bronchiolitis

Summary about bronchiolitis

Bronchiolitis is a viral disease that usually affects children (in particular younger than 2 years and babies between 3 and 6 months old). It can be caused by a variety of viruses, such as adenovirus, human metapneumovirus, or influenza virus.
An adult with a cold can transmit the disease to children and cause bronchiolitis. Exposure to cigarette smoke can also be harmful. Usually transmission of the virus occurs through sneezing, coughing, secretions and contaminated objects.

Symptoms are usually rhinitis accompanied by a dry cough. In some severe cases, the child may have shortness of breath and wheezing. The diagnosis is usually made by looking for the virus in the nasal and throat mucous membranes. X-rays and blood tests may also be used.

Bronchiolitis should be treated as an emergency if it occurs in infants, and in many cases hospitalization is required. Treatment is usually done with washing the nostrils with saline solution and, when necessary, chest physiotherapy.

Some tips to avoid bronchiolitis include always washing your hands before touching a child, not exposing babies to cigarette smoke or very crowded environments, always cleaning the objects that children use most and constantly hydrating the child, especially in winter.

Definition

Bronchiolitis (or infantile bronchiolitis) is a viral illness usually caused by the Respiratory Syncytial Virus or RSV. It is a form of bronchitis that mainly affects children under 2 years of age, in particular babies between 3 and 6 months.
It is an inflammation of the bronchioles, which prevents air from circulating freely in the lung.
Bronchiolitis is an infection that mostly affects babies and young children, especially in winter. The epidemic period in Europe takes place between December and January and can last until February in the United States.

As babies’ bronchioles are tiny, only a small amount of secretion is enough to obstruct them.

Bronchiolitis is transmitted by sneezing, saliva, coughing and especially by dirty hands. It is a mild disease, but it requires hospitalization in cases of complications.

What is the difference between bronchiolitis and bronchitis?
Bronchiolitis is an inflammation of the small branches of the respiratory tract that mainly affects babies and young children. Bronchitis
is an inflammation of the (large) airways that affects older children and adults.

Epidemiology

– In the United States, up to 500 children die each year from bronchiolitis caused by respiratory syncytial virus (RSV)1 . Each year in the United States, RSV leads to approximately 58,000 hospitalizations of children under age 5 and approximately 177,000 hospitalizations of adults age 65 and older.2.

Causes

Respiratory Syncytial Virus (RSV) is the main cause of bronchiolitis. But other viruses can also cause such as adenovirus, rhinovirus , influenza virus or MPVH (human metapneumovirus).
An adult with a cold can cause bronchiolitis in children.
Sensitive children, like premature ones, are the most vulnerable.
Passive smoking is also a risk factor. Recurrence of bronchiolitis is often due to prolonged contact with other sick children.

Most often, the mother infects her baby during a cold . The virus that causes bronchiolitis is very contagious and spreads very often between babies in day care centers or shelters.

It is transmitted by coughing or secretions, but also contaminated objects such as bottles or other utensils. This virus can survive for several hours on contaminated objects or on hands.

Symptoms

Bronchiolitis is characterized by rhinitis accompanied by a dry cough due to inflammation of the trachea, bronchi and nasal obstruction. The child may also have a fever .
The illness is most often accompanied by expectoration, and the child may breathe rapidly and with a hissing or wheezing in severe cases. The child may have nasopharyngitis from 24 to 72 hours before showing clinical signs of bronchiolitis. The virus can incubate for 2 to 8 days and grows in the nasal mucosa before clogging the airways. It clears after 3 to 7 days, but can still continue to infect for up to 4 weeks.

Duration of symptoms:
Bronchiolitis usually lasts for 2 to 3 weeks and most often resolves on its own, as reported by the Mayo Clinic in December 2018 in an article on its website.

Diagnosis

The diagnosis of syncytial virus is made by a simple removal of part of the mucous membrane of the nose and throat and the ELISA test is done.

A blood sample may also be needed if the child has signs of acute bronchiolitis. This test measures the oxygen saturation in the blood.
Lung field opacity, characterized by increased size of intercostal spaces and diaphragmatic reduction, is detected by chest X-ray. These are the biggest indicative signs of the disease.

Complications

When bronchiolitis in infants is considered acute, hospitalization is required. Babies under 6 months of age are particularly at risk of complications.

In this case, the criteria taken into account are a very rapid deterioration in the patient’s health, apnea or cyanosis (for example, blue lips) with repetition or breathing disorders, young age, dehydration, severe chronic heart disease and digestive disorders.

Treatments

Care in bronchiolitis varies according to symptoms. However, there is no treatment for the cause (virus). Unless there are complications or in exceptional cases, antibiotics are useless as this is a viral infection. Remember that antibiotics only work on bacterial infections.

The French High Health Authority ( Haute Autorité de Santé  – HAS) estimated in a November 2019 press release that drug treatment (eg bronchodilators) has little place in the treatment of acute bronchiolitis. In general, HAS recommends a treatment based on “regular nose washing and monitoring for signs of worsening”.

Taking effective actions may be enough. Clearing and cleaning the respiratory system is essential. This is done by injecting saline into each nostril. The child should be laid on his back and his head turned to one side. The use of a nasal sucker is not always very effective, even if it is sometimes possible to suck out nasal secretions, especially after applying saline solution.
Parents must make sure to hydrate the baby, ensure him a normal diet and provide him with a healthy environment.
If breathing difficulties persist or the onset of vomiting and diarrhea and behavioral changes, parents should make an appointment with a pediatrician. He may prescribe a bronchodilator, antibiotic, corticosteroid or antiviral, depending on the severity of bronchiolitis.

For fever, the doctor may prescribe paracetamol with the dose depending on the weight of the baby or child

In case of hospitalization, oxygen may be administered.

Time for healing
In general, bronchiolitis is cured in a few days.

No vaccine (so far) 
In April 2022 (updated date of this article), there was no vaccine against the main virus, respiratory syncytial virus (RSV), which causes bronchiolitis. All attempts to create an effective vaccine against RSV have failed due to a weak immune response[efn note]Revista Superinteressante, August 2020 issue[/efn_note]. That said, in 2022 several pharmaceutical companies (Pfizer, Moderna or J&J) were conducting large-scale clinical trials with RSV vaccines, according to the Wall Street Journal of April 15, 2022. It is possible that the vaccines will be available in the end of 2022, again according to the WSJ.

Tips

– Give the child enough fluids and ventilate the room (optimal temperature above 19°C).

– Advise the child to sleep on their stomach and increase their pillow (about 30°).

– Frequently wash the nostrils with saline solution to clear the nasal cavity (for saline solution use ½ teaspoon of salt dissolved in 240ml of cooled boiled water).

– Seek the advice of a pediatrician before administering medication such as cough syrup.

– Wash your hands with soap and water (at least 30 seconds) before caring for your baby.

– Avoid exposing your baby to cigarette smoke.

– Avoid taking babies in crowded places as much as possible, such as public transport and hospitals.

– Frequently disinfect objects that children use most, such as toys.

– Avoid kissing a child if you have symptoms of a cold or if you are sick.

– Divide the amount of milk given to the child into several small doses.

– The first 48 hours of symptoms are very important and crucial. As noted by the French High Authority for Health ( Haute Autorité de Santé  – HAS) in November 2019, the first 48 hours should be taken into account in relation to the appearance of respiratory symptoms, during which time any baby is likely to get worse.

Sources & References:   
Mayo Clinic, La Tribune de Genève (Tribune of Geneva), Folha de S.Paulo, Haute Autorité de Santé (France) .

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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