Symptoms and Diagnosis of Bronchiolitis in Children

Bronchiolitis is a common childhood illness. The term bronchiolitis refers to wheezing and airway obstruction that results from a viral (rarely bacterial) infection of the lower respiratory tract. Bronchiolitis is most common before 2 years of age and peaks at 2 to 6 months of life. A child may have 1 to 2 days of viral cold symptoms such as a runny nose and sneezing, which quickly turns into wheezing, coughing, and increased work at breathing.

In previously healthy children, bronchiolitis is usually a self-limited disease. This means that medical intervention is required only in the form of supportive measures to ensure that the child remains well-hydrated and well-oxygenated. Examples of common supportive treatment includes hydration with frequent sips of Pedialyte and suctioning of nasal congestion with a suction bulb.

Unfortunately, some kids with bronchiolitis require hospitalization. This is required in children that appear very ill, dehydrated and/or lethargic, or have poor feeding, nasal flaring, intercostal retractions, a respiratory rate of greater than 70 breaths per minute, cyanosis, apnea and/or hypoxemia (oxygen saturation <95% on room air).

Supportive measures that are provided during hospitalization include the administration of fluid, oxygen, and nasal suctioning as needed. Chest physiotherapy is not used in the treatment of bronchiolitis as several studies have shown that there is no improvement in outcomes, but rather an increase in the distress and irritability of the child.

Pharmacologic therapy for bronchiolitis must be tailored to the individual patient. Infants or older children who have chronic lung disease, a history of wheezing, or have been previously hospitalized for severe bronchiolitis may have an asthmatic component to their illness. These children with bronchiolitis will benefit from the use of inhaled bronchodilators and systemic glucocorticoids. Of note, oral (rather than inhaled) bronchodilators and inhaled (rather than oral) glucocorticoids have not been shown to be effective in the treatment of bronchiolitis.

Respiratory syncitial virus, "RSV", is the most common virus that causes bronchiolitis. However, Ribavirin, a drug which has good in vitro activity against RSV, is not routinely used in the treatment of bronchiolitis. Efficacy data is unclear and the high cost of Ribavirin is prohibitive. Even so, Ribavirin may find some use in children with confirmed RSV bronchiolitis who are at great risk for severe disease due to immunocompromise or significant comorbid illnesses.

In previously healthy infants who are older than 6 months and require hospitalization, the average length of stay is three days. However, severe wheezing persists in some infants for a week or longer. This is particularly true in younger infants and those with comorbid conditions such as the chronic lung disease of premature infants.

Whether managed at home or in the hospital, most children younger than 24 months will have resolution of bronchiolitic symptoms by 12 days. However, 10% of children may still have symptoms of wheezing or cough as long as 4 weeks after onset. While bronchiolitis does not cause a child to develop asthma, there does seem to be an association between these two conditions. Therefore, it is important that an episode of bronchiolitis is documented in any child's medical history.