Bronchiolitis
Bronchiolitis is an inflammatory condition affecting the bronchioles, which are the smallest air passages in the lungs. It primarily occurs due to viral or bacterial infections, with the respiratory syncytial virus (RSV) being the most common culprit. Typically affecting children under the age of two, bronchiolitis often manifests following a cold and is most prevalent during the autumn and winter months. Symptoms can include sudden difficulty in breathing, rapid and shallow breaths, wheezing, and signs of dehydration. In severe cases, individuals may experience cyanosis, where the skin or nails turn blue.
Diagnosis is made through physical examination and additional tests, and treatment usually involves maintaining humid air, administering fluids, and potentially using antibiotics or antiviral medications. Risk factors include prematurity, lack of breastfeeding, environmental exposures like secondhand smoke, and crowded living conditions. While bronchiolitis can resolve within a week with proper care, incorrect or delayed treatment may lead to more serious respiratory conditions or complications later in life. Preventative measures, such as hand hygiene, are crucial in minimizing the spread of infections that cause bronchiolitis.
Bronchiolitis
ANATOMY OR SYSTEM AFFECTED: Chest, lungs, respiratory system
DEFINITION: An inflammation of the bronchioles that affects breathing and the transfer of oxygen to the bloodstream.
CAUSES: Viral or bacterial infection
SYMPTOMS: Sudden breathing difficulty, rapid and shallow breathing, wheezing, fever, dehydration, retractions of chest and abdomen
DURATION: Temporary, sometimes chronic
TREATMENTS: Moist air, antibiotics, antiviral medications, bronchodilators
Causes and Symptoms
Bronchiolitis is caused by an infection that inflames and narrows the bronchioles, the smallest branches in the respiratory system, which carry air from the large bronchial tubes to microscopic air sacs in the lungs. The infection is most often viral, though it can also be bacterial or a combination of the two. The respiratory syncytial virus (RSV) is the most common cause of bronchiolitis, while adenovirus, parainfluenza, and influenza viruses can also cause the disease. It usually affects children under two, sometimes after a cold, and is most common in autumn and winter. It is contagious through contact with fluids from the throat or nose of an infected person and often transmitted by sneezing or coughing; it may become epidemic.
Symptoms include sudden breathing difficulty characterized by rapid, shallow breathing, wheezing, coughing, fever, dehydration, and retractions of the chest and abdomen (intercostal retractions). In severe cases, the skin or nails may turn blue. In some cases those infected will exhibited very mild or no symptoms
Treatment and Therapy
A physical examination can detect bronchiolitis by using a stethoscope and performing blood gas tests, chest x-rays, and nasal fluid sampling. The general treatment of bronchiolitis involves keeping the patient’s room as humid as possible with a cool-mist humidifier or by running cold or hot water in the shower with the windows and doors closed. In the case of bacterial infections, a doctor can prescribe antibiotics, and antiviral medications may be helpful in severe cases of viral infection. In addition, bronchodilators, drugs that widen the airways in the lungs, may prove helpful.
The patient should frequently drink clear fluids, such as water, carbonated drinks, lemonade, weak bouillon, diluted fruit juice, or gelatin, to help thin mucus secretions and avoid dehydration. Diagnostic measures include parental observation of symptoms, physical examination by a doctor, laboratory blood studies, and x-rays of the lungs. With proper treatment the disorder is typically curable within seven days.
Perspective and Prospects
Bronchiolitis is usually a disease of early infancy, with almost 90 percent of the patients being less than one year of age. Others at higher risk include those born early and those not breastfed. Environmental risk factors include secondhand smoke and crowded living conditions. The global SARS-CoV-2 pandemic that began in 2020 led to significant changes in rate and peak of RSV infection, although researchers could not say how long this disruption would persist. Though prevention is difficult due to the widespread presence of the responsible viruses, careful hand washing is recommended to avoid spreading the infection. Children at very high risk may be prescribed the immune system booster palivizumab (Synagis) in some cases.
It is important that bronchiolitis be diagnosed and treated properly because it can lead to chronic bronchitis, collapse of a small portion of a lung, repeated bouts of pneumonia, and, in some cases, chronic obstructive pulmonary disease (COPD). Studies also indicate that infants who have two or more episodes of bronchiolitis prior to age two are more prone to developing allergies and asthma.
Bibliography:
"Bronchiolitis." Mayo Clinic. Mayo Foundation for Medical Education and Research, 25 Feb. 2023, www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565. Web. Accessed 28 Mar. 2024.
Chuang, Yu-Chuan, Kuan-Pei Lin, Li-An Wang, Ting-Kuang Yeh, and Po-Yu Liu. "The Impact of the COVID-19 Pandemic on Respiratory Syncytial Virus Infection: A Narrative Review." Infection and Drug Resistance, vol. 16, 2023, DOI: 10.2147/IDR.S396434. Web. Accessed 1 Aug. 2023.
Kaneshiro, Neil K., and David Zieve. "Bronchiolitis." MedlinePlus. Natl. Lib. of Medicine, Natl. Institutes of Health, 5 Aug. 2023, medlineplus.gov/ency/article/000975.htm. Web. Accessed 28 Mar. 2024.
Mason, Robert J., et al., eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia: Elsevier/Saunders, 2010. Print.
Myers, Adam K. Respiratory System. Philadelphia: Elsevier/Mosby, 2006. Print.
Niederman, Michael S., George A. Sarosi, and Jeffrey Glassroth. Respiratory Infections. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2001. Print.
Pennington, James E. Respiratory Infections: Diagnosis and Management. 3d ed. Hoboken, N.J.: Raven, 1994. Print.
West, John B. Pulmonary Pathophysiology: The Essentials. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2013. Print.