Bronchiolitis: symptoms, causes and treatment

By Cristiano Antonino On Feb 27, 2023

Bronchiolitis is an acute viral infection that affects the respiratory system, particularly that of children under one year of age

The disease manifests itself most frequently in the first six months of life and has the highest incidence between November and March.

The respiratory syncytial virus (VRS) causes the disease, generally in 75% of cases

However, other viruses can also affect children’s systems, such as metapneumovirus, coronavirus, rhinovirus, adenovirus, influenza and parainfluenza viruses.

The infection is secondary to a transmission that occurs primarily by direct contact with infected secretions.

The infection phase typically lasts 6 to 10 days.

The virus mainly attacks the bronchi and bronchioles, causing an inflammatory process, which leads to increased mucus production and airway obstruction with possible respiratory distress.

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The symptoms of bronchiolitis

Bronchiolitis in children generally manifests itself with fever and rhinitis, i.e. nasal inflammation.

Persistent coughing, which may become acute, and breathing difficulties, which may be characterised by an increased respiratory rate and intercostal indentations, may then appear.

In most cases, bronchiolitis resolves on its own, without serious consequences.

The causes

Factors that can increase the risk of bronchiolitis and for the condition to worsen are prematurity, the child’s age (< 12 weeks), congenital heart disease, bronchopulmonary dysplasia, cystic fibrosis, congenital airway abnormalities and immunodeficiencies.

The diagnosis of bronchiolitis is clinical

The paediatrician assesses the course of symptoms and prescribes treatment.

Only in special cases can certain laboratory and/or instrumental investigations be carried out, such as, for example, the search for respiratory viruses on nasopharyngeal aspirate, determination of oxygenation by means of a saturimeter and arterial haemogasanalysis, i.e. a test that assesses blood oxygenation.

In some cases also by measuring carbon dioxide and the efficiency of gas exchange.

A chest X-ray is rarely required in the case of possible thickening of mucus and areas of airlessness in several areas of the lungs due to impaired ventilation.

How to prevent bronchiolitis

Usually, a few simple rules of daily hygiene are enough to reduce the risk of contracting bronchiolitis or to avoid related infections, which can worsen the clinical picture.

It is always important to

avoid contact of younger children with other children of the same age or adults with airway infections;
always wash your hands before and after caring for your child;
encourage breastfeeding;
carry out nasal washes with physiological or hypertonic solution;
never smoke in front of the child and also in a different environment where the child is not at the moment.

Treatment for bronchiolitis

The patient with bronchiolitis should have frequent nasal washes with mucus aspiration and undergo aerosol therapy with 3% hypertonic solution.

This serves the child to mobilise the abundant catarrhal mucous secretions.

In more severe cases or if bronchiolitis persists, oral cortisone may be prescribed.

Although the most recent scientific literature does not show that children undergoing this therapy improve.

The use of antibiotics is strongly discouraged.

When is hospitalisation necessary?

When bronchiolitis becomes acute, hospitalisation may be necessary, especially under six months of age.

In infants of these months, there is often a drop in saturation levels, i.e. oxygen in the blood, and dehydration may occur due to the difficulty of feeding and the increased water loss caused by respiratory work.

In addition, the risk of apnoea is higher in premature babies or those born less than 6 weeks old.

The episode of prolonged respiratory pause must be monitored by assessing the cardio-respiratory parameters.

Generally, the disease is benign and resolves spontaneously in about 12 days.

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