What is it?
Bronchiolitis is an infection of the small airways in children mainly under
two years of age. The walls of these airways become thickened and get filled with mucous, thus limiting airflow and making breathing difficult.
A virus known as the respiratory syncytial virus (RSV) is the single most implicated cause of bronchiolitis.
Bronchiolitis follows a seasonal pattern, with most children getting the infection in the wet season and in the cold-but-dry and dusty harmattan periods.
What are the symptoms?
The typical case is that of an infant or toddler below 2 years of age with an initial common cold during the wet season, frequently with a preceding exposure to an older contact with a vague upper airway illness. This initial phase of clear nasal discharge, nasal congestion, excessive sneezing and cough is associated with a mild fever lasting several days.
Characteristically, the main disease is heralded by sudden onset of wheezy (noisy) breathlessness, periodic or bursting cough, irritability, poor feeding, and (especially in the tropics where malaria may coexist) a worsening of the initial fever.
It is necessary to remember that the physical appearance of the sick child is often more frightening than the usual outcome of the condition. However, you should take your child to the hospital immediately if they:
• Have bluish (or darker than usual) lips or skin
• Breathe fast or have flaring nostrils
• Have bad wheezing or a crackly-sounding chest
• Need to make a big effort to breathe, or stop breathing for a few seconds
• Struggle to feed or drink.
What treatments work?
Treatments for bronchiolitis
For the majority of cases of bronchiolitis, management is essentially supportive. Most children can be looked after at home. If your child is usually healthy, your doctor may just suggest you give them plenty of fluids and let them rest.
In hospitalised children, supportive care involves giving them oxygen, calming down the fever and provision of additional fluid and feeds as required. The use of an antiviral agent known as ribavirin for RSV bronchiolitis is reportedly associated with an overall clinical improvement.
Corticosteroids may be recommended in treating a child over 1 year old, who has had wheezing before or has a raised chance of having asthma. They can help to reduce swelling in the airways causing airflow limitation. However, several reports have demonstrated the futility of steroid therapy in modifying the disease course in previously well infants.
Treatments to prevent bronchiolitis
Active immunisation of infants at risk remains the ideal preventative strategy for viral bronchiolitis. Babies who were born early (prematurely) or with heart problems, or who have a lung condition or a very weak immune system are sometimes given a medicine called palivizumab to help prevent bronchiolitis during the months of the year when
it is most common.
Proper hygiene is also very essential both in hospital and community settings to prevent child-to-child transmission of the virus.
What will happen to my child?
Bronchiolitis is not usually life-threatening. Most babies do well on their own without having to stay in the hospital. Even in moderate to severe disease that may require hospital admission, the treatments are quite straightforward an effective.
Children who have had bronchiolitis, especially the moderate to severe ones, are more likely than other children to have episodes of wheezing later on. However, many children outgrow this wheezing by the time they are teenagers.