How to diagnose bronchiolitis

Bronchiolitis is an infection of the lungs. It’s when your child has swelling in the smaller airways (bronchioles) of the lung. This swelling blocks air in the smaller airways.

Bronchiolitis usually happens in the winter and early spring. It most often affects children younger than 2 years old.

What causes bronchiolitis in a child?

The most common cause of bronchiolitis is a virus. At first, the virus causes an infection in the upper respiratory tract. This includes the nose, mouth, and throat. It then spreads downward into the windpipe (trachea) and lungs (lower respiratory tract). The virus causes inflammation and even death of the cells inside the respiratory tract. This blocks airflow in and out of the child’s lungs.

Bronchiolitis is most often caused by the respiratory syncytial virus (RSV). But these other viruses can also cause it:

  • Rhinovirus
  • Parainfluenza virus
  • Adenovirus
  • Influenza
  • Human metapneumovirus

In rare cases, bronchiolitis may be caused by bacteria.

Which children are at risk for bronchiolitis?

All young children are at risk for bronchiolitis. The illness can spread easily through droplets in the air from coughing, sneezing, and talking. But some children have a higher chance of developing it. These are children who:

  • Were born too early (premature)
  • Have been exposed to tobacco smoke
  • Go to daycare
  • Have other serious health conditions
  • Have older children in the home
  • Are not breastfed

What are the symptoms of bronchiolitis in a child?

Bronchiolitis may at first be mistaken for a common cold. It starts out with many of the same symptoms. But your child may have a cough and other breathing problems that get worse over time. Below are the most common symptoms of bronchiolitis:

  • Runny nose
  • Congestion
  • Fever
  • Cough
  • Fast or hard breathing
  • Wheezing
  • Loss of appetite
  • Irritability
  • Vomiting

These symptoms often last about a week. They may look like other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is bronchiolitis diagnosed in a child?

Your child’s healthcare provider can diagnose bronchiolitis with a health history and physical exam of your child. In some cases, your child may need tests to rule out other diseases, such as pneumonia or asthma. These tests include:

  • Chest X-rays. This test makes images of internal tissues, bones, and organs.
  • Blood tests or blood gases. A blood test may help see if the infection is caused by a virus or bacteria.
  • Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To get this measurement, the healthcare provider puts a small sensor (like a bandage) on your child’s finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
  • Swab of the nose and throat (nasopharyngeal swab). This test can quickly spot RSV and other viruses.

How is bronchiolitis treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Most cases are mild and can be treated at home. There is no cure for the illness. So the goal of treatment is to ease symptoms. Antibiotics are not used unless your child has a bacterial infection.

Some babies with severe breathing problems are treated in the hospital. While they are in the hospital, treatment may include:

  • IV (intravenous) fluids if your child can’t drink well
  • Extra oxygen and a breathing machine (ventilator) to help with breathing
  • Frequent suctioning of your child’s nose and mouth to help get rid of thick mucus
  • Breathing treatments, as ordered by your child’s healthcare provider

If your child is at home, the following treatment may be helpful:

  • Drinking lots of fluids
  • Suctioning your child’s nose and mouth with a bulb syringe to help get rid of thick mucus, especially before feedings
  • Raising your child’s head while sleeping. Don’t use pillows with babies.
  • Giving acetaminophen for fever, if directed
  • Use a cool-mist vaporizer in your child’s room at night

Don’t give aspirin or medicine that contains aspirin to a child younger than age 19 unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder. It most often affects the brain and the liver.

What are possible complications of bronchiolitis?

Most children who have bronchiolitis will get well without any problems. But those born early or who have other health problems are more likely to have complications from the condition. These may include:

  • Pauses in breathing (apnea)
  • Breathing failure

How can I help prevent bronchiolitis in my child?

You can help prevent the spread of bronchiolitis. Wash your hands or use an alcohol-based hand cleaner before and after touching your child. While your child has symptoms, keep him or her away from other children.

Your child may also need a palivizumab shot. During RSV season, these shots are recommended for high-risk babies. High-risk babies include those born early or those with lung, heart, or immune system diseases. Talk with your child’s healthcare provider to see if the shot is right for your child.

When should I call my child’s healthcare provider?

Call if your child:

  • Has trouble breathing
  • Turns blue in color, especially the lips and fingertips
  • Is breathing very fast

Call your child’s healthcare provider right away if your child’s symptoms get worse, or if he or she:

  • Can’t keep liquids down
  • Is not eating or drinking

Key points about bronchiolitis in children

  • Bronchiolitis is an infection of the airways in the lungs.
  • It’s often caused by a virus, often the respiratory syncytial virus (RSV).
  • The first symptoms may look like a common cold. But a child develops a cough, wheezing, and breathing problems.
  • Most cases are mild and can be treated at home. Children with severe breathing problems are often treated in the hospital.
  • Bronchiolitis can be prevented with proper handwashing. Your child may get a palivizumab shot if he or she is at high risk for an RSV infection.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

This guideline covers diagnosing and managing bronchiolitis in babies and children. It aims to help healthcare professionals diagnose bronchiolitis and identify if babies and children should be cared for at home or in hospital. It describes treatments and interventions that can be used to help with the symptoms of bronchiolitis.

