Original Editor - Jerome Ng
Clinically Relevant AnatomyBronchiolitis is inflammation of the bronchioles, the smallest air passages of the lungs, in which air passes through the nose or mouth to the alveoli of the lungs where gas exchange takes place.
Mechanism of Injury / Pathological Process
Bronchiolitis typically occurs with primary infection or reinfection with a viral pathogen, but occasionally is caused by bacteria (eg, Mycoplasma pneumoniae). In young children, the clinical syndrome of bronchiolitis may overlap with recurrent virus-induced wheezing and acute viral-triggered asthma.
Bronchiolitis is a major cause of illness and hospitalization in infants and children younger than two years. Symptoms include:
- Persistently increased respiratory effort (tachypnea, nasal flaring, intercostal or suprasternal retractions, accessory muscle use, grunting)
- Acute respiratory failure
Management / Interventions
- Respiratory support
- Nasal suctioning
- Supplemental oxygen
The following are interventions that may be used, but not as a routine intervention:
- Trial of inhaled bronchodilator
- Nebulized hypertonic saline
- Chest physiotherapy
In the Cochrane review titled "Chest physiotherapy for acute bronchiolitis in children younger than two years of age", it was concluded that none of the chest physiotheray techniques (vibrations, percussions, slow passive expiratory techniques or forced expiratory techniques) have demonstrated a reduction in the severity of disease. Hence, these tecniques cannot be used as standard clinical practice for hospitalised patients with severe bronchiolitis.
A state-of-art review suggests avoiding repeated airway clearance in infants and children with acute pulmonary disease.
- Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C, Vilaró J. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD004873. DOI: 10.1002/14651858.CD004873.pub5.
- Morrow BM. Airway clearance therapy in acute paediatric respiratory illness: A state-of-the-art review. South African Journal of Physiotherapy. 2019 Jun 25;75(1):12.