Definition
Inflammation and congestion of the bronchioles, typically caused by a viral infection.
EtiologyMost commonly: respiratory syncytial virus (RSV)
- Other pathogens: rhinovirus, influenza
- Cough
- Wheeze
- Tachypnoea
- Fever (low grade)
- Recent history of rhinitis/URTI
- Increased Wwork of breathing
- Intercostal recession
- Tracheal tug
- Paradoxical breathing
- Grunting
- Nasal flaring
Bronchiolitis is a clinical diagnosis.
Consider CXR in severe disease or treatment failure
ManagementWatchful waiting, with pulse oximetry for monitoring
- Admit to hospital if:
- Difficulty feeding
- Moderate or severely increased work of breathing
- Tachypnoea
- SaO2 under 94%
- Supportive management:
- Oxygen to SaO2 >90%
- Maintain hydration and nutrition
- Consider nebulised hypertonic saline to assist mucous clearance
- Options NOT supported by evidence:
- Bronchodilators
- Corticosteroids
- Chest physiotherapy
- Empirical antibiotic therapy
