Bronchiolitis occurs primarily in infants

Bronchiolitis is an infection of the small airways of the lung, which occurs primarily in young infants; most often in those aged between 2 and 24 months.

Bronchiolitis is usually caused by a virus known as Respiratory Syncytial Virus (RSV) which is a common cause of colds. In babies, RSV can travel to the lower airways causing bronchiolitis. The term bronchiolitis means inflammation of the bronchioles; the smallest airways within the lungs.

It most commonly occurs during winter months - November to March - and it is estimated that up to 1 in 3 babies under the age of 12 months suffer with bronchiolitis at some point. It usually affects babies aged 3 to 6 months and normally it is easily managed by the family GP. It is estimated that approximately 2 in 10 babies will require admission to hospital with bronchiolitis. Babies at higher risk include premature babies, babies with heart conditions and babies with underlying lung conditions. SYMPTOMS

The main symptoms of bronchiolitis are as follows:

- Symptoms of the common cold such as runny nose, cough and mild fever which usually occur for the first 2 to 3 days.

- Fast breathing, difficulty with breathing and wheezing may develop as the infection travels to the bronchioles.

- The nostrils may flare and the number of breaths that an infant takes may go as high as 60-80 per minute as the condition worsens.

- As the baby requires more effort to breathe one can visualise the muscles between the ribs moving inwards during each breath.

- At this point, the baby may have difficulty feeding as they feel tired, unwell and may struggle to breathe and feed at the same time.

Symptoms usually peak in severity from day 2 to 3 of the illness and may vary in severity from mild (a heavy cold) to severe, with serious breathing difficulties requiring hospital admission.

After peaking, the symptoms gradually ease and usually subside entirely within 1 to 2 weeks. A cough may linger for several weeks after the other symptoms have resolved and some children develop wheezy chests. This is called post bronchiolitis syndrome and usually goes away in time. In the minority of cases the wheezy symptoms may develop on and off for several years, usually with coughs and colds.

TREATMENT

Bronchiolitis usually resolves as the immune system clears the virus. There is no medicine that will kill the virus. Antibiotics do not kill viruses and are not usually prescribed. The aim of treatment is:

- To make sure that the baby does not become dehydrated. - To help with breathing if it becomes difficult. Infants may be treated at home in most cases. Your doctor will ensure that your baby is well hydrated and that he or she is able to breathe reasonably well. About 2 in 10 babies will however, require hospital admission and for the most part. This will involve a short stay until they are over the worst of the illness. In the event of a hospital admission oxygen may be administered and a tube may be passed into the baby’s stomach in order to be able to feed the baby, ensuring optimal nutrition. Some babies become seriously ill or develop pneumonia as a complication and intensive care is needed in a very small number of cases.

PREVENTION

It is impossible to totally avoid the RSV virus. It may be sensible, however, to keep young babies away from people with coughs and colds. Studies have shown that not smoking and breastfeeding may be protective against developing bronchiolitis and may prevent infants from developing a more severe bout of illness.