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Bronchiolitis: Causes, Symptoms & Treatment

Bronchiolitis is a common respiratory illness that mainly affects infants, causing inflammation of the small airways (bronchioles). Learn about causes, symptoms, and treatment options.

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Things worth knowing about "Bronchiolitis"

Bronchiolitis is a common respiratory illness that mainly affects infants, causing inflammation of the small airways (bronchioles). Learn about causes, symptoms, and treatment options.

What is Bronchiolitis?

Bronchiolitis is an acute inflammation of the small airways known as bronchioles, which carry air deep into the lungs. During bronchiolitis, the lining of these airways swells, excess mucus is produced, and the airways can become partially blocked. The condition primarily affects infants and children under the age of two, although older children and adults can occasionally be affected as well.

Causes

Bronchiolitis is almost always caused by a viral infection. The most common culprit is the Respiratory Syncytial Virus (RSV). Other viruses that can trigger bronchiolitis include:

Influenza viruses
Parainfluenza viruses
Adenoviruses
Rhinoviruses (common cold viruses)
Human Metapneumovirus (hMPV)

The virus spreads mainly through droplets produced when an infected person coughs or sneezes, or through direct contact with contaminated surfaces. Bronchiolitis is most prevalent during the autumn and winter months.

Risk Factors

Certain factors can increase the risk of developing a severe form of bronchiolitis:

Premature birth (before 37 weeks of gestation)
Congenital heart defects
Chronic lung conditions such as bronchopulmonary dysplasia
Weakened immune system
Age under three months
Exposure to secondhand smoke

Symptoms

Bronchiolitis typically begins with symptoms resembling a common cold:

Runny nose and sneezing
Mild fever
Cough

Over the course of several days, symptoms may worsen and additional signs can develop:

Wheezing (a high-pitched whistling sound when breathing out)
Rapid breathing (tachypnea)
Visible effort to breathe, including retractions of the chest muscles
Difficulty feeding or reduced appetite
Bluish discoloration of the lips or fingernails (cyanosis) in severe cases

If a child shows signs of breathing difficulty, cyanosis, or is drinking less than half the normal amount of fluids, medical attention should be sought immediately.

Diagnosis

Bronchiolitis is primarily diagnosed clinically, meaning through a thorough physical examination and review of the child's medical history. The healthcare provider will listen to the lungs and assess the breathing rate and pattern. Additional tests may include:

Pulse oximetry: Measurement of blood oxygen levels
Nasal swab: To detect the virus (e.g., RSV rapid antigen test)
Chest X-ray: Only if diagnosis is uncertain or complications are suspected
Blood tests: If a bacterial superinfection is suspected

Treatment

Treatment of bronchiolitis is mainly supportive and symptomatic, as no specific antiviral therapy is available for most cases. Key measures include:

Supportive Care

Ensuring adequate fluid intake (frequent small feeds; tube feeding or intravenous fluids if needed)
Nasal suctioning to help clear the airways and ease breathing
Fever management with paracetamol or ibuprofen (as directed by a healthcare professional)
Positioning with the head slightly elevated

Oxygen Therapy

If blood oxygen saturation falls below 90–92%, supplemental oxygen is administered via nasal cannula or face mask.

Hospital Care

Severe cases may require hospitalization, and in rare situations, mechanical ventilation may be necessary. Antibiotics are only used when a bacterial superinfection has been confirmed.

Prevention

Several measures are available to reduce the risk of severe RSV-related bronchiolitis in infants:

Nirsevimab (Beyfortus®): A monoclonal antibody given as a single injection to infants during the RSV season to protect against severe bronchiolitis.
RSV vaccination during pregnancy: Immunizing the mother during pregnancy helps protect the newborn.
Frequent handwashing and avoiding contact with sick individuals
Breastfeeding supports the infant's immune defenses

Prognosis

Most children with bronchiolitis recover fully within one to three weeks. However, high-risk infants or those with severe illness may develop complications. Some studies suggest that a history of bronchiolitis may increase the risk of developing asthma later in life, although the exact relationship is still under investigation.

References

World Health Organization (WHO): Acute respiratory infections in children. Geneva: WHO; 2023. Available at: https://www.who.int
Ralston SL et al. - Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014;134(5):e1474-e1502. doi:10.1542/peds.2014-2742
Florin TA, Plint AC, Zorc JJ - Viral bronchiolitis. The Lancet. 2017;389(10065):211-224. doi:10.1016/S0140-6736(16)30951-1

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