In August 2021, we reviewed the evidence and updated the recommendations on oxygen saturation thresholds for referral to hospital, admission, management and timing of discharge. For more information, see update information.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners and providers
  • Parents or carers of children with bronchiolitis

Guideline development process

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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.

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.

Respiratory syncytial virus (RSV) is a common, and very contagious, virus that infects the respiratory tract of most children before their second birthday.

For most babies and young children, the infection causes nothing more than a cold. But for a small percentage, infection with RSV can lead to serious, sometimes life-threatening problems such as pneumonia or bronchiolitis, an inflammation of the small airways of the lungs.

RSV Symptoms

RSV infection can cause cold-like symptoms, including a cough and runny nose, which usually last 1 to 2 weeks.

When to see a doctor: Call your baby’s doctor if you notice any of the following RSV symptoms:

  • A high-pitched whistling or wheezing noise when they breathe
  • Being unusually upset or inactive
  • A cough with yellow, green, or gray mucus or pauses in their breaths
  • Refusing to breastfeed or bottle-feed : lack of tears when crying, little or no urine in their diaper for 6 hours, and cool, dry skin

If your baby is very tired, breathes rapidly, has difficulty in breathing, or has a blue tint to their lips or fingernails, call 911 or go to the ER immediately.

RSV Causes and Risk Factors

Respiratory syncytial virus spreads through the air, like after a cough or a sneeze, and through direct contact like touching.

The chance of a severe infection is highest for:

  • Babies born prematurely
  • Children younger than 2 who were born with heart or lung disease
  • Infants and young children whose immune systems are weakened because of illness or medical treatment
  • Children under 8 to 10 weeks old

RSV Diagnosis

To diagnose RSV, your child’s doctor will probably look at their medical history and do a physical exam, including listening to their lungs.

Your doctor might do some tests if your child is very sick or in order to rule out other problems. Tests for RSV include:

  • Blood and urine tests to look for a bacterial infection and make sure your child isn’t dehydrated
  • Chest X-rays to look for any signs of pneumonia
  • Tests of material scraped out of your child’s nose or mouth

RSV Prevention

Steps you can take to try to avoid and prevent RSV include:

  • Avoid kissing your baby if you have cold symptoms.
  • Clean and disinfect hard surfaces.
  • Don’t let anyone smoke around your baby.
  • If possible, keep your baby away from anyone, including siblings, with cold symptoms.
  • Keep your baby away from crowds.
  • Ask people to wash their hands before they touch your baby.
  • Limit the time high-risk babies and young children stay in daycare, particularly from late fall to early spring, when RSV is most common. often, especially after contact with anyone who has cold symptoms.

There’s no vaccine for respiratory syncytial virus. But a medication called palivizumab may prevent RSV infections and protect high-risk babies from serious complications of RSV infection. If your baby is at high risk, your doctor may give them a monthly shot of it during peak RSV season.

RSV Treatments

Although palivizumab may help prevent serious complications of RSV infection, doctors don’t use it to treat RSV. No medication treats the virus itself. So caring for a baby with RSV infection involves treating the symptoms and how it affects your baby’s respiratory system.

Most babies and young children can be cared for at home:

  • Remove sticky nasal fluids with a bulb syringe and saline drops.
  • Use a cool-mist vaporizer to keep the air moist and make breathing easier.
  • Give your little one fluids in small amounts throughout the day.
  • Use non-aspirinfever-reducers such as acetaminophen. Check the label and follow all directions carefully.

Babies with more serious cases may need to go to a hospital, where their treatment may include:

  • Oxygen
  • IV fluids
  • Medications or procedures (intubation)to open their airways

Sources

Children’s Hospital of Philadelphia: “Respiratory Syncytial Virus (RSV).”

Een auto-immuunziekte is een ziekte waarbij het lichaam afweerstoffen maakt tegen weefsels in het eigen lichaam. Zulke afweerstoffen zijn normaal bedoeld om infecties te bestrijden. Ze zetten een afweerreactie in gang die uiteindelijk leidt tot vernietiging van de bacteriën, virussen of schimmels die de infectie veroorzaken. Bij auto-immuunziekten gaat er iets mis waardoor de afweerstoffen zich keren tegen lichaamseigen weefsels. Deze weefsels raken hierdoor beschadigd.

