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December 15, 2014

Bronchiolitis and RSV

Winter is right around the corner, and with it cold and flu season. One of the most common conditions we see in the winter is bronchiolitis.

It is an infection of the lower respiratory tract characterized by cough, congestion, and wheezing, and is very common in children. The infection causes cells lining the small airways to die and can clog those airways causing difficulty breathing.

Bronchiolitis is most commonly caused by a viral infection, so antibiotics do not help. The virus most frequently associated with bronchiolitis is called RSV which usually circulates between November and April, with most infections and hospitalizations occurring in January and February. Almost all children have been infected by age 3, but most do not need to be hospitalized. Children most likely to require hospitalization include:

  • Infants under 6 months old

  • Infants with underlying lung disease

  • Infants born before 35 weeks gestation

  • Infants and children with congenital heart disease

  • Children with compromised immune systems

  • Children with asthma and/or exposure to second hand smoke

RSV and other infections that cause bronchiolitis are spread through secretions from the nose and mouth, prevention includes minimizing exposure to those secretions as well as other airway irritants. Preventative steps include:

  • Minimizing exposure to tobacco and other smoke

  • Keeping high risk infants out of daycare if possible

  • Ensuring good hand washing, especially among siblings

  • Practicing good cough hygiene-coughing into elbow or tissue and washing hands after cough or sneeze

When a child does need to be hospitalized for bronchiolitis, the majority of treatment is supportive

  • If the child has a history of asthma, or there is a  family history, he or she may get a breathing treatment with asthma medication to relieve any asthma component to their increased work of breathing

  • If the child is unable to drink enough to stay hydrated, fluids through the IV

  • And if the child is unable to get enough oxygen from the room air,  supplemental oxygen through a mask or tubes in the nose may be given

Bronchiolitis is a self-limited illness that usually resolves within two weeks from the first symptoms. The most severe symptoms usually occur on days five through seven of illness, but the cough can last up to two to three more weeks. For more information: