Bronchiolitis is a viral disease of the lungs most common in young children. The virus causes swelling airways in the small airways of the lungs, called bronchioles, and a build up of mucus in the airways. This can make breathing more difficult and lead to coughing and wheezing.
Bronchiolitis is caused by one of several different types of viruses. These viruses are easily spread from person to person like a common cold. It is passed most easily through droplets of moisture that are released into the air with coughs or sneezing. These droplets may be inhaled by others or land on common surfaces like counters and doorknobs. A healthy person can pick up the virus by inhaling it in the air or coming in contact with the virus on surfaces then touching their face.
Bronchiolitis can affect anyone, but is most common in children under the age of 2 years old. It is also most common during the winter season.
Factors that may increase a child's risk include:
- Premature birth
- Exposure to environmental pollution including second hand smoke
- Weak immune systems
- Child care attendance or older siblings that attend childcare or schools
- Congenital abnormalities of the heart or lungs
- Severe neuromuscular disease
Factors that increase a child's risk of bronchiolitis include:
At first bronchiolitis will have the same symptoms as a common cold. This may include stuffy or runny nose, cough, and mild fever. After a few days, the cough will worsen and breathing rate will increase.
Symptoms may include:
- Wheezing or crackling noises when exhaling
- Abnormal breathing patterns, such as using abdominal muscles to help move air, widening nostrils, or grunting while breathing
- Rapid breathing
- Sunken chest
- Lack of interest or difficulty in eating or drinking which may lead to dehydration (tearless cries, less urinating or fewer wet diapers, dry mouth)
- Bluish tint around lips or fingertips
You will be asked about your child's symptoms and medical history. A physical exam will be done. The doctor will most likely be able to diagnose bronchiolitis based on the history and physical exam.
Lab tests of the blood or mucus or chest x-ray may be done if there is a concern about a secondary infection.
The doctor may also assess the risk of a severe infection based on health history.
Viral infections can not be cured with medication. The virus needs to run its course. Bronchiolitis will usually clear completely on its own by 2-3 weeks.
Treatment will help manage symptoms during more intense periods of the infection.
Management of less severe symptoms include:
- Encouraging liquids to prevent dehydration.
- Avoiding environmental pollutants such as cigarette smoke. Irritants can make symptoms worse.
- Acetaminophen may be recommended if a fever is present. Note: Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome.
If breathing becomes difficult, hospitalization may be needed. Care may include:
- Oxygen therapy
- Inhaled therapy to widen the airway and help loosen mucus
- IV tubes or tubes passed through the nose and into the stomach to provide nutrition and fluids
There is no vaccine to prevent bronchiolitis itself. There are some medications that may lessen the risk of bronchiolitis by respiratory syncytial virus (RSV):
- This preventative medication is usually given to high-risk babies.
- It is given monthly during high risk RSV season.
- If your child is considered high risk, talk to your doctor about prevention.
To help decrease the risk of bronchiolitis or any respiratory infection:
- Avoid close contact with people who have respiratory infections. Do not share utensils or cups with people who have colds.
- Wash your hands often, encourage children to wash their hands. Caretakers should especially their hands while caring for sick children.
- Prevent or limit exposure to second-hand smoke.
- Consider exclusive breastfeeding for the first 6 month of life. Exclusive breastfeeding may reduce the risk of pulmonary infections in children.
Family Doctor—American Academy of Family Physicians
Kids Health—Nemours Foundation
The Canadian Lung Association
Caring for Kids—The Canadian Paediatric Society
Bronchiolitis. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Bronchiolitis.aspx. Updated August 20, 2015. Accessed September 15, 2015.
Bronchiolitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 14, 2015. Accessed September 15, 2015.
Ralston S, et al. Clinical Practice Guideline: Diagnosis, Management and Prevention of Bronchiolitis. Pediatrics Vol. 134 No. 5 November 1, 2014 pp. e1474 -e1502. Available at: http://pediatrics.aappublications.org/content/134/5/e1474.full. Accessed September 15, 2015.
Treating bronchiolitis in infants. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/pages/Treating-Bronchiolitis-in-Infants.aspx. Updated July 28, 2014. Accessed January 15, 2015.
Working Group of the Clinical Practice Guideline on Acute Bronchiolitis, Fundació Sant Joan de Déu. Clinical practice guideline on acute bronchiolitis. Barcelona (Spain): Catalan Agency for Health Technology Assessment and Research (CAHTA); 2010.
2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Panickar J, Lakhanpaul M, Lambert PC, et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med. 2009;360:329-338.
6/8/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: National Institute for Health and Care Excellence. Bronchiolitis in children. Available at: http://www.nice.org.uk/guidance/NG9/informationforpublic. Published May 2015. Accessed June 8, 2015.
Last reviewed September 2015 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.