Is Bronchiolitis Deadly?

What is bronchiolitis?

Bronchiolitis manifests as a chest infection that usually affects babies and infants under 2 years old; however, adults may also suffer from the condition. The medical term derives from the Bronchioles, which are small airways in the lungs and “itis” is the medical term for inflammation or infection. So, in a nutshell, Bronchiolitis is the inflammation or infection of the Bronchioles. It is more common in babies as their small airways are easily blocked by mucus and or dust particles.

Bronchiolitis is not to be confused with Bronchitis, despite sharing a similar name. The latter is an infection of the larger airways in the lungs known as the Bronchi and usually affects people of all ages.1

Types of bronchiolitis

There are three main types of Bronchiolitis:

  • Acute Bronchiolitis usually occurs in babies and infants and is typically a respiratory virus infection.
  • Respiratory Bronchiolitis is mostly associated with smoking and is the most common form of bronchiolitis found in adults.
  • Constrictive Bronchiolitis (Bronchiolitis Obliterans) is usually linked to airflow obstruction and can be common in transplant recipients.

This article will focus on Acute Bronchiolitis and its effects on both children and adults.

Causes and Risk Factors of bronchiolitis

Respiratory Syncytial (Sin-Sish-Uhl) virus (RSV) is the most common cause of Bronchiolitis, accounting for 60-80% of its presentation in babies and young children.2 According to the Centers for Disease Control and Prevention (CDC), RSV is a common respiratory virus that causes mild, cold-like symptoms.3 Although RSV often presents as mild symptoms, there are some cases in which the symptoms may lead to more complicated and serious conditions:

  • Pneumonia (infection of the lungs).
  • Aggravation of certain chronic lung diseases such as COPD (Chronic Obstructive Pulmonary disease).
  • Congestive Heart failure.3

There are also other viruses associated with Bronchiolitis, such as Rhinovirus, Parainfluenza virus, and seasonal coronavirus; however, RSV remains the most common cause of Bronchiolitis. These viruses can easily be spread through the air when someone coughs or sneezes. Air particles can also linger on door handles, toys, and other surfaces.

Babies under the age of 6 months are at a greater risk of developing severe symptoms due to their small lung capacity. In addition, premature babies or babies born with long-term lung conditions or compromised immune systems are more susceptible to severe symptoms of Bronchiolitis.3 Children exposed to secondhand smoke are also at a greater risk of developing Bronchiolitis. Furthermore, children who attend daycare, nurseries or have siblings in school are equally at a higher risk of developing the condition.

Symptoms of bronchiolitis

Most babies will have mild symptoms, which include cold-like symptoms that can be managed at home; however, some may experience severe symptoms which require hospitalization.

Mild symptoms include that can be managed at home:

  • A high temperature above 37.1 degrees Celsius
  • Persistent, dry cough, which often may sound raspy.
  • Stuffy and congested nose
  • Noisy breathing, such as wheezing.
  • Difficulty feeding.
  • When a child is struggling to breathe and you notice an increase in the rate of breathing.

Severe symptoms:

  •   Laboured breathing (looks like hard work).
  •   The baby has not urinated in 12 hours.
  •   A high temperature above 37.5 degrees Celsius.
  •   The child appears sleepier than usual/ lethargic.

If your child is experiencing the above symptoms, seek medical advice from NHS 111 as soon as possible.

Call 999 if:

  •  Your child begins to grunt, or it appears that they are breathing from their tummy.
  •  Your child’s breathing stops for 20 secs or has regular shorter pauses in their breathing.
  •  The colour of your child’s inner lips or under tongue turns blue.

These are all signs that your baby is not getting enough oxygen and needs urgent medical attention.

Outlook of Bronchiolitis

Bronchiolitis can either be Acute (severe and happens quickly), such as Acute Bronchiolitis or chronic which is a long-developing condition such as bronchiolitis obliterans.4

Due to the nature of its symptoms, it is not always easy to spot Bronchiolitis. Babies and children are usually prone to the common cold or cold-like symptoms; therefore, it is difficult to differentiate between the two. It is always advised to seek medical attention if your baby is experiencing high temperature and breathlessness with these symptoms. Your doctor will check for all of these signs as well as the oxygen levels in your baby's blood by use of a pulse oximeter. 

Is bronchiolitis deadly?

Bronchiolitis, if not picked up in time whilst your child is suffering from severe symptoms, can be very deadly. Your child’s lung airways can become partially obstructed by the mucus buildup, which limits the amount of oxygen being passed to the blood. This may cause what’s known as Hypoxia (Low oxygen), which can be detrimental to the child and may even cause death if oxygen is not administered promptly. A common sign of Hypoxia is when your child’s lips look pale blue. It is very important to act fast once you spot this, as your child’s life may be in danger.

Complications

In severe cases which may arise from a complication, a child may need intubating (tube placed down their throat) to open their airways and allow for a machine to breathe for them. This is known as ventilation. This is always the last resort following a trial of high-flow oxygen delivered by a face mask or nasal tube and CPAP (a combination of air and oxygen delivered at high pressure via a face mask. The pressure of the combination helps to open up the child’s airway.

