Bronchiolitis

By Roland Larrabee, M.D.

Bronchiolitis is a specific kind of lung infection caused by a virus. The average age of children who get bronchiolitis is 6 months. They are almost never older than 2 years.

The symptoms of bronchiolitis include:

• wheezing (making a high-pitched whistling sound when breathing out)
• breathing rapidly at a rate of over 40 breaths per minute
• tight breathing (having to push the air out)
• coughing (may cough up very sticky mucus)
• fever and a runny nose that precede the breathing problems and cough.

The symptoms are similar to asthma. The wheezing is caused by a narrowing of the smallest airways in the lung (bronchioles). This narrowing results from inflammation (swelling) caused by a virus, usually the respiratory syncytial virus (RSV). RSV occurs in epidemics almost every winter. While infants with RSV develop bronchiolitis, children over age 2 years and adults just develop cold symptoms. We have already begun to see RSV in the local area.

The virus is found in nasal secretions of infected people. It is spread by an infected person who sneezes or coughs less than 6 feet away from someone else or by his or her hands after touching the nose or eyes. People do not develop permanent immunity to the virus, which means that they can be infected by it many times. Because of this lack of immunity, children can become infected more than once in the same cold-season.

Wheezing and tight breathing (difficulty breathing out) become worse for 2 or 3 days and then begin to improve. Overall, the wheezing lasts approximately 7 days and the cough about 14 days (sometimes even longer). The most common complication of bronchiolitis is an ear infection, occurring in about 20% of infants. Bacterial pneumonia is an uncommon complication. Only 1% or 2% of children with bronchiolitis are hospitalized because they need oxygen or intravenous fluids (because of difficulty feeding and drinking).

In the long run, approximately 30% of the children who develop bronchiolitis later develop asthma. Recurrences of wheezing (asthma) occur mainly in children who have close relatives with asthma. Asthma is easily treated with medications. About 1/3 of children with bronchiolitis are helped by asthma-type medicines. Continue the medicine until your child's wheezing is gone for 24 hours. In addition, you can give your child acetaminophen every 4 to 6 hours or ibuprofen every 6 to 8 hours if the fever is over 102°F (39°C).

Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer warm lemonade or apple juice if your child is over 4 months old. In addition, breathing warm, moist air helps to loosen up the sticky mucus that may be choking your child. You can provide warm mist by placing a warm, wet washcloth loosely over your child's nose and mouth. Or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.

Dry air tends to make coughs worse. Use a humidifier in your child's bedroom. If the nose is blocked, your child will not be able to drink from a bottle or to breast-feed. Most stuffy noses are blocked by dry or sticky mucus. Suction alone cannot remove dry secretions.

Warm tap-water or saline nose-drops are better than any medicine you can buy for loosening up mucus. Place three drops of warm water or saline in each nostril. After about one minute, use a soft rubber suction bulb to suck out the mucus. You can repeat this procedure several times until your child's breathing through the nose becomes quiet and easy.

Encourage your child to drink enough fluids. Eating is often tiring, so offer your child formula, breast milk, or regular milk (if he is over 1 year old) in smaller amounts at more frequent intervals. If your child vomits during a coughing spasm, feed him or her again.

Tobacco smoke aggravates coughing. Children who have an RSV infection are much more likely to wheeze if they are exposed to tobacco smoke. Don't let anyone smoke around your child. In fact, try not to let anybody smoke inside your home.

Call your physician immediately if:

• Breathing becomes labored or difficult.
• The wheezing becomes severe (tight).
• Breathing becomes faster than 60 breaths per minute (when your child is not crying).

Call within 24 hours if:

• Any fever lasts more than 3 days.
• The cough lasts more than 3 weeks.
• You have other questions or concerns.