Canyon View Medical Logo - Color

Understanding Bronchiolitis

Many respiratory viruses circulate in the winter in Utah, passed from person to person by droplets from sneezes and coughs. They can affect the respiratory tract from the nose, down the throat and trachea, to the lungs.

What is bronchiolitis?  

Bronchiolitis is when a virus causes inflammation of the tiniest windpipes in the lungs, called bronchioles, along with lots of mucus in the nose.  The most common cause of bronchiolitis is a virus called RSV (Respiratory Syncytial Virus), but other respiratory viruses can cause the exact same illness. RSV activity is ramping up this week in Utah County, according to surveillance and testing at our local hospitals. It usually goes around here from January through March.

What are the symptoms of bronchiolitis?  

The symptoms of bronchiolitis are wheezing (a multiple-whistling sound when your baby exhales) and lots of stuffiness and mucus coming out of the nose. Sometimes there is fever the first couple of days. The breathing difficulty is typically worst on the fifth day and then tapers off over a few weeks. About one out of 50 babies with RSV bronchiolitis needs to be hospitalized, usually for increased work of breathing, need for more oxygen, or dehydration due to poor feeding.

What is the treatment for bronchiolitis?  

RSV has long been the arch-nemesis of pediatricians because pretty much every medicine that has been studied to treat bronchiolitis has been a disappointment. Here’s a list of what has been shown to not work in most cases: antibiotics, inhaled albuterol or steroids (nebulizer or inhaler treatments), oral steroids, respiratory therapies such as postural drainage or chest percussion. Here’s what does work:  extra oxygen (if needed in the hospital) and clearing out the nose, and hydration. Even the sickest hospitalized babies usually do not receive any medicine.  They just have their noses cleared out and are put on oxygen. At home, you can clear your baby’s nose by putting 10 to 15 drops of saline (just plain saline nose drops or nose spray, not with any medicine in them) in each nostril, usually before feedings and before sleep.

There is no vaccine for RSV.  A very small group of babies born very prematurely or with certain severe heart defects or chronic lung disease receive monthly RSV antibody shots (called palivizumab) during RSV season, which cost about $1000 each shot and can decrease their risk of hospitalization by about half.  If your young baby was premature or has heart defects or lung disease, your doctor can help you find out whether your baby qualifies for these injections.

When should your baby see a doctor for bronchiolitis?

  1.  Labored breathing especially with retractions. This is when her skin sucks in as she breathes in – sometimes it means she needs extra oxygen. You might see the skin sucking in below the ribs, between the ribs, and at the top of the chest (at the little notches at the bottom of the neck and above the collarbones). Have you ever seen her chest when she has hiccups? It can look like that, but the retractions are with every breath. See the doctor if you are not sure whether your baby is having difficulty breathing.
  2.  Blue lips. If the kissing part of the lips, or the tongue, is blue, then the child should see the doctor.
  3.  Poor feeding or dehydration. Sometimes, the fast breathing and/or completely stuffed up nose makes it really hard for a baby to feed.  Signs of dehydration can include:  drinking a lot less than usual, not urinating, cannot awaken fully, cold hands and feet, listless and pale, not making tears when crying, having sunken eyes and a dry mouth. We need to see him if he’s dehydrated or has poor feeding.  If your baby takes longer than 40 minutes to feed, and seems exhausted or sweats a lot during feedings (not just where her skin touches you, but really sweating on the forehead, etc), there are other diagnoses, such as heart problems, that could be the cause of the wheezing.
  4.  Being under 2 months old.  If your baby is under 2 months old and has bronchiolitis symptoms, we should see her. This is especially true if there is a fever over 100.3 in a baby under 2 months old (the fever itself is not harmful, but sometimes it is a clue for a separate serious infection). Babies under 2 months old with RSV sometimes have longer pauses in their breathing – if there are long pauses (over 10-15 seconds) then we need to see her.
  5.  Having a new fever or worsening fever after the first 2-3 days.  Sometimes this is a clue that bacteria have taken advantage of the situation and caused a bacterial ear infection or some other infection (see our previous blog posts about these secondary bacterial infections). Sometimes respiratory viruses make a home for bacteria to grow.
  6.  Still wheezing after 3 weeks.

I hope you feel more empowered to care for your baby with bronchiolitis.  

Next week we will discuss croup, which is also on the pediatric respiratory virus “axis of evil”.

Payson and Spanish Fork, Utah, USA

Haley Pledger, PA
Women’s Care
Matthew Walton, DO
Austin Bills, DO
Family Medicine
Aaron Fausett, PA
Family Medicine
Load more results