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Bronchiolitis

Respiratory MedicinePaediatrics

Bronchiolitis is a common lower respiratory tract illness in infants and young children, characterized by inflammation and narrowing of the small airways, leading to symptoms such as wheezing, increased mucus production, fever, cough, runny nose, and sometimes vomiting or diarrhoea. Due to its similarity to the common cold, parents often confuse bronchiolitis with a cold.

Bronchiolitis primarily affects infants and young children under two, with a peak incidence of around six months. It is most common in winter and spring and is the leading cause of hospitalization in infants. It is a viral illness, with over 50% of cases caused by respiratory syncytial virus (RSV) infection. The source of viral respiratory infections in infants and young children is often parents and family members; transmission primarily occurs through respiratory droplets. Therefore, parents or family members with cold or cough symptoms should avoid close contact with infants and young children as much as possible and should try to avoid taking infants and young children to public places to reduce the risk of transmission.

Symptoms of bronchiolitis typically appear within one to three days after infection and may last for several weeks.

Early symptoms:

Flu-like symptoms include nasal congestion, runny nose, cough, sneezing, and mild fever.
Mild respiratory symptoms: Some patients may experience mild shortness of breath or wheezing.

Progressive symptoms:

Difficulty breathing: Children may experience rapid breathing, difficulty breathing, and shortness of breath.
Wheezing: Wheezing may occur during breathing, especially during exhalation.
Rapid breathing: Respiratory rate may increase beyond the normal range.
Chest retractions: Chest retractions, meaning the chest pulls inward during breathing, may be observed.

Systemic symptoms:

Loss of appetite: Due to difficulty breathing and discomfort, children may have a decreased appetite or refuse to eat.
Fatigue: Difficulty breathing and discomfort may lead to fatigue and restlessness.

It is important to note that the symptoms of bronchiolitis may vary depending on the patient's age, the severity of the condition, and individual differences. Especially for infants and young children who may not express discomfort symptoms clearly, parents should closely observe and seek medical attention promptly to ensure appropriate treatment and care for their infants and young children.

Causes and Factors

Bronchiolitis is typically caused by a viral infection, most commonly by the Respiratory Syncytial Virus (RSV). However, it can also be caused by other respiratory viruses such as adenovirus, influenza, and coronavirus.

Here are the causes and risk factors of bronchiolitis:

Viral Infection: RSV is the most common pathogen causing bronchiolitis, particularly prevalent in winter and early spring.
Contact Transmission: Bronchiolitis usually spreads through contact with respiratory droplets from infected individuals, such as coughing or sneezing.
Age: Infants and young children are most susceptible to RSV infection, especially between 6 months and two years of age.
Environmental Factors: Infants living in crowded environments, with poor hygiene practices or lacking exposure to others, are more prone to RSV infection.
Immune Status: Individuals with compromised immune systems or immunodeficiency conditions, such as premature infants, cardiac patients, immunocompromised individuals, and those with chronic lung diseases, are at higher risk of developing bronchiolitis.
Environmental Factors: Exposure to harmful substances like smoke, air pollution, and chemicals may increase the risk of bronchiolitis infection.

	Bronchiolitis	Cold	Influenza
Symptoms	Severe cough, wheezing, difficulty breathing, rapid breathing, fatigue, pale or bluish skin (signs of oxygen deficiency).	Nasal congestion, runny nose, cough, sore throat, mild headache, fever (usually low-grade).	High fever, severe muscle aches, headache, dry cough, sore throat, fatigue, and severe malaise. Children may also experience vomiting and diarrhoea.
Cause	It is mainly caused by Respiratory Syncytial Virus (RSV) but may also be caused by other viruses such as influenza or adenovirus.	Various viruses, such as coronaviruses, rhinoviruses, influenza viruses, etc, cause it.	There are three types of influenza viruses: A, B, and C. Types A and B are the leading causes of seasonal influenza outbreaks.
Progression	Initially, it may resemble a mild upper respiratory infection but can quickly worsen into severe respiratory distress.	Symptoms typically resolve naturally within about a week.	Symptoms usually worsen rapidly within a few days after onset, but most people recover within a week.
Risk Factors	It mainly affects infants under 2 years old, especially premature infants, children with chronic lung or heart diseases, and children with weakened immune systems.	Anyone can catch a cold, but infants, older people, and those with weakened immune systems may experience more severe symptoms.	Older adults, pregnant women, infants, and those with chronic health problems such as asthma, diabetes, or heart disease are at higher risk.
Severity	There is a higher risk of severe illness, even fatal. It is the most common cause of viral respiratory tract infection, leading to hospitalization in children.	Generally, colds do not cause serious health problems, and most people recover within a week	There is a particular risk of severe illness, even fatal.

