How Long Does Bronchiolitis Typically Last?

Introduction

“How long will my child need to recover from bronchiolitis?” This is the question you might be asking if your child is suffering from this chest infection.  Well, the time of recovery depends on the child, and the severity of the disease.

The course of this condition could last between 7-10 days, but the majority of infants improve in 14 - 21 days provided they receive treatment and are well hydrated.¹ Additionally, the acute phase of bronchiolitis usually lasts 3-7 days, although some symptoms may still be present during recovery.²

This article aims to explain what bronchiolitis is, its causes, symptoms, treatment and prognosis. If you would like to learn more, keep reading.

What is bronchiolitis?

Bronchiolitis is a common viral infection affecting the lungs of children under 2 years old. It causes inflammation in the lower respiratory tract, so the small airways (bronchioles) become narrower, making it hard to breathe. Despite this typically being a mild infection, sometimes it may result in respiratory failure in infants. This is a seasonal condition which is most common during autumn and winter, but it can also appear sporadically throughout the year.^1,2

Causes

Bronchiolitis happens as a consequence of a virus infection. Viruses that can cause this infection include:

• Respiratory syncytial virus (RSV) (this is the most common cause)
• Rhinovirus
• Coronavirus
• Human metapneumovirus
• Adenovirus
• Parainfluenza virus
• Human bocavirus¹ 

Despite RSV being the main cause, in 30% of the cases, bronchiolitis develops because of a combination of two viruses.

Risk factors

Although sometimes adults can develop bronchiolitis, this condition mostly affects infants under the age of 2. Your child might be more at risk of suffering from this respiratory issue if they: 

• Are premature infants with low body weight
• Are less than 5 months old
• Have a congenital (present at birth) immunodeficiency disorder
• Show abnormalities in their airways 
• Have bronchopulmonary dysplasia, a chronic lung disease
• Are in a crowded living space
• Are exposed to parental smoking¹ 

Furthermore, the following risk factors have been identified for making the infection severe:

• Babies less than 3 months old
• Neuromuscular disorder
• Congenital heart disease¹

Symptoms

At the beginning, bronchiolitis symptoms are similar to a common cold, and they include:

• A slight fever ( although their normal temperature is 36.4º C this varies, but according to NHS a value of 37.5º C is considered a fever)
• A dry cough
• A runny nose
• Difficulty or fast breathing
• Wheezing

However, as the disease progresses to a more severe (acute) stage, other symptoms that you may notice are:

• Difficulty feeding
• Laboured breathing
• Increased mucus production
• Atelectasis
• Hypoventilation 
• Grunting when breathing
• Retraction of the chest (looks like it is pulling inwards)
• Bluish skin, lips and nails (cyanosis) 
• Pronounced fatigue and sleepiness
• Flaring of the nostrils
• Dehydration^1,2

If your child has trouble breathing or any of the above signs, you should seek medical help immediately.  

Duration of bronchiolitis

Normally, this respiratory condition lasts a few weeks. The acute phase will appear 48-72 hours after your baby catches the virus, and lasts 3 to 7 days. Most children tend to present a mild version of the disorder, and they start showing improvement within 3-4 days after beginning treatment, with a gradual recovery process of 1 to 2 weeks. However, some symptoms like the cough might persist a little longer. Occasionally, some infants take between 14-21 days to recover, and keeping them hydrated helps speed up the process.^1,2

Treatment and management

Treatment for bronchiolitis focuses on relieving the symptoms. So your paediatrician will prescribe some of the following if your child has mild bronchiolitis:

• Nasal saline
• Antipyretics (medication to reduce fever)
• Cool-mist humidifier¹ 

However, if your infant develops a more severe infection, showing signs of acute respiratory distress, hypoxia or dehydration, they’ll need to be admitted to the hospital and monitored. In addition, they’ll be treated with:

• Humidified oxygen 
• Nebulized hypertonic saline
• Bronchodilators beta-adrenergic agonists (e.g. epinephrine, albuterol) or corticosteroids. However, these therapies are inconsistent and they don’t always have an effect 
• Mechanical ventilation (e.g., high-flow nasal cannula)^1,2

Since this is a viral infection, your paediatrician won’t prescribe antibiotics, unless the patient develops respiratory or other bacterial infections.³

Prevention strategies

It’s difficult to prevent bronchiolitis as the viruses causing it are quite common. However, there are some things you can still do to reduce your child’s risk of having it:

• Good handwashing and hygiene
• Good oral hydration
• Avoid exposure to smoking and to people who are sick
• Control temperatures at home
• Educate yourself about the topic.¹

Moreover, if your infant is at higher risk of suffering from this respiratory infection, your medical provider might suggest injections with palivizumab, to prevent RSV.^1,2  

Complications 

Some of the complications that are associated with bronchiolitis are:

• Healthcare-associated infection in babies who are admitted to the hospital
• Barotrauma as a consequence of  ventilation
• Arrhythmias caused by beta-agonists
• Nutritional deficiencies due to persistent vomiting induced by coughing
• Apnea
• Aspiration pneumonia
• Episodes of recurrent wheezing subsequently
• Respiratory failure^1,2  

Summary

Bronchiolitis is a respiratory infection caused by the respiratory syncytial virus, primarily affecting children who are less than two years old. Symptoms are similar to a cold, however, infants can also show difficulty breathing, problems feeding, wheezing, increased fatigue, and dehydration among other things. This acute phase of the condition is visible after 48-72h of the virus incubation, and it lasts 3-7 days. After a few days, children start improving progressively, although the cough can persist for longer. With the appropriate therapy and hydration, this issue usually lasts for a median of 12 days. Treatment focuses on symptom relief and ensuring hydration, although a higher severity means your infant will be admitted to the hospital. Unfortunately, it’s hard to prevent bronchiolitis from developing, but with good hygiene, hydration and not exposing your baby to sick people and smoke you can reduce its risk.  

FAQ’s

Can my child develop bronchiolitis multiple times?

Yes, they can. This condition is caused by viruses that are quite common, especially in autumn and winter, your infant can develop the infection more than once, especially during the mentioned times.

Can bronchiolitis damage the lungs?

Bronchiolitis causes inflammation and mucus build-up in the smaller airways of the lungs (bronchioles). Usually, it’s presented as a mild case, and with treatment, it can improve. However, sometimes the severity of the disease can progress and lead to respiratory or lung failure. This will also be determined by your infant’s immune system.

Is bronchiolitis worse at night?

Yes, the symptoms worsen at night. Nonetheless, with the recommended treatment by your paediatrician, the signs will typically begin improving after 3-4 days. 

Can bronchiolitis turn into a chest infection?

Normally, it’s a mild condition. However, in more severe cases your child might develop pneumonia or a chest infection, which are treated with antibiotics prescribed by your health provider.

What is the prognosis for bronchiolitis?

The majority of infants with bronchiolitis usually recover in 12-14 days, without complications. Only 3% of patients need hospitalisation and the mortality rate is 0.5% to 7%. The increased mortality rate is because of side effects and lack of health resources.¹