BRONCHIOLITIS

General Information

DEFINITION--Inflammation of the bronchioles, the smallest branches of the respiratory tree. These carry air from the large bronchial tubes to microscopic air sacs in the lungs. The air sacs transfer oxygen to the bloodstream. Bronchiolitis may be confused with inhaled objects lodged in the child's lung.

BODY PARTS INVOLVED--Bronchioles.

SEX OR AGE MOST AFFECTED--Children under age 6.

SIGNS & SYMPTOMS--

Sudden breathing difficulty, usually preceded by a mild common cold and cough, and characterized by the following:

• Wheezing.
• Rapid, shallow breathing (60 to 80 times a minute).
• Retractions (see-saw movements) of the chest and abdomen.
• Fever (occasionally).
• Dehydration.
• Blue skin or nails (severe cases).

CAUSES--Viral or bacterial infection, or a combination of the two. Some young children develop this disorder after every cold. Bronchiolitis is contagious and often becomes epidemic.

RISK INCREASES WITH

• Illness that has lowered resistance, especially respiratory infection.
• Family history of allergies.
• Day care environment.
• Contact with an infected person.

HOW TO PREVENT

• Observe and avoid any activities that seem to trigger attacks in the child, such as active play in cool night air.
• Decrease the child's exposure to groups of people, especially other children, to avoid colds.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood studies.
• X-rays of the lungs.

APPROPRIATE HEALTH CARE

• Home care.
• Doctor's treatment.
• Hospitalization for intensive care and oxygen (severe cases).

POSSIBLE COMPLICATIONS--Permanent lung damage leading to chronic bronchitis, collapse of a small portion of the lung, bronchiectasis, repeated pneumonia, and rarely, chronic obstructive pulmonary disease (COPD).

PROBABLE OUTCOME--Usually curable in 7 days with treatment. Some studies indicate that infants who have 2 or more episodes of bronchiolitis before age 2 are more likely to develop allergies and asthma.

How To Treat

GENERAL MEASURES--

• Keep the humidity in the child's room as high as possible. Use an ultrasonic, cool-mist humidifier. Clean humidifier daily. If you don't have a humidifier, run cold or hot water in the shower with windows and doors closed to produce a high-humidity room. Hold the child in this room for 20 minutes several times a day, especially at bedtime. If the child awakens at night with wheezing or shortness of breath, repeat the process.
• Breathing cool outside air may help.

MEDICATION--Your doctor may prescribe:

• Antibiotics to fight bacterial infections.
• Antiviral medications may help in severe cases.
• Bronchodilators (drugs that widen the airways in the lungs) may be helpful.

ACTIVITY--Have the child rest until symptoms have subsided for 48 hours. Then normal activities may be resumed gradually.

DIET--Offer the child clear fluids frequently. Give water, tea, carbonated drinks, lemonade, weak bouillon, diluted fruit juice or gelatin.

Call Your Doctor If

• Symptoms don't improve in 4 hours, despite treatment.
• Temperature (rectal) rises to 101F (38.3C) or higher.
• Breathing becomes more difficult.
• A cough begins that produces colored phlegm.
• The skin, lips or nails turn dark blue.
• The child becomes lethargic.