3855 Trueman Court | Hilliard, Ohio | 43026
Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD
Bronchiolitis is a viral respiratory illness, usually caused by respiratory syncytial virus (RSV). Bronchiolitis is characterized by runny nose, nasal congestion, moist cough, and wheezing. The wheezing often sounds like a high-pitched whistling sound when the child breathes out. Although it can occur year-round, it is much more common during the winter and early spring. The virus infects and inflames the upper and lower respiratory tracts, causing the smallest airways to narrow. This causes the air to then make the whistling sound (wheezing). Bronchiolitis is most common in infants and young children. Bronchiolitis is very different from bronchitis in adults.
Bronchiolitis begins a few days to a week after exposure to the virus. Bronchiolitis is very contagious. Mild cold or cough symptoms without wheezing occur in many persons, therefore, many children with bronchiolitis were not exposed to someone else with the same symptoms. Infants with RSV typically develop bronchiolitis, while anyone over 2 years of age usually just has cold symptoms. Bronchiolitis is usually worse for boys, formula-fed infants, infants born prematurely, infants born with heart problems, and infants exposed to cigarette smoke.
Bronchiolitis usually begins with mild cold symptoms of runny nose and congestion. A decreased appetite and a fever are often present. The fever is typically 100.5 to 102 degrees, but may be much higher. Children with mild cases of bronchiolitis then develop a wheezy cough and fussiness that gradually resolves over a few days. Severe cases develop over a few hours to a day. These severely affected children often cough at least every one to five minutes, may wheeze so loudly it can be heard without a stethoscope, and have signs that their body is having to do extra work to breathe: the muscles at their ribs may "suck in" when they breathe in ("retractions"), how many breaths they take each minute may increase to 50-60 or more, and their nostrils (two holes in our nose) may flare out when they breathe. The cough of bronchiolitis often sounds "mucousy" (as if there is a rattle of phlegm to the breathing or cough) because this viral infection causes increased mucous production by the child's respiratory tract. Although the coughs can sound similar, we treat this differently than bronchitis in teenagers and adults. The congestion, cough, and wheezing of bronchiolitis is often worse at night or with increased activity. Some children with bronchiolitis will develop an ear infection. A number of children will also vomit from a vigorous bout of coughing.
Although some children will have bronchiolitis once, it is quite possible to have bronchiolitis more than once (even during the same cold weather season). Infants born prematurely, infants with a family history of asthma and/or allergy, infants with a number of older brothers and sisters, infants exposed to second hand smoke, and infants in large daycare settings seem to be the children at most risk for having bronchiolitis more than once. About 1 in 4 of children with bronchiolitis will go on to have recurrent wheezing and be diagnosed with asthma. This also means, however, that many children (even with a family history for asthma/wheezing) will not develop asthma after this first episode of bronchiolitis. There is no test available that lets us know which children will go on to have recurrent wheezing and asthma. Only 1 in 100 children with bronchiolitis require a stay in the hospital. These are usually only those infants with dramatic labored breathing that does not respond to treatment in the office or at home.
Because bronchiolitis is spread so easily through casual contact with the virus, it is difficult to prevent. The virus can spread to another person through sneezing or coughing. It can also be picked-up from toys, cups, door-handles, and other objects recently in contact with someone with the virus. Frequent hand washing for older children and adults is important during the cold and flu season. For most children in daycare, they will be repeatedly exposed to this virus during the cold weather season.
Infants should be kept home from daycare during days in which they have a fever, are coughing frequently, or show signs of more labored breathing (breathing 50-60 or more times a minute, having retractions or nasal flaring as discussed above).
Some infants born prematurely are eligible for a monthly injection during their first cold weather season to prevent worse cases of RSV bronchiolitis. If your child was born prematurely, discuss this with your doctor.
Bronchiolitis will generally run its course without special treatment. However, for more severely affected infants, there are treatments available. Because bronchiolitis is caused by RSV and other viruses, antibiotics will not affect bronchiolitis.
Some children with bronchiolitis have their cough and wheezing improve while taking prescription medicines usually given to those children or adults with asthma. The RSV virus and asthma both cause the lung's air passages to narrow and for inflammation to cause mucous and swelling in the air passages. Therefore, it makes sense that some children will improve with asthma medicines aimed at fighting the narrowing and inflammation. Unfortunately, it is impossible to predict which child will improve with these medicines, which child will have no effect from these medicines, and which child will have side effects while on these medicines. To help you better understand them, here is more information about the two medicines we commonly use:
ALBUTEROL - also called Ventolin or Proventil
PREDNISOLONE - usually called Orapred, Prelone, or Pediapred