Summary
Definition
History and exam
Key diagnostic factors
- cough
- tachypnea
- wheezing
- retractions, grunting, and nasal flaring
Other diagnostic factors
- rhinitis
- fluctuating clinical findings
- irritability, malaise, and poor feeding
- fever <104°F (<40°C)
- crackles
- apnea
- thoracoabdominal asynchrony
Risk factors
- infants <3 years
- winter months
- prematurity or bronchopulmonary dysplasia
- passive tobacco smoke exposure and air pollution
- impaired airway clearance and function
- congenital heart disease
- immunodeficiency
Diagnostic investigations
1st investigations to order
- pulse oximetry
Investigations to consider
- enzyme-linked immunosorbent assay (ELISA) rapid antigen detection
- chest x-ray
- reverse transcriptase polymerase chain reaction (RT-PCR)
Emerging tests
- infant pulmonary function tests
Treatment algorithm
infants at high risk of severe RSV infection
confirmed bronchiolitis
Contributors
Authors
Howard B. Panitch, MD
Professor
Division of Pulmonary Medicine
Children's Hospital of Philadelphia
Philadelphia
PA
Disclosures
HBP is a member of the American Thoracic Society's Guideline Committee, Long-Term Oxygen Therapy for Infants and Children, past Chair of the American College of Chest Physicians' Home Based Mechanical Ventilation and Neuromuscular Disease NetWork, a member of the ATS guideline committee on bronchopulmonary dysplasia (BPD), and a member of the current new guideline committee updating the BPD Statement. He is a member of the planning committee of the Pediatric Assembly of the American Thoracic Society, and receives royalties from Up-To-Date for the review of two topics (Spirometry in Children and Bronchopulmonary Dysplasia).
Acknowledgements
Professor Panitch would like to gratefully acknowledge Dr Isaac Desheng Liu, Dr Woon Li Seo, Dr Jennifer L. Nayak, Dr Caroline B. Hall, and Dr Clement L. Ren, previous contributors to this topic.
Disclosures
IDL, WLS, JLN, and CLR declare that they have no competing interests. CBH is an author of a number of references cited in this topic.
Peer reviewers
Robert Welliver, MD
Professor of Pediatrics
Women and Children's Hospital
Buffalo
NY
Disclosures
RW declares that he has no competing interests.
Giovanni Piedimonte, MD
Wyeth Research Scholar Professor and Chair
Department of Pediatrics
WVU School of Medicine
Physician-in-Chief
WVU Children's Hospital
Morgantown
WV
Disclosures
GP declares that he has no competing interests.
H. Cody Meissner, MD
Professor of Pediatrics
Infectious Disease
Department of Pediatrics
Tufts-New England Medical Center
Boston
MA
Disclosures
HCM is an author of a number of references cited in this topic.
John Henderson, MBBS
Professor of Paediatric Respiratory Medicine
University of Bristol
Bristol
UK
Disclosures
JH declares that he has no competing interests.
Differentials
- Bacterial pneumonia
- Chlamydial pneumonia
- Cystic fibrosis (CF)
More DifferentialsGuidelines
- Bronchiolitis in children: diagnosis and management
- Australasian bronchiolitis guideline
More GuidelinesPatient leaflets
Bronchiolitis
Asthma in children
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer