Bronchiolitis in adult: A review

Bronchiolitis is a viral infection of the lower airways, most often in infants but can affect children up to two years of age. It is commonly caused by respiratory syncytial virus (RSV), although it can be caused by numerous other viruses and it has a peak incidence in the autumn/winter. Affected infants present with coryzal symptoms, moist cough, reduced feeding and low grade pyrexia. Typical chest signs include varying degrees of respiratory distress, fine scattered crackles and wheeze.

Check blood gases regularly (capillary gases adequate in most cases). A peak pressure of around 20 cmH2O or tidal volume of 6-8 ml/kg is a reasonable starting point and adjust depending of chest movement blogsubmitterpro.org and blood gases. We are always looking to expand the number of resources that link to the RCEM curriculum. If you would like to contribute relevant links to be included, simply fill out the form below.

Emergency Evidence Updates – April 2022

Read more about the symptoms of bronchiolitis for advice about when to call an ambulance. They will listen to your child’s breathing using a stethoscope to check for any crackling or high-pitched wheezing as your child breathes in and out. The infection causes the bronchioles to become inflamed (swollen) and increases the production of mucus.

• Comforting your child is important as symptoms may worsen if they are agitated or crying.
• 2-3% of babies who develop bronchiolitis during the first year of life will need to be admitted to hospital because they develop more serious symptoms, such as breathing difficulties.
• In clinical groups, it was thought to have hypersensitivity pneumonitis (HP) characteristics but not specific antigens were identified.
• HRCT scans of ACIF show a combination of “ground-glass” opacities, traction bronchiectasis, and bronchial wall thickening.
• This is a small clip or peg that’s attached to your baby’s finger or toe.
• The incidence of bronchiolitis shows seasonal variation – peaking in winter.

Smoking is known to make bronchiolitis worse and parents should be counselled about smoking in the home or near their children. If your baby is admitted to hospital they will likely require additional oxygen delivered via a thin tube under their nose. Some babies are able to maintain oral feeding but many will need a nasogastric (NG) tube. This is a tube which goes down in through their nose to their tummy and their milk is delivered through this to allow them to rest and recover.

Keep your baby away from cigarette smoke

Your child will be able to leave hospital and return home when their condition has stabilised. If it has not already been tested, a sample of your child’s mucus may be collected and tested to find out which virus is causing the bronchiolitis. This is a small clip or peg that’s attached to your baby’s finger or toe.

How may it affect feeding?

If your child cannot be given a nasogastric tube, or they’re at high risk of respiratory failure (their breathing is very laboured and difficult), they’ll be given fluids directly into a vein (intravenously). A few babies with bronchiolitis – about 3 in 100 – may need to go to hospital for help with their breathing and feeding. It’s usually if they aren’t getting enough oxygen into their bloodstream, or if they’re not eating or drinking enough. Any kind of breathing difficulty your infant or child experiences can be scary for parents.

Bronchiolitis usually gets better by itself, and most children can be looked after at home.

Terms like ‘wheezy bronchitis’ and ‘acute bronchitis’ are still in use and the term ‘acute viral lower respiratory tract infection’ may be more appropriate as an umbrella term for all these conditions. Steroid treatment is not recommended for children with episodic wheeze. Oral steroids do not decrease the length of hospital admission or reduce symptom severity in viral induced wheeze.

Leeds Health Pathways

About 20 per cent of infants have cough and wheeze for a rather prolonged period after a bout of bronchiolitis (post-bronchiolitic syndrome). Rapid RSV diagnostic tests using immunofluorescence or PCR on nasopharyngeal secretions will confirm the diagnosis and help infection control in hospitalised infants. These injections may help limit the severity of bronchiolitis if your child becomes infected. But they can be expensive and are not always available on the NHS.

Laboratories perform a panel of viral immunofluorescence on a nasopharyngeal aspirate sample including RSV, metapneumovirus, adenovirus, influenza and parainfluenza. This will reduce unnecessary interventions including antibiotic use. Pulse oximetry should be performed in infants where hypoxia is suspected. The infant’s weight should be checked and plotted on the growth chart.