Clinical Review Bronchiolitis in children

Clinical Review Bronchiolitis in children

Hi-flow oxygen or CPAP is often used and may uncommonly need ventilation and transfer to a PICU. Bronchiolitis is a common viral respiratory condition affecting the small airways of young children only. The results suggest that steroids are not effective in the treatment of chest infections in non-asthmatic adult patients. Diagnosis
Bronchiolitis is a clinical diagnosis based upon typical history and examination.

  • The air trap can be diffuse or mosaic perfusion (geographical areas with variable attenuation of patchy distribution) that are most obvious in the expiratory phase [2].
  • In most children, breathing problems usually improve after a few days.
  • Treatment with corticosteroids and bronchodilators may require the use of separate inhalers, but increasingly these medications are provided together in single inhalers.
  • A focused history and full clinical examination with assessment of the severity of the disease is vital.
  • About 2 to 3% of babies who develop bronchiolitis during the first year of life will need to be admitted to hospital because they develop more serious symptoms, such as breathing difficulties.
  • In most cases, bronchiolitis is mild, children manage well at home and will get better within 2-3 weeks without needing treatment.

It’s also more likely to cause side effects, so is often only used alongside these medicines if they’re not effective enough. The effect of theophylline is weaker than other bronchodilators and corticosteroids. Theophylline is usually taken in tablet or capsule form, but a different version called aminophylline can be given directly into a vein (intravenously) if your symptoms are severe.

Lower Respiratory Tract Infections

Several things can increase a child’s likelihood of developing the infection. Most cases of bronchiolitis are not serious, but the symptoms can be very worrying. The symptoms usually get worse during the next few days before gradually improving. Wheeze is a common symptom, however, it may be mistaken for other sounds such as stridor, snoring or congestion.

  • Oxygen saturations should be measured on all patients, by an appropriately trained health care professional.
  • The results suggest that steroids are not effective in the treatment of chest infections in non-asthmatic adult patients.
  • This latter finding is characteristic of most advanced peribronchiolar fibrosis [20].
  • Others had chronic silent microaspiration, hypersensitivity or toxic reactions, turning it difficult to segregate the contribution of each factor [37].
  • Administration can however cause temporary irritation and bronchospasm which can be reduced by administering with a bronchodilator e.g. adrenaline.

Long-acting bronchodilators should never be taken without corticosteroids. Authors AA and IA contributed equally in the planning, data collection, data analysis, writing and critical review. 3) In most patient’s tissue is required to make the diagnosis and classification. Dehydration is an important sequelae of bronchiolitis and all patients should have a hydration assessment.

What is the treatment for bronchiolitis?

For example, antibiotics and corticosteroids aren’t recommended for treating bronchiolitis. A small plastic tube will be inserted into your child’s nostrils to suck out the mucus. Always follow the manufacturer’s instructions or check with your pharmacist before using saline nasal drops. Always follow the manufacturer’s instructions when giving your child medication.

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If your child develops complications from bronchiolitis, it’s likely that they’ll need hospital treatment. Research also suggests that chest physiotherapy, where physical movements or breathing techniques are used to relieve the symptoms, is of no benefit. If your child cannot use nasogastric fluids, or they’re at high risk of respiratory failure, they may be given fluids directly into a vein (intravenously). If your child has RSV, they’ll need to be kept away from other children in the hospital who are not infected with the virus to stop it spreading.

When to get medical advice

While it is unusual for children to need hospital treatment for bronchiolitis, the symptoms can get worse very quickly. It’s particularly important to get medical advice if your baby is less than 12 weeks old or they have an underlying health condition, such as a congenital (present from birth) heart or lung condition. Around 1 in 3 children in the UK develop bronchiolitis during their first year of life. I am writing this blog to be a go to for any mum who may find herself with a baby with bronchiolitis and who needs access to feeding advice.


Club cells (originally called Clara cells) promote the regeneration of airway epithelium and may be reduced in number or eliminated as a result of epithelial injury. Certain polymorphisms of genes of the immune system favor this phenomenon which represents a rejection of the allo-graft towards the host and is an expression of GVHD [2]. The condition typically develops within the first 2 years of transplantation, although it can occur several years later.

Passive smoking can affect the lining of your child’s airways, making them less resistant to infection. A small number of children will still have some symptoms after 4 weeks. In most cases, bronchiolitis is mild and gets better within 2 to 3 weeks without needing treatment.