The Not-So-Happy Wheezer
Bronchiolitis is a common viral infection of the lower respiratory tract that usually affects young infants. Bronchiolitis commonly presents with rhinorrhea, increased work of breathing, and wheezing, caused by inflammation in the bronchioles of the lung. Bronchiolitis remains a clinical diagnosis. Laboratory studies, viral panels, and radiographs are not helpful. Once the diagnosis of bronchiolitis is made, the next important step is to assess the severity of the illness since this will drive the treatment options as well as the disposition. Many therapeutic options such as albuterol, steroids, and hypertonic saline have been shown to not be effective. High flow oxygen as compared to continuous positive airway pressure therapy has been shown to be the only modality that decreases intensive care unit length of stay and intubation rates. Patients with mild/moderate cases of bronchiolitis can be discharged home, if they are able to maintain oxygen saturation of 90% with appropriate work of breathing, adequate oral intake, and reliable follow-up. In moderate to severe cases of bronchiolitis, care should be taken to monitor the vital signs and the respiratory status and escalate supportive care as necessary.