Bronchiolitis

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Last reviewed: 23 Aug 2023
Last updated: 06 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • tachypnea
  • wheezing
  • retractions, grunting, and nasal flaring
More key diagnostic factors

Other diagnostic factors

  • rhinitis
  • fluctuating clinical findings
  • irritability, malaise, and poor feeding
  • fever <104°F (<40°C)
  • crackles
  • apnea
  • thoracoabdominal asynchrony
Other diagnostic factors

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
More risk factors
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Diagnostic investigations

1st investigations to order

  • pulse oximetry
More 1st investigations to order

Investigations to consider

  • enzyme-linked immunosorbent assay (ELISA) rapid antigen detection
  • chest x-ray
  • reverse transcriptase polymerase chain reaction (RT-PCR)
More investigations to consider

Emerging tests

  • infant pulmonary function tests
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Treatment algorithm

INITIAL

infants at high risk of severe RSV infection

ACUTE

confirmed bronchiolitis

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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.

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  • Guidelines

    • Bronchiolitis in children: diagnosis and management
    • Australasian bronchiolitis guideline
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