bronchiolitis in infants: signs, diagnosis, causes, treatment and FAQ Bronchiolitis is an infectious disease affecting the tiny airways, called "Bronchioles" it narrows or blocks as they are already very small. It often affects very young children where it can be dangerous.
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What are the signs? How is it diagnosed? The diagnosis of bronchiolitis is quite easy. It is based on the finding of the following, occurring during an epidemic that is to say November to March for respiratory syncytial virus, the most common:
cough, acute tone slightly.
Breathing difficulties mainly expiratory.
Rapid breathing.
Distension of the chest often difficult to assess.
Rails piping or sub-expiratory crackles on auscultation.
Fever is usually moderate below 38 5.
signs of severity are assessed quickly Age less than 3 or 6 months is an invitation to caution.
The draw which results in a depression between or subcostal inspiration, swinging thoracoabdominal or flaring nose. The
panting or increased respiratory rate.
The presence of crackles indicates the presence of fluid in the alveoli.
radiography, rarely made "in town" shows distended lung, too dark (too much air) with more horizontal ribs and a flattened diaphragm due to air trapped in the lungs. The "white blob" is the heart. Below the diaphragm, you can see well on the plate from left, front, a gray spot which is the air pouch of the stomach.
What may be confusing bronchiolitis? In fact I said the diagnosis is fairly easy but I've seen wear diagnoses
gastroenteritis when the child is vomiting because of coughing or
nasopharyngitis if it is a mild form or a beginner, a point which is of little consequence, but given the long duration of illness (12 days), the parents consult again. It is easy to correct diagnosis and tailor treatment.
can also confuse this disease with a real crisis of asthma
especially as bronchiolitis can trigger an asthma attack. In France, this has little consequence because the treatments are similar, which is not the case in other countries.
can also confuse this situation with a bronchial hyperactivity
(HAB), which in small children under 2 years sometimes gives exactly the same table. To be simple, I would say that the child with cough 3 weeks HAB when others cough three days. The triggering factor can be breathing any aggression, especially by viral or allergic Rhinovirus greatest.
What causes bronchiolitis? Bronchiolitis is a viral infectious disease still
This beautiful pie chart shows all the viruses responsible for acute respiratory diseases. They can all give bronchiolitis but some more than others. Bronchiolitis is an acute respiratory illness. There is also the croup or laryngitis, tracheitis, bronchitis, broncho-alveolitis, alveolitis pure rare or cardiac origin. The
Respiratory syncytial virus (RSV) is responsible for 50% and 100% at certain times of the year.
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recent years has emerged a
Metapneumovirus (20%) which gives the same signs as with RSV, however, complications such as ear infections a little more frequent. The influenza virus
(influenza) rather cause of pneumonia, parainfluenza virus
laryngitis and responsible officials of the two adenovirus and rhino-virus responsible for anything, but more frequent colds, share the ; remaining 30% of bronchiolitis.
These viruses are all active at the same time as shown in this picture: respiratory syncytial virus and the flu are most active in winter.
Image "N Eng J Med
Anyway diagnosis of the virus in question is only useful for research and is of no importance for the patient because it does not change the treatment.
Evolution: A
RSV bronchiolitis lasts about 12 days in 3 phases: 1. Installation with aggravation the first 4 days, 2. Period status: it coughs and coughs it, 3. slow healing.
Complications: Respiratory failure requiring assisted ventilation is fortunately rare. It concerns rather the
small infants. Among the greatest, it is rather due to adenovirus infection in children already fragile.
bronchial superinfection occurs after several days and results in a fever higher than 39 °. It should be distinguished from a purulent otitis fortunately rare.
Treatment: There is no cure. We can only relieve symptoms. The
humidification seems very useful because water vapor
decreases the viscosity of secretions, which then more easily evacuated during coughing.
Morning mist Picture "Internet copyright DS665 (??)"
added that a bath for 15 minutes is as effective as a meeting of aerosols as the child breathes air saturated water vapor liquefies and his "mucus" that removes easily when coughing. The
nose care are often very useful.
