Bronchiolitis is a viral infectious disease. In most cases, the disease heals on its own after a mild course.
What is bronchiolitis?
Bronchiolitis is an inflammation of the bronchioles (small bronchial branches of the lower respiratory tract). Bronchiolitis occurs primarily in infants and young children younger than 2 years of age because their airways are still comparatively vulnerable. The disease is more common during the winter and spring months. Possible symptoms of bronchiolitis include coughing and difficult breathing; such a breathing disorder can be manifested, for example, in the form of flattened and/or accelerated breathing or a flaring of the nostrils during inhalation. Fever and an accelerated heartbeat may also accompany bronchiolitis. In addition to other symptoms such as fatigue and irritability, vomiting also occurs in some cases. A distinction can be made between acute and persistent bronchiolitis. The disease occurs significantly more frequently in its acute form.
Causes
Acute bronchiolitis is usually caused by a viral infection with the so-called RS viruses (respiratory syncytial viruses). Other possible pathogens (which are also frequently responsible for persistent bronchiolitis) include influenza (flu) viruses or so-called adenoviruses (DNA viruses). The viruses responsible for bronchiolitis are transmitted by droplet infection, i.e. by ingestion of the viruses with the respiratory air. The ingested viruses enter the respiratory tract through the nasal mucosa. It is also possible for bronchiolitis to be transmitted via various objects (such as toys or cutlery) that are contaminated with the corresponding viruses. Here, a so-called self-infection occurs, as the viruses first get onto the hands of an affected person and from there into the respiratory tract.
Symptoms, complaints, and signs
In most cases, bronchiolitis has a positive course of disease without complications. In this case, treatment is also not always necessary, since bronchiolitis often also heals on its own. Those affected suffer from various complaints of the respiratory tract. There is a strong cough, and patients may also suffer from shortness of breath and sore throat. If the shortness of breath persists for a longer period of time, the affected person may lose consciousness and possibly injure himself in the event of a fall. The internal organs or even the brain are also damaged if there is a prolonged undersupply of oxygen. Furthermore, bronchiolitis can lead to shortness of breath or abnormal breathing sounds. Affected persons also suffer from the breathing difficulties at night and thus from sleep problems or irritability. The patient’s quality of life is considerably reduced by bronchiolitis. The infection can also cause fever and general fatigue and exhaustion. The disease can also lead to palpitations. As a rule, the life expectancy of the affected person is not reduced by bronchiolitis if it heals completely. If the disease is not treated or takes a serious course, it can also cause lasting damage to the respiratory tract.
Diagnosis and course
Various medical measures are used to diagnose bronchiolitis. Usually, various basic techniques are used first: For example, the upper body of an affected person is tapped by the physician. This triggers various vibrations of the tissue, which can give the physician initial diagnostic clues. Another basic technique frequently used to detect bronchiolitis is listening to sounds in the upper body; this can be done either directly by placing the ear on the patient or by using a stethoscope. In some cases, chest x-rays may also be necessary to detect bronchiolitis. The incubation period (time between infection and onset of disease) of bronchiolitis is approximately two to eight days. After infection, the viruses usually spread rapidly through the bronchial mucosa. After a comparatively mild course, bronchiolitis often heals on its own within a period of up to 7 days. In severe cases, bronchiolitis can lead to an undersupply of oxygen to the blood.
Complications
In most cases, bronchiolitis heals within a week. However, if complications occur, there may be a lack of oxygen in the blood. The skin then appears ashen or blue – especially around the lips – which is also known as cyanosis. In addition, patients then suffer from fatigue and increasing shortness of breath, which can even lead to lung failure. If breathing difficulties worsen, hospital treatment is required. Children suffering from immunodeficiency or congenital lung or heart disease may require hospitalization even earlier, as they are highly susceptible to severe bronchiolitis. In rare cases, bacterial pneumonia occurs in addition to bronchiolitis and must be treated separately. If bronchiolitis recurs several times, it may also develop into asthma. It should also be noted that bronchitis medications do not have any effect in bronchiolitis, but that physiotherapeutic respiratory therapy is required in this case, although this should be avoided in the early stages, as otherwise the airways could become even more blocked.
When should one go to the doctor?
