Bronchiolitis is an acute infection of the lungs of viral origin, which affects children under two years of age. It is characterized by an inflammation of the bronchioles, these small channels following the bronchi which lead the air to the pulmonary alveoli. Children with this condition have difficulty breathing and wheezing.
This disease is one of the most common causes of hospitalization in children under two years of age. Complications, rare, can be serious.
Autumn and winter are the seasons when bronchiolites are the most common.
Causes of Bronchiolitis
- Respiratory syncytial virus or RSV infection in the majority of cases. However, not all children infected with this virus develop bronchiolitis. Indeed, the majority of them have a specific immune defense against it, even before the age of two years.
- Infection with another virus: parainfluenza (5 to 20% of cases), influenza , rhinovirus or adenovirus.
- A hereditary disorder: some genetic diseases interfere with the proper functioning of the bronchi and could be taken into account. See the section at risk.
Contagion and contamination
- The virus is transmitted through the airways, and can be carried by soiled objects, hands, sneezes and nasal secretions.
The symptoms of bronchiolitis last from 2 to 3 weeks , the median duration being 13 days.
Patients with bronchiolitis will often develop asthma in the coming years.
Generally benign, bronchiolitis may nevertheless lead to some more or less serious complications, as the case may be:
- bacterial superinfection, such as obits media or bacterial pneumonia;
- seizures and other neurological disorders;
- respiratory distress
- central apnea;
- asthma, which can occur and persist for several years thereafter;
- heart failure and arrhythmias;
- death (very rare in children who do not have another disease).
- Signs related to dehydration: sometimes, the disease causes dehydration due to the child’s coughing too much to absorb liquid through the mouth. In this case, the baby may be irritable, have tongue and dry lips, cry without tears and stop urinating.
- During the next two to five days: fever, coughing, wheezing, difficulty and fast.
- Warning signs: a cold with significant nasal discharge, sneezing, a rather dry cough, a mild fever, a refusal to eat.
- Signs of aggravation:
– flutter of the nose
– rapid breathing
– accelerated heart rate
– bluish discoloration of skin, nails and lips caused by lack of oxygen (rare and severe);
– crept rattles (during the inspiration, a succession of dry sounds is heard).
NB The child may wheeze but do not disturb the child too much. He eats and sleeps without problems. In such a case we may think that the presentation is more benign. The doctor will most often diagnose bronchiolitis based on symptoms, vital signs including oximetry and physical examination. Blood tests or x-rays are not routine.
People at risk
With exception, young children under the age of two are the most at risk. Of these, some are nevertheless more susceptible to the disease:
- premature babies;
- infants less than six weeks old;
- children with a family history of bronchial asthma;
- those who suffer from congenital heart disease;
- those whose lung development was abnormal (bronchodysplasia);
- those who suffer from cystic fibrosis of the pancreas (or cystic fibrosis), a genetic disease. This disease causes excessive viscosity of gland secretions in various parts of the body, including bronchial tubes.
- Amerindian children and native of Alaska.
- Be exposed to second-hand smoke (especially when it comes to the mother).
- Attend a daycare.
- Live in a disadvantaged environment
- Live in a large family.
- Vitamin D deficiency at birth . One study reported that a low concentration of vitamin D in umbilical cord blood is associated with a six-fold higher risk of bronchiolitis.
|Basic preventive measures|
It is important to avoid the risks associated with hand or air transmission (coughing, sneezing). Here are some simple steps to put luck on your side:
As with most childhood diseases, breastfeeding provides the child with antibodies that have not yet had time to develop. Studies tend to confirm the protective effect of breastfeeding against bronchiolitis. According to one of these studies, this protective effect would be stronger in children exposed to cigarette smoke.
In all cases of bronchiolitis, seek immediate medical attention.
If it is a mild form of bronchiolitis, treatment can continue safely at home. Hospitalization will be used if the physician identifies risk factors for poor prognosis, specific risk factors, low oxygen saturation, dehydration that cannot be corrected orally, or other signs of complication. .
Treatment of the acute episode
– Treat the fever. To do this, acetaminophen is effective.
– In addition to bronchial obstruction, there is very often a nasal obstruction that aggravates the situation. It can be helped by nasal instillation with saline. This technique can be applied by parents and is recognized as more effective than the baby fly.
– Make sure the child is eating enough. For this, we can unclog the nose and pharynx before he eats, split his meals or “thicken” his bottles.
– Correct dehydration caused by fever and fast breathing by making the child drink a lot of fluids.
– Provide the child a healthy environment: correct ventilation, no tobacco smoke
– Lay the child in a semi-sitting position, including sleeping.
– Doctors sometimes prescribe antiviral medication if the respiratory syncytial virus is involved; its use is reserved for extremely severe cases, immunosuppressed patients or with congenital heart disease.
– Antibiotics are sometimes given, but only if the bronchiolitis is complicated by a bacterial infection, such as obits media or pneumonia.
– Respiratory physiotherapy, or physiotherapy, was found to be ineffective in bronchiolitis according to a review of the Cochrane literature in 2012.
– Research published in 2013 demonstrated the efficacy of dexamethasone (a systemic corticosteroid) combined with salbutamol (a bronchodilator) in patients with bronchiolitis who have eczema or a family history of asthma.
In case of hospitalization
For more severe cases, oxygen administration using a mask or a probe and intravenous hydration may be required. It may be that the child, whose energy is all focused on breathing, cannot drink or eat. In the most severe cases, the use of non-invasive, or invasive, artificial ventilation may be necessary.