What is bronchiolitis?
Bronchiolitis is an acute inflammatory disease affecting the smallest branches of the bronchial tree, the bronchioles. They are tubular in structure and act as airways. They lead to the alveoli, the basic structural units of the lungs, which perform the main function of lung tissue: gas exchange (the exchange of carbon dioxide and oxygen).
Local inflammation involving the bronchioles leads to retention of secretions and a narrowing of the airways. This reduces the amount of oxygen entering the blood through the alveoli. The most frequent cause of bronchiolitis is one of various infectious agents, most of which are viruses.
Although the disease can affect people of any age, acute bronchiolitis most often occurs in young children. In older children and adults, infection usually affects the larger airways, and they also cope better with swelling of the mucous membranes.
Because bronchiolitis usually affects children under the age of 2, the treatment plan must always be appropriate. For this reason, there is some disagreement among doctors about the use of different groups of medicines.
Treatment in Switzerland draws on advanced knowledge of the respiratory system in children and adults. In treating bronchiolitis, doctors at the best clinics in Switzerland rely exclusively on evidence-based medicine, which supports the fastest possible recovery with no lasting consequences for children’s health.
Risk factors for acute bronchiolitis include:
- newborns (especially premature babies)
- young infants (1–3 months) because of their low immunity
- children who attend group settings such as nurseries
- children with other conditions (cardiac / respiratory / allergic / neurological / renal)
Diagnosis
The typical symptoms of coughing, wheezing and laboured breathing in an infant often make it possible to diagnose the condition simply by examining the child. It is important to watch the child’s breathing. The easiest way to do this is to uncover the child’s upper body. If the child is having difficulty breathing, you may notice the skin below the larynx and between the ribs being drawn in on each breath. The child also usually breathes faster than normal. Children with such breathing difficulties should be seen by a doctor as soon as possible.
The examination assesses how severe the breathing difficulties are and what the child’s general condition is. The lungs are listened to with a stethoscope, which is usually enough to make the diagnosis. The oxygen saturation of the blood can also be measured. In rare cases, bacterial infections are ruled out with a blood test.
In most infected children, the symptoms are mild enough to be treated at home. Hospital admission may be an option for serious breathing problems. Children with other chronic conditions should be treated at a clinic. For others, exhaustion caused by rapid breathing is sometimes the reason for hospital admission.
Treatment includes:
- Positioning – lying on the back with the upper body raised.
- Fluids – by mouth; bronchiolitis carries a risk of dehydration due to insufficient feeding, rapid breathing (polypnoea) and vomiting. Overhydration, which can worsen bronchial obstruction, should also be avoided.
- Oxygen therapy – indicated for patients with hypoxaemia (SpO2 <95%) or respiratory failure;
- Suction of nasopharyngeal secretions – indicated for patients with upper airway secretions or apnoea; performed before feeds, before inhalation therapy and as needed. Nasal 0.9% sodium chloride solution can be used before suction.
- Bronchodilators – indicated in severe forms of the disease;
- Systemic glucocorticoids – indicated in severe forms;
- Antipyretics – paracetamol 10–15 mg/kg every 4–6 hours; ibuprofen 5–10 mg/kg every 6–8 hours;
- Mechanical ventilation – required in a small percentage of cases.
What is the prognosis for acute bronchiolitis
In uncomplicated cases, the prognosis is favourable. Recovery follows a normal course of 3–5 (7) days, depending on severity.
