Bronchiolitis

How the disease is contracted

Bronchiolitis is an extremely contagious disease and may therefore devolve into an epidemic- in both the entire family and in other children and babies who come into contact with the patient (in preschools). 

Infection occurs in 2 ways: 

• In direct contact with the patient’s nasal secretions and saliva. 
• In contact with the patient’s hands or with objects that carry secretions, such as toys and towels. 

Risk groups 

Infants and babies under the age of two are at high risk of contracting bronchiolitis. Other groups are also at high risk of developing a serious disease and occasionally even complications: 

• Premature infants 
• Premature infants suffering from chronic neonatal lung disease (bronchopulmonary dysplasia – BPD). 
• Infants under 3 months of age. 
• Infants and children suffering from chronic heart disease. 
• Infants and children with compromised immune system. 
• Infants and children exposed to passive smoking. 

The disease period 

In the first days, symptoms will appear in the upper respiratory tract, such as runny nose and sore throat. Symptoms such as coughing, wheezing and shortness of breath may later appear in the lower respiratory tract. The disease peaks after 3-4 days, after which improvement begins. The course of the disease is approximately two weeks but the coughing may last for over one month. 

Diagnosis

In most cases, the pediatrician will be able to diagnose the disease based on a description of the symptoms alone. In more complex cases, such as hospitalization, a swab may need to be performed to determine the type of virus. 

If symptoms do not improve after 4 days or if they worsen, blood tests may need to be carried out for inflammatory measures as well as a chest x-ray to detect possible secondary bacterial infection. 

Recommended treatment

Because bronchiolitis is a viral disease, its treatment is supportive only and based on the symptoms: 

• Treatment of nasal congestion by saline solution. In infants, a nasal suction may be used. 
• Prevention of dehydration by frequent nursing or bottle feeds in small and frequent amounts. 
• Prevention of smoking in the patient’s environment. 

In the event of a serious illness, hospitalization may be required for respiratory observation and monitoring, use of oxygen if necessary, monitoring of administration of fluids and a proper diet. 

Prevention 

There is no way to completely prevent bronchiolitis but measures can be adopted to protect from infection, particularly among premature infants and small babies in the first months of life. 

• Wash hands: maintain hygiene and wash hands with soap and water, particularly around small babies and when coming into contact with them. This guideline is relevant not just for family members but for preschool staff and medical staff who come into direct contact with children. 
• Stay away from sick people: keep infants and babies away from other sick people and various items that they touched, such as towels, sheets and toys. 
• Prevent smoking: children exposed to passive smoke are at higher risk of developing the disease and its complications, as smoking affects the body’s natural mechanism that helps remove phlegm. 
• Breastfeeding: breastfeeding significantly reduces the chances of contracting various diseases, including RSV. 
• RSV vaccine: in accordance with the physician’s recommendation. 
• Stay at home: after a viral illness such as bronchiolitis, the recommendation is to give babies time to recover and rest before returning to the routine and preschool. When babies are returned to their preschool too quickly, before the immune system becomes sufficiently strong, they can recontract the illness.