Understanding Bronchiolitis

These posts are for the truly Smart Parent that wants to avoid doing things that are unnecessary, wasteful, and perhaps even harmful to their child.  Bronch-iol-itis is different from bronchitis.  One of the primary differences is that bronchiolitis tends to affect young children and bronchitis tends to affect adults (especially smokers).  It is generally not serious but there is a shocking amount of misinformation out in the community.  To make matters worse, it seems to me that many doctors do not keep up with the current medical information and treat their patients with all kinds of things that have clearly been shown to be of NO benefit in the management of bronchiolitis.

What is Bronchiolitis?

Bronchiolitis is caused by RSV which stands for Respiratory Syncitial Virus.  It is a viral infection.   Like all viral infections, it is completely resistant to all antibiotics.  The RSV virus generally causes two different problems in children:

1. Nasal congestion
2. Low oxygen levels

Nasal Congestion

This is the most common problem in kids who get RSV.  Their symptoms are essentially the same as anyone with the common cold – low grade fever, runny nose, congestion, and cough.  For most kids these symptoms are only bothersome and will not cause any significant problems.

Very young babies (less than 3 months) tend to have more trouble with nasal congestion.  This is because small babies are obligate nose breathers, which means they do not know how to breath from their mouth.  This is made worse by the fact that babies have small nostrils and thus even a little congestion tends to clog up their nose.  Add these two things together and you have a recipe for problems.

Problems with nasal congestion come in 2 varieties.  The first, and most common, is that babies get very irritated when they can not breath well through their nose.  This often leads to a fussy baby who does not sleep well.  Add poor sleep on top of everything else and it is easy to see why parents end up in the doctor’s office desperate for something to make the congestion go away.

The second, and more problematic issue with the nasal congestion, is difficulty feeding.  Small babies need to eat every few hours both for nutrition and hydration.  If the nasal congestion is bad enough that baby cannot breath and eat at the same time, and it goes on for more than a day or two, it could lead to dehydration.  Thus babies who are unable to feed well because of the congestion in their nose may need to be evaluated for dehydration.

Low oxygen levels

While RSV, and the congestion it causes, is generally confined to the nose, it can move down into the lungs in some children.  This is when you get the clinical syndrome of bronchiolitis.  Babies who have bronchiolitis have mucous and inflammation in their bronchioles (see picture below).  When you listen to the lungs with a stethoscope you can hear this mucous (called “crackles”).  You can also hear wheezing which is causes by the inflammation.

In some babies (but not all) this will interfere with their ability to get enough oxygen and thus their oxygen levels may be low.  We call this hypoxia and is it is generally defined as a number less than 94%.  Babies who have hypoxia will exhibit “increased work of breathing”.  Initially babies will start breathing faster.  As the work of breathing increases further, babies will start “flaring” their nose.  As they need to work even harder they will start having retractions.  You can tell when your baby has retractions because you will be able to see their ribs when they breath.  As the work of breathing increases even more your baby will start having head “bobbing” and grunting.  Head bobbing and grunting are late signs that the work of breathing is very difficult and always requires medical evaluation.

Mild increased work of breathing is often relieved by treating the nasal congestion and helping your baby open up their nose.  More severe or persistent increased work of breathing require medical evaluation.

Summary

To sum things up, bronchiolitis is caused by the RSV virus.  Antibiotics are completely useless to treat bronchiolitis.  It tends to cause two problems: significant nasal congestion and low oxygen levels.  It is generally not something that needs to be seen by a doctor unless the nasal congestion is interfering with your baby’s ability to eat or breath.  If you notice that your baby is having increased work of breathing despite a trial of nasal suction, then medical evaluation is indicated.

Now this is where things really get frustrating for me.  If you happen to see the doctor there are all kinds of things that you may be given.  While many things have been tried for bronchiolitis, most things DO NOT help at all.  In fact, some may actually even make things worse.  In my upcoming posts I will cover antibiotics, breathing treatments, steroids, etc.  So stay tuned and … You Decide.

Next Post

Breathing Treatments for Bronchiolitis

References:

CDC Review of RSV