How to diagnose bronchiolitis

Hoe wordt de diagnose gesteld?

Meestal kunnen auto-immuunziekten worden aangetoond met behulp van bloedonderzoek. In het bloed van iemand met een auto-immuunziekte zijn namelijk vaak de afweerstoffen aantoonbaar die de ziekte veroorzaken. Dergelijke afweerstoffen worden ‘auto-antistoffen‘ genoemd. Het aantonen van auto-antistoffen in het bloedserum van een patiënt geeft een sterke aanwijzing voor de diagnose.

Voorbeelden van auto-immuunziekten

De volgende ziekten, of bepaalde vormen van deze ziekten, worden beschouwd als auto-immuunziekte:

Kijk voor meer informatie over de ziektebeelden op de betreffende webpagina’s.

Engelse term

Synoniemen

Andere namen voor auto-immuunziekte zijn autoimmuunziekte, autoimmuun ziekte, auto-immuun ziekte, autoimmuunziektes, auto-immuun ziektes, auto-immuun ziekten, auto-immuunziekten, autoimmuun ziekten, autoimmuunziekten, en autoimmuun ziekte.

Gepubliceerd door: Simpto.nl
Datum van publicatie: 19 februari 2016
Auteur: Erwin Douwes
Laatst bijgewerkt op: 21 maart 2021

6 gedachten over “Auto-immuunziekte”

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Respiratory syncytial (sin-SISH-ul) virus (RSV) is a major cause of respiratory illness in young children. The virus infects the lungs and breathing passages.

What Are the Signs & Symptoms of Respiratory Syncytial Virus?

Kids with RSV might have cold symptoms, such as:

  • a stuffy or runny nose
  • mild headache
  • fever
  • not eating or drinking well
  • a general ill feeling

Sometimes, an RSV infection can lead to:

    or pneumonia, especially in premature babies; infants younger than 1 year old; and kids with diseases that affect the lungs, heart, or immune system

Is Respiratory Syncytial Virus Contagious?

Respiratory syncytial virus is highly contagious. It spreads through droplets containing the virus when someone coughs or sneezes. It also can live on surfaces (like counters or doorknobs) and on hands and clothing. So people can get it if they touch something that’s contaminated.

RSV can spread quickly through schools and childcare centers. Babies often get it when older kids carry the virus home from school and pass it to them. Almost all kids have had RSV at least once by the time they’re 2 years old.

RSV infections often happen in epidemics that last from late fall through early spring. Respiratory illness caused by RSV — such as bronchiolitis or pneumonia — usually lasts about a week, but some cases may last several weeks.

How Is Respiratory Syncytial Virus Diagnosed?

Health care providers usually diagnose respiratory syncytial virus by taking a and doing an exam. In most healthy kids, they don’t need to distinguish RSV from a common cold.

But if a child has other health conditions or more serious symptoms, they might want to make a specific RSV diagnosis. In that case, the virus is identified by testing nasal fluids. The sample is collected either with a cotton swab or by suction through a bulb syringe.

How Is Respiratory Syncytial Virus Treated?

Most cases of respiratory syncytial virus are mild and don’t need medical treatment. Antibiotics aren’t used because RSV is a virus — antibiotics work only against bacteria.

RSV infection can be more serious in babies, though. Some might need treatment in a hospital. There, they can be watched closely and get fluids, if needed, and treatment for any breathing problems.

Home Care

  • Make your child as comfortable as possible.
  • Allow time for recovery.
  • Provide plenty of fluids. Babies may not feel like drinking, so offer fluids in small amounts often.

Avoid hot-water and steam humidifiers, which can be hazardous and can scald skin. If you use a cool-mist humidifier, clean it daily to prevent mold and bacteria growth.

If your child is too young to blow their own nose, use saline (saltwater) nose spray or drops and a nasal aspirator (or bulb syringe) to remove sticky nasal fluids. Clearing a baby’s nose before offering fluids can make it easier for them to drink.

Treat fever using a non-aspirin fever medicine like acetaminophen or, if your child is older than 6 months, ibuprofen. Do not give aspirin to children who have a viral illness. Such use is linked to Reye syndrome, which can be life-threatening. Do not use over-the-counter cold medicines, which can be dangerous for young children.

Can Respiratory Syncytial Virus Be Prevented?

Because RSV can spread easily by touching infected people or surfaces, washing hands well and often can help stop it. Wash your hands after being around someone who has cold symptoms. And school-age kids who have a cold should keep away from younger siblings — especially babies — until their symptoms end.

To prevent serious RSV-related respiratory disease, at-risk infants can get a monthly injection of a medicine with RSV antibodies during peak RSV season (roughly November to April in the U.S.). The protection it gives doesn’t last long, though. So they’ll need injections each RSV season until they’re no longer at high risk for severe RSV infection. Ask the health care provider if your child is considered high-risk.

