It’s once again BRONCHIOLITIS season (winter)
Bronchiolitis is a very common condition but can be potentially very serious and even be fatal. It is an infection of the smaller airways low down in the lungs.
Bronchiolitis is diagnosed mainly in babies ,infants and children under 2 years of age in the winter months. Generally the younger the child the bigger the risk of it being serious.
It is transmitted from one person to another via airborne droplets and on hands of caregivers.
It is highly infective as long as there is a runny nose and a cough that helps with the spread of the virus in these secretions. During this time they should stay away from daycare and crèches.
The bronchioli are the smallest and narrowest airways that ends at the alveoli (the air sacks where oxygen is absorbed and carbon dioxide is released from the blood into the lungs.)
When these narrow airways get inflamed they swell up and produce phlegm and the small muscles in them go into spasm. All of this results in narrowing of the airways and the babies/infants find it difficult to breath out as well as breath in because air is trapped in the lungs.
RSV (Respiratory synsitial virus) is the most frequent cause.
Influenza A + B + Swineflu.
Other less common viruses.
There is a high percentage of secondary bacterial infection in bronchiolitis ,henge the use of antibiotics in many cases that are hospitalized.
With the introduction of vaccines like PREVENAR against the Pneumococcus bacteria ,these secondary infections were significantly reduced and resulted in much less hospitalizations due to bronchiolitis.
NATURAL HISTORY of bronchiolitis:
•Cold symptoms with a runny nose or blocked nose.
•3-5 days later it moves into the chest.
•Phlegmy tight cough.
•Wheezy and rattling chest.
•Might or might not have fever.
Criteria to have the baby admitted to hospital:
•Shortness of breath.
•In drawing of the lower chest cage or notch in neck with breathing.
•Lips and tongue thats less pink or even blue.
•Poor feeding and or vomiting.
If at all possible do not let babies under 4 months go to daycare or creche especially between April and August in the southern hemisphere’s winter.
Currently there is no effective vaccine that can be used universally.
There is an injection called Synagis that is used in high risk babies and infants during the at risk season. This is given monthly during the winter and costs approximately R 13 000 a shot.At risk babies and infants are those born prematurely and with lung or heart problems or an immune deficiency. Some medical aids might reimburse it in selected cases.
Treatment of this condition is very controversial in medical circles because most recommendations are based on research that will only indicate whether a specific treatment shows statistical significant benefit in a large group of patients.It does not show that there are some children who will respond very well to some of the treatments.Because there is no way to predict who the good responders to treatment will be, I will give every child the benefit of the doubt and treat them with what is safe and available to me.
Out of hospital.
1. SINGULAIR / MONTEAIR 4 mg per day in the evenings x 14 days
2. ASPELONE(Prednisolone)in the mornings x 5 days
The above two medications are to control or reduce the inflammation caused in the bronchioli by the virus.
3. An antibiotic if a secondary infection is suspected
4. Inhalations of DUOLIN(Ipratropium plus Salbutamol)to reduce phlegm and open up the airways.
5. Physiotherapy to get the phlegm out of the airways.
6. Insure good fluid intake and prevent dehydration.
In hospital treatment.
All of the above plus:
1. Oxygen via nasal prongs for respiratory distressed babies.
2. Nebulize medication using oxygen instead of room air.
3. Intravenous fluid or nasogastric feeding if intake is poor.
4. Regular physiotherapy
5. Intravenous antibiotics if a resistant secondary bacterial infection is suspected.
6. Supervised administration of medication by nursing professionals.
7. Sometimes babies end up in the ICU and might even require mechanical ventilation. This is very seldom the case if we intervene early enough.
I often have parents ,which have included doctors and medical specialists ask me why their children need to be admitted to hospital and what could be done in hospital that can’t be done at home. I hope the above mentioned points help them to understand why hospitalization are sometimes necessary.
Babies could carry on coughing for weeks after an episode of bronchiolitis and may even have a recurrent wheezy chest in the first few years of their lives.
Dr Willem Smit