Bronchiolitis
Summary/Definition
Bronchiolitis is an acute inflammatory disease of the bronchioles caused mainly by viral infection and often occurs in children under 2 years of age, in whom the structure and function of the bronchioles are not yet fully formed. Respiratory syncytial virus (RSV) is the most common causative agent, accounting for 50-75% of all causes. Bronchiolitis can also be caused by parainfluenza viruses, influenza viruses, rhinoviruses, adenoviruses, and mycoplasma infections, etc.
Symptoms
The symptoms of a cold suddenly appear 2-3 days after the first symptoms: runny nose, nasal congestion, mild fever, and mild cough. then auscultation reveals rapid breathing (60-80 times per minute), wheezing, and respiration. As the symptoms intensify, there is difficulty breathing, tachypnoea, heart rate increases, there is blowing of the wings of the nose, and retraction of the intercostal spaces and subcostal spaces. If the child has vomiting, shallow and rapid breathing (more than 40 breaths per minute), livid color around the lips and on the fingertips, doesn’t play well, looks lethargic or, on the contrary, constantly fusses, cannot lie down comfortably and makes lurching sounds, does not eat well on its own or refuses breast milk, etc., it is necessary to urgently contact a medical institution.
Diagnostics
The diagnosis is made depending on the patient’s age, symptoms, and examination findings. Chest X-rays and blood tests can help to determine both the diagnosis of the disease itself and its severity and differentiate other causes of the disease. The physical examination can provide insight into the patient’s condition. Children with bronchiolitis may present with symptoms such as breathing faster and heavier than normal, excessive flaring of the nostrils when breathing, and visible chest contractions. In bronchiolitis, air fills the lungs, and it expands and presses on the diaphragm, which in turn presses on the liver and spleen below it, so the patient begins to feel pain under the ribs. The diagnosis can be confirmed with a chest X-ray and a test for respiratory viruses.
Treatment and course of the disease
The initial symptoms of a common cold are clear nasal discharge, nasal congestion, sneezing, and mild fever, but after a few days, the cough increases, the person becomes fussy and in severe cases there is severe respiratory distress. The younger a patient is the smaller the diameter of his bronchioles so in children, the symptoms may be more serious.
Viral bronchiolitis is treated symptomatically like a cold, but hospitalization is necessary if there are signs of breathing difficulties. Medical treatment includes bronchodilators, steroids, antibiotics, and antiviral drugs. No antibiotics are usually required, but they may be prescribed if there is evidence of a bacterial infection. Symptomatic treatments such as antipyretics, humidification, and proper nutrition are prescribed to reduce fever, and if hospitalization is required, add inpatient treatments such as oxygen therapy, an artificial respirator, and intravenous fluids.
Complications
Complications such as atelectasis of t he lung due to sputum, otitis media, or pneumonia due to a secondary bacterial infection, cyanosis due to hypoxaemia, and severe respiratory failure may occur.
