Bronchiolitis
Bronchiolitis is inflammation of the small airways in the lungs. Acute bronchiolitis is due to a viral infection usually affecting children younger than two years of age. Symptoms may include fever, cough, runny nose, wheezing, and breathing problems. More severe cases may be associated with nasal flaring, grunting, or the skin between the ribs pulling in with breathing. If the child has not been able to feed properly, signs of dehydration may be present.
| Bronchiolitis | |
|---|---|
| An X-ray of a child with RSV showing the typical bilateral perihilar fullness of bronchiolitis. | |
| Specialty | Emergency medicine, pediatrics |
| Symptoms | Fever, cough, runny nose, wheezing, breathing problems |
| Complications | Shortness of breath, dehydration |
| Usual onset | Less than 2 years old |
| Causes | Viral disease (respiratory syncytial virus, human rhinovirus) |
| Diagnostic method | Based on symptoms |
| Differential diagnosis | Asthma, pneumonia, heart failure, allergic reaction, cystic fibrosis |
| Treatment | Symptomatic treatment (oxygen, support with feeding, intravenous fluids) |
| Frequency | ~20% (children less than 2) |
| Deaths | 1% (among those hospitalized) |
Chronic bronchiolitis is the general term used for small airways disease in adults, notably in chronic obstructive pulmonary disease.
Acute bronchiolitis is usually the result of infection by respiratory syncytial virus (72% of cases) or human rhinovirus (26% of cases). Diagnosis is generally based on symptoms. Tests such as a chest X-ray or viral testing are not routinely needed.
There is no specific treatment. Symptomatic treatment at home is generally sufficient. Occasionally, hospital admission for oxygen, support with feeding, or intravenous fluids is required. Tentative evidence supports nebulized hypertonic saline. Evidence for antibiotics, antivirals, bronchodilators, or nebulized epinephrine is either unclear or not supportive.
About 10% to 30% of children under the age of two years are affected by bronchiolitis at some point in time. It commonly occurs in the winter in the Northern Hemisphere. It is the leading cause of hospitalizations in those less than one year of age in the United States. The risk of death among those who are admitted to hospital is about 1%. Outbreaks of the condition were first described in the 1940s.