Bronchiolitis: Everything you need to know

Bronchiolitis is a condition common in children that have symptoms very similar to asthma, and is most common between November and April.

These patients usually present to the emergency room with symptoms such as nasal flaring, retractions, grunting, wheezing, coarse inspiratory crackles, increased secretions, nasal stuffiness and congestion, cyanosis, hypoxia, increased heart rate, noisy breathing,  increased respiratory rate, irritability, and refusing to breast feed. They often commonly present with otitis media.

It's more common in children because their airways are smaller and more susceptible to narrowing. Usually it occurs within the first two years, with it's peak at 3-6 months.This condition presents nearly identical with asthma, and is often treated or misdiagnosed as such.

The best way to diagnose it is with a nasal swab. The most common causative agent is the respiratory syncytial virus (RSV), although it may also be caused by adenovirus, enterovirus, influenza, and chlamydia pneumoniae.

Asthma symptoms are caused by narrowing of the airways caused by inflammation that irritates smooth muscles wrapped around airways, causing them to constrict and squeeze (narrow) airways. The treatment for this is bronchodilators and corticosteroids.

Bronchiolitis symptoms are caused by the virus irritating airway epithelial cells, causing them to become inflamed. This mostly causes increased secretions that may cause a narrowing of the airways. This can cause difficulty breathing, resulting in wheezing, nasal flaring, chest retractions, and hypoxia. It can also cause a stuffy or snotty nose, making breathing difficult for nasal breathers.

Unlike asthma, bronchiolitis does not result in bronchospasm, and therefore corticosteroids and bronchodilators will be of little use. However, respiratory viruses can trigger asthma symptoms in those infants with a predisposition to developing asthma. When this happens, asthma treatment will be of use.

In most infants with this diagnosis, the best treatment is palliative care, such as good nutrition, hydration, suctioning, and oxygen. Some studies, however, have shown that epinephrine breathing treatments and dexamethasone might prove useful. A trial may be indicated for epinephrine, and if it fails to produce any benefit can be stopped. Otitis media can be treated with antibiotics. Nasal Steroid and Neosynephrine also work well to help keep the nasal passages open.

The best treatment that respiratory therapists can give is to perform a good nasal suctioning. This can be performed with a bulb syringe or a bugger-be-gone. Nasal irrigation can best be performed with a bugger-be-gone, and often clears the airways of snot enough to improve symptoms. If this doesn't work, then a breathing treatment with albuterol or epinephrine may be trialed. Usually, however, suctioning does the trick.

Myth buster: B2 agonists will benefit patients with RSV/bronchiolitis

I have now updated my post "15 myths of respiratory therapy" to now include 16 myths of respiratory therapy.  I have added the following: 

 B2 agonists will benefit patients with RSV/ bronchiolitis:  According to guidelines set forth by the Agency for Healthcare Research and Quality, beta 2 bronchodilators (which includes ventolin and xopenex) are not recommended for the routine treatment of bronchiolitis (RSV).  Studies show B2 agonists will work if asthma is a component, however, but not for pure RSV/bronchiolitis.  Racemic epinephrine has been shown in some studies to work, so this can be trialed.  What has been proven beneficial is nasal suctioning.  One of the main reasons for low sats and dyspnea is increased secretions and the inibility to expectorate, and thus suctioning (ideally with a Booger-B-Gone) is beneficial.  To view the guidelines, which are based on the latest research and studies, you can click here.
Actually, I think I'm up to 17 myths now.  You can view those myths by clicking here.