In most cases, bronchiolitis will heal itself. A doctor should be consulted for this reason, especially if the complaints and symptoms of bronchiolitis do not disappear on their own and the quality of life of the affected person suffers significantly in the process. In children, too, a doctor should be consulted in any case in order to avoid further complications or consequential damage. The symptoms of bronchiolitis include the usual symptoms of flu or a cold. If these symptoms persist over a longer period of time, a doctor must be consulted. In particular, a severe cough or severe breathing difficulties may indicate bronchiolitis and should be investigated. Abnormal or unusual breathing sounds are also among the symptoms of this disease and give reason for a medical examination. Examination and treatment of bronchiolitis may be performed by a general practitioner or an otolaryngologist. As a rule, the course of the disease is positive. If the symptoms still persist after about a week, a physician should be consulted.
Treatment and therapy
Currently, the viruses that cause bronchiolitis cannot yet be effectively combated. Therefore, possible treatment steps consist of relieving symptoms that occur as part of the disease. For example, independent healing of bronchiolitis can be supported by general measures such as bed rest and adequate fluid intake. If a person affected by bronchiolitis develops a high fever, antipyretic drugs are occasionally administered in consultation with the attending physician. Depending on the dominant symptoms of bronchiolitis, it may also be beneficial to ensure sufficient humidity in the patient’s room; the humidity can be increased, for example, by using so-called liquid nebulizers or by placing containers filled with warm liquid. If bronchiolitis takes a very severe course (such a course is characterized, among other things, by very severe breathing difficulties or high fever), temporary hospitalization may be necessary in individual cases.
Outlook and prognosis
The prognosis of bronchiolitis is very good in the vast majority of cases. If the respiratory illness is treated early, symptoms resolve after a few days. Hospitalization or a visit to the doctor is not necessary if the course is positive. Only in elderly or immunocompromised persons is medical monitoring necessary, as there is a risk of complications or late complications. In addition, bronchiolitis can be spread and may develop into a chronic disease. Patients at risk, such as those with lung disease or other chronic medical conditions, are particularly at risk. In acute bronchiolitis, the prognosis is less positive. Pneumonia or other secondary bacterial infection may develop. This may result in the development of a hypersensitive bronchial system, which may eventually result in spastic bronchitis.In the absence of treatment or if treatment is inadequate, parts of the lung may also be completely blocked. In principle, however, bronchiolitis usually progresses well. If the patient is otherwise healthy and physically fit, the disease disappears after a few days to a week. Long-term consequences are not to be expected if the course is positive.
Prevention
Bronchiolitis can be prevented primarily by avoiding sources of infection. For this purpose, it is helpful, for example, to avoid very close physical contact with persons suffering from bronchiolitis. After contact with objects belonging to people who have bronchiolitis, cleaning the hands can prevent virus transmission to the mucous membranes.
Follow-up
In most cases, there is no need for follow-up after bronchiolitis has healed. The disease is over after five to seven days. No symptoms remain. Patients do not build up immunity, however. A recurrence of the disease is therefore always possible. Large crowds in particular pose a risk of infection. Close and intimate contact with people should be avoided. Especially in times when infectious diseases are rampant, it is important that people wash their hands several times a day. Young and old people are considered comparatively at risk for infection. Preventive measures lead to individual responsibility. If the disease recurs, it is essential that patients remain on bed rest. Sufficient fluid intake and fever-reducing agents ensure a rapid recovery. Additional humidification of the air is advisable. The physician listens to the breath sounds on the upper body. Rapid initiation of treatment is beneficial to recovery. Bronchiolitis that recurs several times can become chronic. Affected individuals then often suffer from asthma. As shown, medical measures take place mainly acutely. Preventive measures fall to the affected person. Everyday life for the sufferer usually consists of bed rest. Scheduled follow-up examinations, on the other hand, are not necessary.
What you can do yourself
With bronchiolitis should in any case go to the doctor if the typical symptoms (shortness of breath, shortness of breath, swelling in the throat) do not subside after a few days. A visit to the doctor is particularly urgent if the symptoms are accompanied by fatigue or sleep disturbances. Fatigue, concentration problems and headaches are clear warning signs of a severe course – medical advice is required in any case. If heart rhythm disorders or circulatory problems also occur, a trip to the emergency room is recommended. Infants and small children should be taken to a pediatrician immediately if bronchiolitis is suspected. This is especially true if problems with swallowing are observed. If the affected person stops taking in fluids or food, a doctor should also be consulted. Since bronchiolits sufferers are mostly small children up to the age of two, even the first abnormalities should lead to a pediatrician or hospital. Adults should also have the above-mentioned symptoms clarified as soon as they lead to health restrictions or even physical and mental deficits. Other contacts, in addition to the family doctor, are the ENT physician or a specialist in bronchial lung diseases.