When Should I Call the Doctor?

Call your health care provider if your child:

  • develops a fever after having a cold or has a high fever
  • has a cough or other symptoms that get worse
  • is wheezing
  • shows signs of dehydration, such as fewer wet diapers than usual

Also call if your infant is very cranky, or refuses to breastfeed or bottle-feed.

Sarcoidosis is a rare disease caused by inflammation. It usually occurs in the lungs and lymph nodes, but it can occur in almost any organ.

Sarcoidosis in the lungs is called pulmonary sarcoidosis. It causes small lumps of inflammatory cells in the lungs. These lumps are called granulomas and can affect how the lungs work. The granulomas generally heal and disappear on their own. But, if they don’t heal, the lung tissue can remain inflamed and become scarred and stiff. This is called pulmonary fibrosis. It changes the structure of the lungs and can affect your breathing. Bronchiectasis can also occur. This is when pockets form in the air tubes of the lung and become infected. But, these problems are not common.

What causes pulmonary sarcoidosis?

The cause of pulmonary sarcoidosis is unknown. Experts think that bacteria, viruses, or chemicals might trigger the disease. It may also be genetic. This means a person is more likely to develop sarcoidosis if someone his or her close family has it. This is an active area of research.

What are the symptoms of pulmonary sarcoidosis?

Most people with sarcoidosis do not have symptoms and probably don’t know they have the disease. It can affect many organs, causing a variety of symptoms. Pulmonary sarcoidosis can reduce the amount of air the lungs can hold and cause lung stiffness.

The following are the most common symptoms of pulmonary sarcoidosis. However, each person may experience symptoms differently. Symptoms may include:

  • Shortness of breath, which often gets worse with activity
  • Dry cough that will not go away
  • Chest pain
  • Wheezing

Sarcoidosis can also cause symptoms not directly related to the lungs, such as:

  • Extreme tiredness
  • Fever
  • Inflammation of the eyes and pain, burning, blurred vision, and light sensitivity
  • Night sweats
  • Pain in the joints and bones
  • Skin rashes, lumps, and color changes on face, arms, or shins
  • Swollen lymph nodes
  • Weight loss

The symptoms of pulmonary sarcoidosis may look like other conditions or medical problems. Talk with your healthcare provider for a diagnosis.

How is pulmonary sarcoidosis diagnosed?

In addition to a complete medical history and physical exam, tests used may include:

  • Chest X-ray. A type of imaging test used to assess the lungs, as well as the heart. Chest X-rays may show important information about the size, shape, and location of the lungs, bronchi (large breathing tubes), and mediastinum (area in the middle of the chest separating the lungs).
  • CT scan. An imaging test that uses X-rays and computer technology to produce horizontal, or axial, images or slices of the body. A CT scan shows detailed images of any part of the body, including the lungs. CT scans are more detailed than regular X-rays. They can be used to diagnose lung diseases, monitor disease progression, and evaluate response to treatment.
  • Pulmonary function tests. These are tests that help to measure the lungs’ ability to move air in and out of the lungs. The tests are usually done with special machines into which the person must breathe.
  • Blood tests. These can be used to check the amount of carbon dioxide and oxygen in the blood, evaluate liver and kidney function, and look for infection and other diseases.
  • Bronchoscopy. A long, thin, flexible tube with a light at the end is put down the throat and into the lungs. This lets the doctor to view the bronchi, the main airways of the lungs. It is done to help evaluate and diagnose lung problems. Lung tissue samples (biopsies) and lung washings (lavage) that remove cells from the lungs can be done through the bronchoscope.
  • Bronchoalveolar lavage. This is a procedure in which a sterile saline solution is put into the lungs through a bronchoscope and then suctioned out. The saline carries out cells from the lower respiratory tract, which can be checked under a microscope to help identify inflammation and infection. It can help rule out certain causes.
  • Lung biopsy. A test in which a small piece of tissue, cells, or fluid from the lungs is taken out and checked under a microscope.

Sarcoidosis is usually diagnosed when other lung disorders are ruled out.

How is pulmonary sarcoidosis treated?

Treatment is generally done to control symptoms and improve the function of organs affected by the disease. Steroid medicine, such as prednisone, may help reduce inflammation. It can be taken by mouth or inhaled. Other medicines, such as methotrexate, may be used in severe cases or if steroids don’t work.

In many cases, no treatment is needed for pulmonary sarcoidosis. Different treatments work better for different people. Sometimes more than one treatment is used. Most medicines used to treat sarcoidosis suppress the immune system.

You may also join a rehab program that includes education, exercise, and support. In severe cases, which are not common, oxygen therapy and even lung transplant may be needed.