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Respiratory Health

Bronchiolitis: A Parent’s Guide to Symptoms, Causes & How to Prevent It

Wheezing, coughing, and difficulty breathing can be signs of a viral infection called bronchiolitis, which affects children. But did you know that you can help prevent it with a few simple steps?

Dec 13, 2024

7 min read

Written by 
Dr Linnet Thomas 

Medically Reviewed by 

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Bronchiolitis: A Parent’s Guide to Symptoms, Causes & How to Prevent It

Bronchiolitis can be a big concern for parents, especially with little ones at home. If you've ever felt confused about what it is, how it’s different from bronchitis, or what signs to watch out for, you’re in the right place. Let’s break it down in simple terms to give you a good handle on this common respiratory illness.

What is bronchiolitis?

Bronchiolitis is a common lung inflammation in babies, especially during the winter months. It’s usually caused by a virus called the respiratory syncytial virus (RSV). 

Various viral agents have been recognised as the causes of acute bronchiolitis, including RSV, rhinovirus, parainfluenza viruses, influenza virus, adenovirus, and coronavirus. RSV is the predominant cause, responsible for 50%-80% of cases.

In India, the epidemiology of RSV infection has been extensively studied in young children (0-5 years), more so than in other age groups. Various studies indicate that the rates of RSV detection in younger children (0-5 years) range from 2.1% to 62.4% in India, which is higher than in other age groups.

In bronchiolitis, the bronchioles, which are the tiny airways in the lungs, become inflamed and mucus-filled, leading to blocked airflow. This causes symptoms like coughing, wheezing, and difficulty breathing. Bronchiolitis mostly affects children under two and is one of the main reasons babies are hospitalised during winter. Most cases can be managed at home, but sometimes hospitalisation is necessary. Identifying symptoms early and providing supportive care can make a big difference in helping babies recover comfortably.

Quick Explainer

In bronchiolitis, the bronchioles, which are the tiny airways in the lungs, become inflamed and mucus-filled, leading to blocked airflow.

What is the difference between bronchiolitis and bronchitis?

Bronchiolitis and bronchitis are both lung inflammations, usually caused by viruses, but they affect different parts of the lungs and often strike different age groups.

Bronchiolitis mainly affects babies and toddlers under two. It causes swelling in the small airways (called bronchioles), which can lead to coughing, wheezing, and trouble breathing. Young children might also show other signs of struggling to breathe, like flaring their nostrils or using extra muscles in their chest.

Bronchitis, on the other hand, affects the larger airways (bronchi) and can happen to people of all ages, though it’s rare in very young children. Acute bronchitis often comes after a cold or flu and can bring chest pain, tiredness, and a cough with mucus. Chronic bronchitis is a long-term condition classified as a chronic obstructive pulmonary disease (COPD).

What are the signs and symptoms of bronchiolitis?

Bronchiolitis typically begins with cold-like symptoms, such as:

  • Runny or stuffy nose
  • Mild cough
  • Fever
  • Loss of appetite

After a day or two, symptoms may worsen and can include:

  • Fast breathing
  • Wheezing (a high-pitched sound when breathing out)
  • Difficulty breathing; watch out for widened nostrils, grunting sounds, wheezing, and difficulty drinking. A bluish hue on the lips and fingertips can also signify low oxygen levels resulting from obstructed airways. 
  • Irritability

Dr Abdulsamad Mannaravalappil, Pulmonology, Assistant Professor at KMCT Medical College, Mukkam, Calicut, explains the clinical presentation of bronchiolitis in children, “Mild bronchiolitis is characterised by little to no respiratory distress and a normal mental status and activity level. In moderately severe bronchiolitis, you’ll notice moderate tachypnea and respiratory distress, with retractions but without grunting or head bobbing. Severe bronchiolitis involves persistent tachypnea, considerable respiratory distress, agitation, apnea, and lethargy.”

He emphasises the importance of monitoring symptoms such as apnea, hypoxemia requiring oxygen therapy, poor feeding, and dehydration, as these are concerning signs of disease progression.

In severe cases, babies may have trouble eating or drinking, which can lead to dehydration. Signs of dehydration include:

  • Drinking less than usual
  • Dry mouth
  • Crying without tears
  • Urinating less often

If you observe any signs of trouble breathing or dehydration, contact your child's doctor immediately.

vector

2.1%-62.4%

2.1%-62.4% is the rate of RSV detection in younger children (0-5 years) in India.

What causes bronchiolitis?

The primary trigger for bronchiolitis is a virus; RSV being the most widespread. Other viruses, like influenza, rhinovirus, adenovirus, parainfluenza, and sometimes COVID-19, can also lead to it.

