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Wednesday, March 26, 2008

Bronchiolitis

Bronchiolitis is an infection of the lungs airways. It most often occurs in young children, commonly between 3 and 6 months of age. About one in nine babies gets bronchiolitis in his or her first year of life, usually during the fall and winter months.

Bronchiolitis starts out with signs and symptoms similar to those of a common cold but then progresses to coughing and wheezing.

Although a child's bout of bronchiolitis may be scary, particularly for parents, signs and symptoms typically last for about a week and then go away. In the meantime, you can take a number of self-help measures to make your child more comfortable.

Causes:
Bronchiolitis occurs when an infectious agent — usually a virus — enters the respiratory system and makes its way to the bronchioles, causing them to become inflamed and swollen. As a result, mucus often collects in these airways, which can make it difficult for air to flow freely through your lungs.

In older children and adults, the resulting signs and symptoms are generally mild. But an infant's bronchioles are much narrower than are an adult's and are more easily blocked, leading to greater difficulty breathing.

The respiratory syncytial virus (RSV), a common virus, causes more than half of all childhood bronchiolitis cases. The rest are caused by infectious agents such as parainfluenza viruses, the influenza (flu) virus, some adenoviruses, Mycoplasma pneumoniae organisms or human metapneumovirus. Severe cases of bronchiolitis may reflect multiple infections, such as a combination of RSV and metapneumovirus.

Bronchiolitis is a contagious condition. You contract the infectious virus just like you would a cold or the flu — by inhaling airborne droplets of infected mucus or other respiratory secretions or by touching objects contaminated by these secretions and then touching your eyes, the inside of your nose or mouth.

Symptoms:
For the first two or three days, the signs and symptoms of bronchiolitis are similar to those of a common cold:

* Runny nose
* Stuffy nose
* Slight fever (may or may not occur)

After this, there may be two or three days of:

* Wheezing — breathing seems more difficult or noisy when breathing out
* Coughing — tends to be harsh, comes in fits and doesn't produce any phlegm
* Rapid or difficult breathing
* Rapid heartbeat

Severe bronchiolitis may cause your child to have difficulty breathing or develop bluish-looking skin (cyanosis) — a sign that he or she isn't getting enough oxygen. This requires emergency medical care.

Diagnosis:
Your doctor will likely listen to your child's lungs with a stethoscope to check for wheezing and prolonged breathing out (exhaling). These may indicate obstructed airflow in the bronchioles. The doctor may consider specific risk factors for bronchiolitis as well.

Sometimes other tests are recommended, including:

* Chest X-ray-In severe or uncertain cases, your doctor may request that a chest X-ray be taken to visually check for inflammation of the airways in the lungs and any signs of pneumonia. Your doctor may also check for the presence of a foreign object, such as a peanut or small piece of plastic, that your baby or toddler may have inhaled.
* Mucus sample test-In addition, your doctor may collect a sample of mucus from your child — using a nasal pharyngeal swab or a suction catheter that's gently inserted into the nose — to test for the virus that may be causing the bronchiolitis.

Treatment:
You can treat most cases of bronchiolitis at home with self-care steps. Because a virus is usually the cause of bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — aren't effective against it. If your child has an associated bacterial infection, such as pneumonia, your doctor may prescribe antibiotics for that.

In more severe cases, doctors may prescribe a bronchodilator, a medication to open up the airways in the lungs, such as albuterol or albuterol inhalers (Proventil, Ventolin, others). Inhaled antiviral drugs may also be used, although they may not always be as effective as desired.

Ribavirin is an antiviral drug which has a controversial role in treating RSV infection. There is no proven benefit but it is used sometimes for infants with pre-existing lung, heart or immune disease.

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