map of affected regions, symptoms, treatment …

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“The bronchiolitis is an infectious viral disorder that affects the small bronchi, bronchioles“, explains Professor Christophe Delacourt, pneumo-pediatrician at Necker Hospital. The disease is defined by acute episode of respiratory discomfort (rhinitis sequence followed by respiratory signs: cough, wheezing and / or crackles, with or without polypnea and / or signs of respiratory control) at any time of the year.

The respiratory syncitial virus (RSV) is the main infectious agent of this disease. “It occurs by winter epidemic.

“The epidemic peak is reached in the first half of December.”

It usually starts early November to end in late January. The epidemic peak is reached in the first half of December“, specifies the practitioner.

We think that almost all children under the age of two will contract this virus, and that a third of them will develop bronchiolitis. “RSV alone accounts for half of bronchiolitis. The other half will be due to RSV associated with another virus, or another virus alone“, he explains. Adults and older children who carry the respiratory syncytial virus usually have no signs or have a simple cold.

“The caliber of an infant’s bronchioles is very small. Theviral infection will touch the wall of these bronchioles, and will cause an inflammatory reaction, edema of the wall and hyper-secretion which will lead to the obstruction of these bronchioles. This obstruction is all the easier since the size of these bronchioles is naturally small“, explains Professor Delacourt. In addition, the infant boy has slightly narrower bronchi than those of a girl, which explains why he is more regularly affected.”From the moment the bronchioles are blocked, the distribution of air in the lungs is heterogeneous, which causes a hissing sound“, he adds.

“The first signs of viral infection are a runny nose and a slight cough. Then will gradually settle a more or less significant respiratory discomfort, and this fairly characteristic hissing noise“, explains the practitioner. Then comes a fatty and productive cough, and a decreased diet caused by respiratory discomfort. In addition to these digestive signs, the child may present irritability, fatigue and a moderate fever. A isolated mild cough can be observed for up to 4 weeks.

Before the onset of these symptoms, it is important to consult your doctor quickly in order to identify respiratory complications that may require hospitalization.

Bronchiolitis is usually easily diagnosed by clinical examination from the doctor, without the need for further examinations. “The doctor will look for signs requiring possible hospital monitoring, to find out if bronchiolitis can be managed in a simple way at home“, he concludes.

Infant bronchiolitis evolves naturally towards healing on average within 10 days. “It is a viral infection, so we must limit ourselves to symptomatic measures, and wait until the infection passes and the bronchi repair themselves. There is no specific treatment for this”, details the pediatrician. To relieve the little patient, parents can declutter his nose with physiological saline, especially before meals. It is also recommended to:

• Lay the infant on his back flat.
• Split the food.
• Express breast milk in the event of feeding difficulties in the breast-fed infant.
• To rule out smoking in the places where the infant lives and is transported.
• Maintain a temperature of 19 ° C in the room where the infant is staying.
• Limit physical contact from infants to parents.

pharmaceuticals

Bronchodilators, adrenaline, hypertonic saline, nebulization of hypertonic saline, systematic antibiotic therapy … No need to take medication for bronchiolitis. For the High Health Authority, they only have “little space in care “ . The same goes for treating symptoms like cough. Caffeine, bronchial thinners, cough suppressants, N acetylcysteine, anti-reflux treatments, immunoglobulins and surfactant are not recommended.

Respiratory physiotherapy

Respiratory physiotherapy is no longer recommended in the treatment of bronchiolitis in children under 12 months of age by High Authority of Health since November 2019. “Theatcurrent analysis of the literature does not show a beneficial effect” She justifies. Several studies have shown that respiratory physiotherapy did not reduce hospital stay infants with bronchiolitis. And to remember that “this care method has only developed in liberal practice mainly in Belgium and France, which makes international comparison difficult “. For physiotherapist unions, their support “goes much further than simple bronchial drainage” . “The physiotherapist examines, assesses and redirects the baby to the emergency room or the treating doctor if necessary. He reassures and supports parents. He is a key player in health education” did they call back in a communicated published November 14. Without forgetting that “The establishment of physiotherapist networks in the 2000s has made it possible to significantly reduce the use of emergency rooms”.

You should watch a child with bronchiolitis especially the first 48 hours after the onset of respiratory symptoms because this is the period during which everything is likely to worsen.

Some signs, if they persist after a nose wash, require an appointment with a doctor for your baby to be re-examined:

• His behavior changes and seems unusual to you (he is tired; less reactive or very agitated; whines a little).
• His breathing became faster.
• He becomes embarrassed to breathe and he digs his chest.
• It increases his respiratory discomfort (he digs more in his chest).
• He drinks less well on several consecutive meals.

• It turns blue around the mouth.
• He is uneasy.
• He takes breathing pauses
• His breathing becomes slow while remaining very embarrassed to breathe.
• He no longer reacts, is very tired, sleeps all the time, whines.
• He refuses to drink the bottles or to take the breast.

“The elements of concern that will lead the doctor to recommend hospital care are: significant undernourishment, very significant respiratory discomfort, or the fact that he seems very sleepy and not very active”, warns Professor Delacourt. In the most severe stages, hospitalization can be done in intensive care or resuscitation unit. Infant bronchiolitis is a pathology to be taken seriously, especially in very young children, and in particular those under 6 weeks. In this case, hospital care is necessary, “because they are more at risk of breathing apnea“, specifies the doctor.

Certain more fragile children are particularly at risk of severe complications of bronchiolitis, such as those affected by other pathologies and premature. For these there is a preventive treatment. It’s about antibody injections (Palivizumab), to be done monthly during the first two winters, and protecting against RSV. For other children, especially those under 12 months, several bronchiolitis prevention tips must be applied.

Thank you to Professor Christophe Delacourt, Department of Pneumology-Allergy – Necker Hospital – Sick Children – AP-HP.

Sources:

• Management of the first episode of acute bronchiolitis in infants under 12 months of age. Good practice recommendation – November 14, 2019.
• Bronchiolitis: HAS recommendations misinterpreted. Physiotherapy is important in the overall management of bronchiolitis in infants, November 14, 2019.

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