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Bronchiolitis

Last updated: January 19, 2021

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Bronchiolitis is a lower respiratory tract infection (RTI) in which the bronchioles become inflamed because of a viral infection. Most often, the respiratory syncytial virus (RSV) is responsible. The infection occurs mainly in children below the age of two and is characterized by initial upper RTI symptoms (low-grade fever, stuffy nose) followed by a cough and possibly signs of respiratory distress (i.e., tachypnea, wheezing, nasal flaring, intercostal retractions, cyanosis) that may require hospitalization. Ill children should be closely monitored and receive oxygen and proper hydration for supportive therapy.

  • Primarily affects children < 2 years
  • Peak incidence: 2–6 months of age
  • Common during winter months

Epidemiological data refers to the US, unless otherwise specified.

An upper RTI followed by symptoms of respiratory distress and wheezing in a child < 2 years of age should prompt evaluation for bronchiolitis.

The differential diagnoses listed here are not exhaustive.

  • Pharmacologic treatment [1][2]
  • Supportive treatment
    • Adequate hydration
    • Relief of nasal congestion/obstruction
    • Monitoring
  • Indications for hospitalization

We list the most important complications. The selection is not exhaustive.

  • With timely diagnosis and adequate treatment, the prognosis is good
  • Bronchiolitis in infancy is associated with an increased risk of developing asthma.

Palivizumab [2]

Palivizumab is used for RSV (Paramyxovirus) Prophylaxis in Premature infants.

  1. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014; 134 (5): p.e1474-1502. doi: 10.1542/peds.2014-2742 . | Open in Read by QxMD
  2. Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev. 2014; 35 (12): p.519-530. doi: 10.1542/pir.35-12-519 . | Open in Read by QxMD