Bronchiolitis Treatment

What is bronchiolitis?

The inflammatory disorder of the bronchi of the lung is known as bronchiolitis or bronchiolitis obliterans. The damage or inflammation caused by bronchiolitis to the bronchioles results in significant oxygen scarring. Infants are quite frequently prone to bronchiolitis. The symptoms are minimal in most cases of the condition. In some instances, nevertheless, significant symptoms may be present which require hospitalization. In mild cases, bronchiolitis can be treated at home. 

Causes and symptoms

Bronchiolitis is a  respiratory syncytial virus (RSV) mediated chest infection. However, it might also occur as a result of exposure to poisons like diacetyl. This infection is airborne, which means that the virus transmits through coughing and sneezing. 

Older children may have coughing or colds from the respiratory syncytial virus as opposed to young children.

 At the early stage of Bronchiolitis, most of the symptoms are similar to common colds such as sneezing,  runny or blocked nose,  cough and a slightly high temperature of 38℃.

Additional signs and symptoms of bronchiolitis obliterans include 

• quick breathing 
• feeding or eating challenges 
• Wheezing
• Irritation

Diagnosis

The doctor can make the initial diagnosis by watching your child and using a stethoscope to listen to the lung. However, a doctor may order testing in cases of acute bronchiolitis, such as 

• X-ray of the chest: to look for any indication of pneumonia.
• Viral analysis:  In this process, the doctor uses a swab to gently remove mucus from your child in order to test for the respiratory syncytial virus (RSV).
• Blood test: A blood test reveals your child's blood's White Blood cell count. An increase in WBC counts shows that the body is fighting an infection.

Treatment 

Treatment for bronchiolitis is available in both the hospital and at home. Home remedies are available for mild bronchiolitis. Patients with acute bronchiolitis must be admitted to the hospital.

Treatment at home

There is no specific therapy for bronchiolitis.  Patients with bronchiolitis can get better with time. There are a few natural therapies, including 

Ibuprofen is advised for infants older than 3 months, while children's paracetamol is advised for those older than 2 months (only with a doctor's prescription) 

Apply saline water drops to your nose if it is blocked. 

When your child is awake, try to keep them as upright as you can to increase oxygen flow. Encourage your child to drink more extra water or diluted fruit juice to increase fluid intake.

Treatment at hospital

Hospitalization is necessary in the event of acute symptoms. In the emergency department, there are primarily two treatments that are accessible to the affected patients. Naso-gastric feeding and nasal cannula oxygen.

Nasal cannula oxygen 

For newborns with acute bronchiolitis, nasal cannula oxygen therapy provides a high flow of oxygen to help their respiratory systems. It offers a high flow of humid air with an adjustable oxygen content at body temperature. This medication is well tolerated by infants.

Naso-gastric feeding

The AAP clinical practice recommends nasogastric feeding for infants who have trouble sustaining oral hydration. The main method of hydration is IV fluids. Nasogastric feedings are advised for infants between the ages of one and 24 months.

Admit to intensive care unit

The majority of the time, hospital admission is not necessary for bronchiolitis. Acute bronchiolitis, however, may necessitate admitting your kids to the pediatric intensive care unit. Invasive mechanical breathing was needed in about 2–6% of hospitalizations. Prematurity, youth, environmental factors, and comorbid conditions such as chronic lung illness, congenital heart disease, immunodeficiency, and neurological diseases are some of the risk factors which lead to being admission to an intensive care unit. 

Treatment in intensive care unit

There are five basic categories of treatment in intensive care units. The mainstays of the treatment include physiotherapy, hydration and nutrition support, antibiotic therapy, nebulizer use, and breathing support.

Breathing support

A ventilator, which provides high flow oxygen in the mouth and nose with the help of a tube or a small incision on the chest, which is known as tracheostomy is usually done to support breathing in cases of acute Bronchiolitis obliterans. A monitor is attached to track vital heart rate, blood pressure and oxygen saturation levels.

Antibiotics

The condition known as bronchiolitis obliterans is not caused by bacteria. Antibiotics are therefore not suggested for the treatment. To treat throat infection symptoms, you can use Azithromycin to reduce lower respiratory tract infection. 

According to data from the Canadian Bronchiolitis Epinephrine Steroid Trial, dexamethasone and epinephrine are the most effective medications for treating bronchiolitis in infants between the ages of 6 weeks and 12 months.

Fluids and feeding

Dehydration is a result of bodily fluid loss in both mid- and acute symptoms. It's crucial to practise maintaining the body's hemodynamic balance in order to avoid dehydration. Saline water is the main component of the fluids utilized in the treatment. Additionally, nasal passages are cleaned with saline water to improve oxygen flow. 

Many vital nutrients wash out of the body as a result of fluid loss, therefore, maintaining a healthy diet is crucial. Foods in liquid form that are high in nutrients are preferred.

Nebulisers

Nebulizers are advised when bronchiolitis symptoms become acute. Nebulizers are devices that include a face mask, a chamber where medications are transformed into a fine mist, and a compressor to deliver the medication to the lungs.

Saline water is one of the treatments that can be delivered using a nebulizer. All of these drugs work to thin the phlegm, which makes it easier to cough. Antibiotics are occasionally administered using nebulizers.

Physiotherapy

Through clearing lung secretions and the places where the lungs collapse, chest physical therapy  minimizes the breathing effort. As a result of bronchiolitis, the bronchioles in the lung collapse and become inflamed. The collapsed bronchioles can be treated with physiotherapy, which can also improve the lung's ability to increase oxygen flow.

Looking after the child at home

There are certain measures you may take to lower your child's risk of developing bronchiolitis obliterans, including 

• Wash your hands and your kids' hands more frequently. 
• Frequently clean surfaces and wash toys 
• Use disposable tissues to sneeze
• Keep young children (especially under two months or premature babies) away from people who are sick
• Avoid smoking in your child's presence. Secondary smoke can lead children to be at an increased risk of developing acute bronchiolitis symptoms.

Complications

Following are some potential complications in cases of severe bronchiolitis: 

• Cyanosis (due to lack of oxygen) which results in blue lips or skin. 
• Apnea (irregular breathing which usually occurs during sleep) is a common condition in newborns or premature neonates. 
• Dehydration. 
• Low oxygen levels and respiratory failure. 

You must take your child to the emergency room if they have acute bronchiolitis so that endotracheal intubation can be done to improve oxygen flow. Minute surveillance is advised if your baby has an existing heart /lung condition or immune system suppression. 

Summary

In young children between the ages of 2 and 12 months, bronchiolitis, also known as bronchiolitis obliteran, is a relatively frequent condition. This is an airborne disease which leads to obstruction of oxygen flow to the lungs. In the majority of cases, home remedies can be used for therapy. Patients must take high oxygen flow or supplemental oxygen support when they have acute symptoms. Any severe breathing difficulties should be informed to the paediatrician or physician and it is advised to avoid self-medication if you are unsure of the side effects.