These viruses transmit readily through small droplets released during coughs and sneezes as well as by contacting contaminated surfaces. This is why kids in daycares or crowded places are more likely to catch them. Infants are especially at risk during their first RSV infection, which is usually the most severe.

What are the risk factors for bronchiolitis?

  • Age: Babies under 6 months old are more likely to get bronchiolitis.
  • Birth factors: Babies born prematurely (before 37 weeks) and those who have a low birth weight face an increased risk.
  • Living conditions: Crowded homes and families with low socioeconomic status can increase the chances.
  • Feeding: Babies who are not breastfed may have weaker immune systems.
  • Health issues: Chronic lung problems, airway birth defects, and immune disorders make children more vulnerable.
  • Exposure: Being around cigarette smoke or having parents who smoke can raise the risk.

Did You Know?

The viruses that cause bronchiolitis are easily transmitted through respiratory droplets in the air or by contacting shared surfaces.

What are the types of bronchiolitis?

Based on the cause, bronchiolitis is divided into viral bronchiolitis and bronchiolitis obliterans:

  • Viral bronchiolitis: Common in children under 2, especially infants under 6 months. Mainly caused by the RSV virus and often spreads in autumn and winter.
  • Bronchiolitis obliterans (popcorn lung): A rare, severe form affecting adults, typically due to inhaling harmful chemicals or severe infections, leading to irreversible airway scarring.

Based on age, bronchiolitis is divided into infantile and adult bronchiolitis:

  • Infantile bronchiolitis: Seen in young children, often due to viral infections like RSV.
  • Adult bronchiolitis: Occurs in adults and can result from environmental exposure or infections.

Can you prevent bronchiolitis?

There are simple ways to help protect your child from bronchiolitis infection. Start by washing your hands often, especially after being in public places. Keep your child away from people who are sick, and avoid sharing cups or utensils. Clean toys and frequently touched surfaces to keep them germ-free and protect your child from exposure to smoke. If your child does get sick, keep them at home until they’re better to help avoid spreading the illness to others.

What are the complications of bronchiolitis?

Bronchiolitis is usually mild and resolves on its own, but some children, especially those born prematurely or with existing health issues, may face complications. Possible complications include:

  • Breathing issues: Such as pauses in breathing (apnea) and breathing failure
  • Severe respiratory conditions: Includes acute respiratory distress syndrome (ARDS) and bronchiolitis obliterans.
  • Heart problems: Includes heart failure or irregular heartbeats
  • Infections: Other infections can develop as well
  • Chronic lung disease: Long-term respiratory issues can develop

Treatment of bronchiolitis

Regarding treatment in children, Dr Abdulsamad Mannaravalappil, Pulmonology Assistant Professor at KMCT Medical College, Mukkam, Calicut, explains, “Supportive care is the mainstay of management in both emergency and inpatient settings.”

Be a better-prepared caregiver

While bronchiolitis can be worrisome, especially if you’re a parent, understanding what it is and how to spot it can make a world of difference. By knowing the symptoms, risk factors, and steps to help prevent it, you can feel more prepared if it comes around. And remember, always trust your instincts. If you’re ever concerned about your child’s breathing or health, reach out to a doctor. Here’s to healthy, happy little lungs!

Frequently Asked Questions

1. How common is bronchiolitis?

Bronchiolitis is a common respiratory illness in children under 2, affecting about 11%–15% of infants in their first year. The World Health Organization estimates 150 million new cases globally each year, with 2%–3% of infants requiring hospitalisation.

2. What can I expect if my child has bronchiolitis?

When a baby has bronchiolitis, the small airways in their lungs (called bronchioles) become swollen. This swelling restricts airflow to and from the lungs, resulting in breathing difficulties. Babies are particularly affected because their airways are smaller and more likely to get blocked compared to older children. As a result, they may experience symptoms like coughing, wheezing, and trouble breathing. In severe cases, bronchiolitis can require medical attention to help the baby breathe more easily.

3. Can you have bronchiolitis more than once?

Yes, you can have bronchiolitis more than once. In fact, it’s possible for children to experience bronchiolitis multiple times, even within the same season, due to different viral infections.

4. What is the maximum age for bronchiolitis?

Bronchiolitis typically affects children younger than 2 years old, with the highest incidence occurring in infants between 3 to 6 months of age.

5. Is bronchiolitis a viral infection?

Bronchiolitis is primarily triggered by a viral infection, most likely caused by the respiratory syncytial virus (RSV).

6. What are the most common viruses that cause bronchiolitis?

The primary virus responsible for bronchiolitis is Respiratory Syncytial Virus (RSV). Other viruses that can also cause bronchiolitis include human rhinovirus, human metapneumovirus, adenovirus, parainfluenza virus, human bocavirus, influenza virus, and coronaviruses.

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