets in the air. The droplets get into the air when someone sneezes or coughs.

What are the signs and symptoms of bronchiolitis?

Signs and symptoms of bronchiolitis resemble those of colds and flu. They include:

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.

Your child might show more severe signs, including:

Making grunting noises.
Having trouble sucking and swallowing, which makes feeding difficult on top of having a poor appetite.
Trying so hard to breathe that their chest retracts (the skin is drawn down tightly against the rib cage and looks like it is going inward).
Turning blue or gray in the lips, fingertips or toes.
Being sluggish.

If you see that these things are happening, call your healthcare provider immediately or take your child to an emergency room. This is also true if your child is showing signs of dehydration, such as dry mouth, not urinating often and crying without producing tears. Dehydration is very serious in a young child.

How can you tell the difference between bronchiolitis and other diseases with the same symptoms?

Bronchiolitis does have symptoms that are similar to other lower respiratory infections like bronchitis and pneumonia. It also may seem like asthma, which is known to cause wheezing and trouble breathing. You might wonder if your child has aspirated (breathed in) something other than air. Any time that you notice that your child has problems breathing, you should call your healthcare provider. They are the ones who will be able to tell one kind of breathing issue from another.

Diagnosis and Tests

How is bronchiolitis diagnosed?

Your provider is probably very familiar with bronchiolitis. They will ask you questions like how long your child has been sick, if your child has a fever, and if your child has been around anyone else who has been sick.

The provider will examine your child and listen to their lungs. A pulse oximeter, an electronic device that can be placed painlessly on fingertips or toes, can find out how much oxygen there is in your child’s blood.

It’s not likely that more tests will be needed. If they are, they might include having a chest X-ray or sending a sample of mucus for testing. Your provider might order a urine test if it seems like your child might have a urinary tract infection.

Management and Treatment

How is bronchiolitis treated?

In most cases, bronchiolitis is not treated. Antibiotics will not help because this is a viral infection. You will be advised to keep your child hydrated as best you can.

Are there drugs to treat bronchiolitis?

Some doctors have used steroids, while others used inhaled bronchodilators to treat bronchiolitis. There is no hard evidence to show that these are useful. However, it is likely that research will continue to find ways to improve treatment. For instance, oxygen therapy is also being studied and is sometimes used.

What are complications related to bronchiolitis?

A common complication of bronchiolitis is an ear infection. Another less common complication is bacterial pneumonia.

A small percentage of children may need oxygen therapy or intravenous (IV) fluids, which would be given in the hospital. Bronchiolitis is the main reason that infants are hospitalized in the U.S., with about 100,000 hospital admissions per year. While bronchiolitis is manageable, it can also be life-threatening in rare cases, such as when it causes respiratory failure.

There are fewer than 100 children per year who die from bronchiolitis in the U.S. Globally, this number is about 200,000 per year.

What can you do at home to help your child with bronchiolitis?

You can try some things that might make your child feel better. These suggestions treat the symptoms, not the disease.

Breathing

For congestion, you can use saline nose drops that your provider or pharmacist recommends to make mucus thinner. If your child is 6 months old or younger, you can get mucus out of your child’s nose with a suction bulb. This involves squeezing the bulb before putting the tip gently into one nostril. When you slowly let go, mucus that is stuck will be drawn out because of the suction.

Your child might have an easier time breathing if they are sitting up. A humidifier will keep the air moist, which could help with breathing and coughing. Keep your child away from any kind of airborne irritant, like cigarette smoke, strong perfumes or strong-smelling cleaners.

Fever

For fever, your child can get the recommended dose of acetaminophen (Tylenol®) for their age, but do not use any other cold treatments or other medications unless your provider tells you to do so. Do not give your child aspirin.

Feeding

Preventing dehydration is a significant part of keeping your child well. Make sure that your child gets enough liquid. They might prefer water or other clear liquids to milk or formula. They might not be hungry. You might find it easier to give smaller amounts of food or liquid at one time but increase the number of times you feed your child.

How long does bronchiolitis last?

The most uncomfortable period of bronchiolitis might last about seven to 10 days. Days three to five are often the worst days. Most children get better in 14 to 21 days if they are not dehydrated.

Can you have bronchiolitis more than once?

If you get bronchiolitis, you do pick up some immunity against RSV and other viruses. However, the immunity is not complete and you can become infected again.

Prevention

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. Do not share cups, forks or spoons.

In some cases, children may be given the RSV antibody palivizumab (Synagis®) to prevent RSV infections. This might happen if your healthcare provider thinks that your child is at a higher risk of having serious complications. Your child might be one of these if they have congenital heart defects or were very premature.

As with any type of medication, you should discuss palivizumab with your doctor so you understand what it is supposed to do, how and how often it is given and what the side effects might be. Also, you might want to check with your insurance provider to check on costs.

Living With

When do I call the doctor about bronchiolitis?

Call the doctor if your child:

Is showing signs of breathing problems (nostrils flaring, squeezing of muscles under rib cage, rapid breathing).
Is showing signs of dehydration (dry mouth, lack of tears when crying, decreased urination).
Is lethargic (sluggish, tired).

Don’t be afraid to call your healthcare provider if your child doesn’t seem to be getting better or if you are worried about something and want answers.

Questions to ask your child's doctor about bronchiolitis:

Should I give my child medication? If so, for how long and at what times of the day?
How should I store the medication? Should I refrigerate it?
When will my child start to feel better?
Will I need to bring my child back for a follow-up visit?
Should I keep my child home from school or daycare?
Should he or she be limited from certain activities? If so, which ones?
Are there certain foods or liquids he or she should have or avoid?
Which over-the-counter pain relievers do you recommend?
Which over-the-counter medications/preparations do you not recommend?
Which symptoms should I report to you/your office?

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Bronchiolitis