Treatment for bronchiolitis

As Bronchiolitis is caused by a viral infection, there is no specific treatment or cure for the condition. However, depending on the severity of the symptoms, measures can be taken to relieve these symptoms and prevent them from becoming deadly.

If your baby is experiencing mild symptoms, then this can be managed at home by doing the following:

  • Encourage plenty of fluid.
  • Offer smaller portions more frequently throughout the day. Ensure your child is getting at least half to 3 quarters of their normal intake.
  • Ensure that your baby is held in an upright position when feeding.
  • Keep the temperature down below 38 degrees Celsius.
  • Use a humidifier in your baby's room to help loosen the mucus compromising the airways to relieve cough and congestion.

For severe symptoms which require hospitalization:

  • Oxygen will be administered via face or nasal specs to bring oxygen levels up.
  • Fluids will be given via a feeding tube which passes through the nose to the stomach, known as a Nasogastric (NG) tube or intravenously (needle tube attached to a vein).

Whilst in hospital, a sample of your baby’s mucus may be tested to look at which virus is causing bronchiolitis. If it is found to be RSV, your child may be placed in a different room to avoid further transmission of the virus.

According to the British Lung Foundation (BLF), approximately 3% of babies or young children with Bronchiolitis require hospitalization for assistance with their breathing, feeding and/or dehydration. Babies born prematurely are also at a greater risk of being hospitalized from severe symptoms.4

When would the child be admitted to the ICU?

In the likelihood that the child experiences Apnoea (short episodes of not breathing) or the oxygen saturation in their blood is relatively low, the child is likely to be admitted to the Intensive Care Unit (ICU) for more advanced treatment. 

Prevention

As the virus that causes Bronchiolitis is contagious, the best way to prevent bronchiolitis is through effective handwashing and limiting contact with other people to reduce transmission. As air particles can linger on door knobs, toys and surfaces, it is vital to ensure that these areas are cleaned thoroughly on a regular basis. The British Lung Foundation suggests that adopting “good hygiene is an important way of reducing infections, such as bronchiolitis.”

Summary

Bronchiolitis is a respiratory virus infection that occurs in the lungs and is usually common in babies and young children. It can also present in adults as either Respiratory bronchiolitis (caused by smoking) or Bronchiolitis Obliterans (chronic lung disease). The most common cause of bronchiolitis is Respiratory Syncytial Virus (RSV) which is a virus that causes cold-like symptoms such as runny nose, raspy cough and congestion. The symptoms of bronchiolitis are usually mild; however, there are cases where symptoms can be severe and life-threatening. There is no medical treatment for Bronchiolitis and most mild symptoms can be managed at home. In severe cases, it may require hospitalization for further treatment, such as oxygen administration or supplementation of fluids.

It is very important to seek medical advice if you notice that your child is finding it difficult to breathe, their lip or under tongue appears a blue-tinged colour, or they appear lethargic. These are warning signs that your child requires oxygen fast.

Good hygiene, especially hand hygiene and cleaning surfaces with antibacterial wipes, is the best way to prevent the spread of the RSV virus that causes Bronchiolitis.

Bronchiolitis can be a deadly condition if the severe symptoms are not managed in a timely manner. Always seek help from a health care professional if you notice worsening symptoms.

References

  1. Rodriguez-Fernandez R, González-Sánchez M, Perez-Moreno J, González-Martínez F, de la Mata Navazo S, Mejias A et al. Age and Respiratory Syncytial Virus Etiology in Bronchiolitis Clinical Outcomes. Journal of Allergy and Clinical Immunology: Global. 2022;.
  2. Dalziel S, Haskell L, O'Brien S, Borland M, Plint A, Babl F et al. Bronchiolitis. The Lancet. 2022;.
  3. Bont L, Checchia P, Fauroux B, Figueras-Aloy J, Manzoni P, Paes B et al. Defining the Epidemiology and Burden of Severe Respiratory Syncytial Virus Infection Among Infants and Children in Western Countries. Infectious Diseases and Therapy. 2016;5(3):271-298.
  4. Bronchiolitis [Internet]. nhs.uk. 2022 [cited 26 July 2022]. Available from: https://www.nhs.uk/conditions/bronchiolitis/
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Kadi Ajilogba

Master of Science - MS, Adult Health Nurse/Nursing, Keele University, England


With over 10 years of experience working within the healthcare industry, in both acute and mental health settings, I pride myself in being able to cater to the patient's needs using a holistic approach. I am an advocate for promoting patient safety and wellbeing and I also embrace the notion of making every contact count with patients of different backgrounds and cultures.

I have worked in mental health settings which means that I am able to deal with patients presenting with challenging behaviours or those perhaps going through a crisis. I am trained in PMVA (Prevention Management of Violence and Aggression) as well as Team Teach which looks at teaching positive behaviour management in order to support young people going through a mental health crisis.

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