RSV and Bronchiolitis: What Do I Need to Know?

Bronchiolitis. For some, it sounds like a big, scary disease. Others confuse it with simple bronchitis. Many have never heard of it at all. It’s a viral disease and pretty common at this time of year. In fact, the majority of bronchiolitis is caused by a virus known as RSV, which infects nearly all children by 2 years of age.

Who Is at Risk?

Most adults and older kids with RSV (respiratory syncytial virus) have symptoms similar to the common cold. But RSV infection can result in serious symptoms, too, especially for those in high-risk groups. These include:

• Infants, especially premature babies
• Those with underlying health conditions, such as asthma and heart disease
• People with compromised immune systems (including those undergoing chemotherapy)
• Elderly adults

How Does RSV Cause Bronchiolitis?

When a child is exposed to RSV, the virus infects cells in the upper respiratory tract. This results in a lot of mucous production, which clogs the nose and makes it difficult to breathe. The virus also infects cells lining the bronchioles, which are tiny air-carrying tubes deep inside the lungs.

When bronchioles become infected, inflammation sets in and obstructs airflow. This results in wheezing and other signs of difficult breathing, such as breathing faster. Rapid breathing may interfere with feeding and, when extreme and prolonged, may lead to respiratory fatigue, apnea and even death.

How Do I Know If My Child Has Bronchiolitis?

Many symptoms of RSV infection resemble the common cold. These include fever, lots of nasal mucous, cough, sore throat and headache. When these symptoms progress to include problems breathing (wheezing, rapid breathing, decreased oxygen saturation and/or apnea), we say the child has bronchiolitis.

Symptoms of RSV infection can last two weeks or more, but most kids improve within 7-10 days. It’s important to remember that the majority of RSV infections are mild and never get diagnosed. Even when RSV causes bronchiolitis, most cases resolve without the need for specialized medical care or hospitalization.

Please take note: If your child is very young or has a fever lasting more than a couple days, or if he or she is wheezing, breathing rapidly, or having difficulty feeding, be sure to call your doctor right away. And if your child exhibits more serious symptoms, such as respiratory distress, color change or apnea, call 911.

Preventing Bronchiolitis

RSV is spread through respiratory droplets. This means the best way to prevent infection is staying home when your child is sick, properly covering coughs and sneezes, and frequent handwashing. Additionally, parents of infants less than 8 months of age who are entering their first RSV season should ask their child’s doctor about nirsevimab (brand name: Beyfortus). This is a one-time injection of monoclonal antibodies that remain in the body during RSV season and drastically reduce the risk of severe bronchiolitis caused by RSV.

My Child Has Bronchiolitis. How Is It Treated?

Unfortunately, there is no miracle drug to cure bronchiolitis — and antibiotics won’t help! RSV is a virus, and antibiotics only treat bacterial infections.

Treatment for RSV consists of symptom relief and supportive care while the body fights the virus and repairs itself. Keeping the nose free of mucous with saline and suction goes a long way toward helping babies with RSV breathe easier. Acetaminophen and Ibuprofen (for babies older than 6 months of age) can be used to treat fever and discomfort. Sometimes supplemental oxygen and/or IV fluids are also required.

In the recent past, children with bronchiolitis were given a trial of inhaled albuterol, which was thought to improve airflow to the lungs. However, recent studies have found that albuterol does not help symptoms and results in uncomfortable side effects. The American Academy of Pediatrics now specifically advises against albuterol for bronchiolitis.

There are other conditions that make babies wheeze, so don’t diagnose bronchiolitis at home. If your child is wheezing or having difficulty breathing, always check in with your doctor.