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: Bronchiolitis in Children
DEAR DR.PAUL: My 8 month old son developed bronchiolitis due to RSV. He was wheezing and had difficulty breathing. What is RSV and will this become asthma?
DR.PAUL ANSWERS: This is a very good question, as every year many babies develop bronchiolitis and some so badly, that they have to be admitted to hospital. Bronchiolitis is an infection of the bronchioles, or small lung airways (tubes). The Respiratory Syncytial Virus known commonly as RSV causes this infection, which usually develops during the winter or early spring. The typical symptoms of bronchiolitis include:
Cough
Wheezing
Difficulty Breathing
Production of large amounts of secretions
Decrease feeding or drinking
What is the treatment of bronchiolitis? First of all, antibiotics are not effective in treating RSV. An antiviral medication (ribavarin) has been tested. Because of its potential side effects and impracticality of use, this medication is not generally used. The treatment is therefore supportive, and depending on the severity of the infection. Most infants with RSV bronchiolitis cough and/or wheeze a bit, but in general feed well and do not need oxygen or any other treatment. Within a few days their infection clears on its own. Some babies may have enough discomfort and difficulty from the wheezing and secretions that they may need extra oxygen, or even the administration of Ventolin or salbutamol (a broncholdilator used in asthma). Also, if they cannot drink enough they may require an intravenous. One of the most important aspects of treatment is helping these babies get rid of their excessive secretions and this usually requires hospitalization. Rarely, in very severe cases, some babies are actually placed on respirators to help them breath. It is of note that premature babies, and those with chronic respiratory or cardiac problems are at higher risk for developing severe bronchiolitis. Because of this, a special vaccine has been developed for these high-risk babies that offers protection against RSV. If you have a baby who is at high risk for RSV, you should speak to your doctor about it.
Your question about RSV becoming asthma is an important yet potentially confusing one because the symptoms of bronchiolitis are the same as those of asthma. Asthma is defined as a condition of recurrent episodes of wheezing and/or cough and/or difficulty breathing in a child with no other lung problems or conditions. There is some uncertainty as to the relationship of RSV infection and subsequent development of asthma; some experts say that children who have an inherited allergic or asthma tendency are more prone to RSV infections, while others say that RSV may trigger subsequent asthma. In any case, if a child seems to be getting recurrent episodes, I would have to think of asthma and not recurrent bronchiolitis. On the other hand, if a child has had only one isolated RSV episode and nothing else later on, then by definition this is not asthma.
On a final note, RSV usually causes the typical bronchiolitis symptoms described above, in children less than 2 years of age. In older people, it usually causes infections that resemble the common cold.
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