Medical history inquiry: The doctor will ask the patient or parents questions about the onset of symptoms, the severity of symptoms, the degree of difficulty breathing, and potential exposure risks.
Physical examination: The doctor will conduct a physical examination of the patient, especially listening to the lungs. In patients with bronchiolitis, increased breath sounds, difficulty breathing, wheezing, and other respiratory symptoms may be heard.
Respiratory function tests: The doctor may perform respiratory function tests, including measuring oxygen saturation and respiratory rate, to assess respiratory function and oxygen levels.
X-ray examination: Sometimes, the doctor may suggest a chest X-ray to rule out other respiratory problems or lung infections.
Virus detection: After diagnosing bronchiolitis, the doctor may further perform virus detection, such as throat swab testing or other methods, to determine the pathogen causing the disease, such as respiratory syncytial virus (RSV).

Treatments

The goal of treating bronchiolitis is to relieve symptoms, ensure adequate oxygen intake for the child, and prevent complications.
Here are some standard treatment methods:

Rest and fluid intake: Ensure the child gets enough rest and ample fluid intake (such as water, soup, and juice) to help keep the airways moist and prevent dehydration.
Maintain indoor air humidity: Using a humidifier can help alleviate airway irritation and assist in clearing secretions.
Fever control and discomfort relief: Use fever-reducing medications the doctor recommends, such as children's paracetamol (acetaminophen), to control fever and alleviate discomfort.
Nasal hygiene: Use saline nasal drops or sprays to help clear the child's nasal passages, allowing smoother breathing.
Inhalation therapy: In some cases, the doctor may recommend using inhaled bronchodilators or steroids to assist in widening the airways and reducing asthma symptoms.
Adequate nutrition: Ensure the child receives sufficient food to support their immune system.
Antibiotic treatment: The doctor may prescribe antibiotics if a bacterial infection causes bronchiolitis. However, most cases of bronchiolitis are caused by viruses, making antibiotics ineffective in such cases.
Hospital monitoring and oxygen therapy: Hospital monitoring and oxygen therapy may be necessary for severe cases with significant breathing difficulties.

Although it is more challenging to prevent bronchiolitis completely, the following measures can be taken to reduce the risk of infection, especially during the peak season of RSV:

Frequent handwashing: Regularly wash hands with soap and water, especially after handling food, using the restroom, blowing the nose, changing diapers, and after contact with sick individuals. Educate children to adopt the same hygiene habits.
Avoiding contact with sick individuals: Minimize infants' exposure to people with colds and flu, especially during the RSV epidemic season. If someone at home is ill, try to reduce their contact with infants as much as possible.
Maintaining cleanliness: Regularly clean and disinfect toys, doorknobs, and other frequently touched surfaces to reduce the spread of viruses.
Avoiding crowded places: During the peak season of RSV, try to avoid taking infants to overcrowded areas such as shopping malls, schools, or public transportation.
Maintaining good air circulation: Keep good air circulation at home to reduce the duration of virus exposure indoors.
Breastfeeding: Research shows that breastfeeding can help strengthen the baby's immune system, reducing the risk of RSV and other respiratory diseases.
Immunization: Ensure that infants receive all recommended vaccinations on time. Although no RSV vaccine is available for infants, vaccination against other respiratory diseases (such as the flu vaccine) can help reduce the risk of severe respiratory illnesses.
Using RSV preventive medication: For infants at extremely high risk (such as highly premature infants or infants with severe cardiopulmonary diseases), doctors may recommend the use of RSV preventive medications, such as Palivizumab.