Bronchiolitis is the inflammation of the bronchioles caused by an acute viral infection. It is the most common lower respiratory infection in infants and young children.
Inflammation of the bronchioles causes swelling, irritation and accumulation of mucus in the small airways of the lungs. Obstruction of airways leads to overinflation in some alveoli which can complicate to lung atelectasis.
Risk Factors
- Prematurity – underdeveloped lungs and less surfactant production
- Pre-existing lung or heart conditions
- Immunosuppression – inability to fight infections
- Contact with other infected children
Clinical Manifestations
- Palour of the mucus membranes, lips and nail beds
- Harsh, dry cough
- Refusal to feed
- Tachypnea
- Respiratory distress with apnea
- Nasal flaring and congestion
Investigations
- History taking and physical examination — assessments for hyperthermia, wheezing, tachycardia, cyanosis and tachypnea. Wheezing and crackles on auscultation.
- Chest X-ray: to rule out pneumonia
- Pulse oximetry: to establish oxygen saturation in the body
- Blood tests: to check WBC count
- Nasopharyngeal swab: mucus sample is tested to establish the causative agent.
Differential Diagnosis
- Asthma
- Congenital heart conditions
- Gastroesophageal reflux
- Cystic fibrosis
Management
Treatment of bronchiolitis requires supportive management that can be done at home through
- High humidification of air through steaming
- Ensure the child gets enough rest
- Adequate fluid administration
- Prescription of antivirals, i.e. Ribavirin
In severe cases, hospitalization is required through the following indications
- Accelerating to respiratory distress
- Apnea by history
- Hypoxemia and cyanosis
- Underlying cardiac and immunocompromising conditions
Prevention
- Continuous and thorough respiratory assessment
- Keep children away from ill individuals
- Avoid exposure to tobacco smoke
- Practicing proper handwashing
Complications
- Acute Respiratory Distress Syndrome
- Congestive Heart Failure
- Myocarditis
- Chronic lung disease
Written by Angela David
