Dr. Jaber Jassam

Bronchiolitis (التهاب القصيبات)

Bronchiolitis is a major cause of respiratory morbidity in young children and usually affects children under two years old. The peak age in infants is between 3 and 6 months. The peak season is usually between November and March, but also between March and July.

Bronchiolitis is the most common cause of children's visits to hospitals. It is mostly mild but may lead to severe deterioration in the child's condition.

Among all cases of bronchitis, only 1-2% may require hospitalization. 1% of hospitalized infants may lose their lives.

Causes of bronchiolitis 

The causes of bronchitis include Respiratory Syncytial Virus (RSV), which accounts for more than 80% of cases, in addition to influenza viruses and others.

By the age of three, almost all children have serological evidence of RSV infection at some point in their lives, 

Symptoms of the disease: 

When bronchiolitis affects young infants, the clinical manifestations may be subtle, which may include:

- Child discomfort 

- Difficulty feeding during the first two to five days of illness;

- Low-grade fever (usually < 38.6 degrees Celsius, and if temperatures are high, i.e., above forty, there may be another cause) 

- Infants younger than one month may experience low body temperature;

- Nasal congestion and runny nose

- Temporary and repeated apnea, which may be the only symptom.

- In severe cases of bronchiolitis, infants may become very nervous and irritable, suffer from irregular breathing with nasal congestion, irregular heartbeat, respiratory contraction, and in more severe cases, they may develop cyanosis of the lips, 

Diagnosis 

The diagnosis of bronchiolitis depends on clinical symptoms and the presence of the aforementioned signs of the disease 

Examinations

Bronchiolitis is a clinical diagnosis, so there is no need for any laboratory test 

Treatment of bronchiolitis

Since there is no definitive treatment for bronchiolitis, treatment is mainly symptomatic only 

- Fever control: 

- Tylenol 10-15 mg/kg every 4-6 hours, not to exceed five doses (50-75 mg/kg/24 hours) 

Ibuprofen (Advil) for infants older than 6 months, 5-10 mg/kg every 6-8 hours as needed, not to exceed 40 mg/kg/24 hours 

. Avoid aspirin in children with fever.

- Nasal drops or spray - saline nasal drops (water with salt, available at pharmacies) can be used along with suction and cleaning of nasal secretions. Saline nasal spray can be used in older children (also available at pharmacies) 

- Encourage adequate but not excessive fluid intake.

- Antibiotics are not recommended unless bacterial complications occur.

- Hand sanitization and washing with soap and water are advised to prevent spread.

- Avoid exposure to secondhand smoke.

- Breastfeeding is recommended.

- Avoid going to daycare, kindergarten, or mixing with other children when the child is sick.

Monitoring - Monitor for signs or symptoms of worsening bronchiolitis, which may include increased respiratory rate and heart rate, worsening chest retraction, nasal congestion, cyanosis of the lips, loss of appetite, or cessation of urination. If these symptoms occur, hospital emergency should be visited promptly or call 911 

Parents need education on this issue and instructions on home treatment and the correct timing to see a doctor, go to the hospital, or call emergency 911 

Dr. Jassam 

Medhaven Medical Center - Ottawa