What is bronchiolitis?
As noted in the previous article, bronchiolitis is an acute inflammation of the bronchioles, typical of infants and infants. In this conclusive analysis, we focus our attention on the symptoms generated by bronchiolitis, on the diagnostic techniques and on the therapeutic procedure to which patients are subjected.
Symptoms
To learn more: Bronchiolitis symptoms
Emblematic symptoms of bronchilitis are represented by: respiratory distress, wheezing, accentuated dyspnea, irritative and panting cough, tachycardia and irritability. The symptomatological picture that results is however variable, depending on the sensitivity of the subject, the age and the state of health of the same.
In general, the first prodromes generate infection of the upper airways, thus frequent nasal secretion / burning and sneezing, loss of appetite and variation in the basal temperature (not always present). After a short period, varying from 2 to 5 days from the onset of symptoms, the patient tends to complain of a wheezing cough, often associated with milder dyspnea and wheezing and accelerated breathing (tachypnea).
In some affected individuals, these symptoms are accompanied by cyanosis - a condition in which the patient's face tends to take on a bluish color due to the lack of oxygen - and intercostal retractions - the difficulty in breathing causes excessive effort at the level of the respiratory muscles, such as to "lift" the ribs. Insomnia (even more pronounced lethargy in infants), mood alteration, nausea and vomiting may be additional symptoms that complete the patient's clinical profile.
Fortunately, in most cases, bronchiolitis tends to regress in a few days: in particular, the acute phase of the disease has a duration of about two days. Also the recovery of the patient's health is generally almost rapid, although breathing difficulties tend to last for longer periods.
Complications
Generally, patients with bronchiolitis do not face any additional risks or complications; it is however necessary to point out that the subjects of advanced age, suffering from chronic cardiopathies and bronchitis, and the immuno-depressed patients are potentially at risk of complications, such as, for example, pneumonia.
Diagnosis
The diagnosis of bronchiolitis is mainly based on the clinical observation of the patient, possibly supported by further diagnostic analyzes to confirm the disease.
The poor introduction of air into the lungs, a characteristic of bronchiolitis, is diagnosed through the auscultatory finding of the thorax, an examination that also allows us to verify a possible bronchiolar obstruction.
In the case of bronchiolitis, the chest radiograph usually shows atelectasis (collapse or lack of aeration of a part of the lung), emphysematous hyperdiafania (accumulation of air in the lung associated with inflammation), thickening of the bronchial mucosa, increase in thoracic diameter and, sometimes, lowering of the diaphragm [taken from Manual of infectious diseases, by Mauro Moroni, Spinello Antinori, Vincenzo Vullo]
On the other hand, oximetry allows us to observe the percentage of oxygen saturation in the blood: this diagnostic test is indispensable in infants presenting an acute form of bronchiolitis. In fact, when the saturation rate reaches 92-94%, the sick child must be hospitalized.
In order to isolate the pathogenic microorganism, some diagnostic tests are recommended, such as:
- Immunoenzymatic tests (ELISA)
- Indirect immunofluorescence test (IFA)
- Culture test (isolation of the pathogen from a nasal mucus sample)
The differential diagnosis is essential to distinguish bronchiolitis from asthma, the most probable pathology when these symptoms occur after the 18th month of age. Other differential diagnoses include those with chronic lung disease, pertussis and cystic fibrosis.
Care
See also: Bronchiolitis Care Medications ยป
It is not possible to draw a standard therapy for bronchiolitis, as this depends on the severity of the patient's clinical profile. The therapeutic strategies are based above all on the rehydration of the patient and on oxygenation. The hospitalization of the patient is sometimes essential: in this way, it is possible to monitor the patient's symptoms and eventually intervene promptly on the occasion of complications, especially respiratory problems.
The most widely used pharmacological specialties in the treatment of bronchiolitis are bronchodilators, although the occlusion of the respiratory canals is due not so much to a bronchospasm, rather to accumulations of mucus in the respiratory tract and to a thickening of the bronchial walls.
For small patients with bronchiolitis associated with congenital heart disease, cystic fibrosis, chronic lung disease or, again, hypertension, treatment with ribavirin (antiviral drug) administered by aerosol is reserved.
In the event of complications such as seizures due to anoxia or cyanosis, the patient must be subjected to assisted ventilation as soon as possible.
In the case of bronchiolitis, it is important to promote rest and to provide frequent hydration for the sick child, in order to alleviate the symptoms and allow the healing time to be accelerated.
Cortisonics and sedatives are strongly contraindicated; even antibiotics are certainly not the most suitable therapeutic option, except for cases of bronchiolitis due to severe bacterial infection (very rare case).
There are no vaccines aimed at the prevention of bronchiolitis, given that the viruses responsible are particularly widespread in the environment.