Elevate head of bed with a pillow under the mattress improves only some children. Most often it is necessary
split meals because, firstly, the child gets tired and struggling to breathe while eating, on the other hand, the meal takes up space. It goes directly into the stomach just below the lungs that which it is separated by the diaphragm, which supports him.
drugs are very effective dispute:
Bronchodilators spray seem useful, however. They are commonly used in France but are discouraged in the United States.
anti-inflammatory spray given immediately after the bronchodilator seem equally helpful.
Cortisone (the Celestène R) is rarely used. I use it sometimes in small infants to avoid hospitalization but cortisone causes a transient immunosuppression, and it catches everything that passes for three weeks. It is a drug that does not use lightly.
Physiotherapy is useful in infants. Unfortunately the new methods of acceleration of expiratory flow are, in the opinion of all mothers, poorly supported and generate significant anxiety in children even smaller. I therefore reserve Children crowded and less than 1 year when he is to avoid hospitalization.
Antibiotics have no effect on viruses, they are not employed so that in case of superinfection in the course of evolution.
Questions in bulk:
Bronchiolitis becomes Does Asthma? In my opinion not . Some even say it would protect! It is debatable but, given the very large epidemics we had a few years ago, my office should now be filled with asthma, it is not out.
Bronchiolitis weakens she children? Yes sometimes. Some children take more hissing sometimes bronchitis (asthma = as asthma) but not asthmatic asthma. It's like the "Canada Dry" which resembles "Whisky" but is not.
These children may have a bronchial hyper (HAB) already reported, that is to say they cough 3 other weeks when they cough 3 days. There are specific treatments for these situations. These treatments require testing and trial and error, but if the medicine was simple, the studies would not last 11 years.
Bronchiolitis is it more common? I do not think , but it's hard to say because this word means different countries, different situations. The excessive heating of houses generating very dry air may have helped aggravate coughs being neglected in the past. But once they had pneumonia, sometimes double, sad memory. Fortunately we should not choose between the plague and cholera!
How wet? to dry clothes, put towels on the radiators or tissue wet ground if the soil is heated, pressure cooker that whistles.
bowls of water, no! is for exotic fish, they are still full the next morning so unnecessary.
The ideal would be a bit of condensation on the windows . The next day, air, it purifies the air and glue together the wallpaper!
A bath, which can breathe air saturated with water very effectively replaces a meeting of aerosol and physical therapy can facilitate (just before bathing).
Can I get my sick child? Yes naturellemen t. It must cover if it froid.C 'was the time of carriages, which poured into dirt roads, we stayed at home waiting for the doctor who came to make his horse " Visit learned "
and an order of clear soup, a bleeding or leeches when he had no recourse to the priest. But it's over now. Doctors have better drugs. They have more horses and carriages are heated. So we can go out with her baby.
Image: http://surlezinc.blogs.com/bis/
With this type of vehicle, it is perhaps unwise to make long journeys with a sick child!
Conclusion: Bronchiolitis is a common disease occurring in epidemics highly contagious, often long and tiring sometimes disturbing especially in small infants.
During these critical situations, nothing is insignificant. For treatment I often say:
"Humidification is 50%, 10% split meals, care of the nose 5%, 5% bronchodilators, anti-inflammatory 5%, and the time pass the rest. " Keywords Infection, Lung, Bronchiolitis, Infant, respiratory syncytial virus, metapneumovirus, rhinovirus VRS
References: ML. Everard: Acute Bronchiolitis and Croup. Pediatr. Clin.N Am.56 (2009) 119-133
JV Williams and neck: Lower Respiratory Tract and Humanmetapneumovirus Disease inOtherwise heathy Infants and Children No Eng J Med 350, 5 29 Jan 2004 P443-450
B. Bommenel, V Gadjos: bronchiolitis in infants. Science387 for January 2010 p42-49
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