BRONCHIOLITIS

Bronchiolitis caused by RSV can be one of the most frightening things a parent has to deal with in a young infant. It is the most common cause of respiratory illnesses in young children, affecting millions yearly.  Not only does it affect the very young, but it can also affect the elderly and people with lung diseases such as COPD and asthma.

Patients at the highest risk of needing to be hospitalized include premature infants, babies under three months, children with lung and heart issues, and infants exposed to parents who smoke cigarettes.

RSV is spread through respiratory droplets and can even live on surfaces such as countertops and toys for up to 30 hours, which is why it’s so easy to spread within daycare, schools, and homes. After exposure, it usually takes between two and eight days before symptoms start. Patients with RSV are contagious for around ten days.

The RSV virus causes the lining of the bronchioles to start to peel from the inside and clog them. That is why babies struggle to breathe, wheeze, and cough severely. Because their airways are smaller, younger children are much more affected than older children, especially when they are younger than six months.

Symptoms of bronchiolitis, whether because of RSV or other viruses such as rhinovirus and coronavirus, can include wheezing, runny nose, cough, fever, and nasal congestion. They may also eat less because they don’t feel as well. They may also develop retractions or nasal flaring. Rapid breathing is also common. The worst day of symptoms with RSV bronchiolitis is day four from the start of symptoms. Although RSV is usually diagnosed with a nose swab, it’s unnecessary to do so.

Treatment for RSV bronchiolitis is usually supportive, meaning nasal suctioning, Tylenol or Motrin as needed for fever, pushing fluids, and giving lots of love is all that’s required. Antibiotics are not prescribed because this is viral and not bacterial. Although we often prescribe albuterol breathing treatments, these often don’t help. We may also prescribe steroids, but they don’t help much either. In terms of patients that are in the hospital, the treatments may vary and will not be discussed here. The last thing to go is usually a cough which can last up to 3 weeks.

If your child has been diagnosed with RSV bronchiolitis or bronchiolitis by any other virus, the red flag signs that you need to look for in your child that may mean they need to go to a local ER immediately include:

1. Low oxygen
2. Struggling to breathe or rapid breathing
3. Blue lips
4. They stop drinking fluids and appear dehydrated with dry lips or lack of tears
5. They stop breathing between 10-20 seconds at a time

After decades of trying, the FDA approved three new vaccines for the RSV virus this year. The first one I will discuss is Beyfortus or Nirsevimab. This vaccine was approved for infants between birth and 19 months of age; however, it’s primarily geared toward infants under eight months who are going into their first RSV season. It’s given as a one-time dose as early as one week of age. It can be given to older children if they are going into their second RSV season and have a history of lung or heart problems. Vaccine studies showed that only 0.6% of healthy children who got the vaccine needed to be hospitalized versus 1.6% of healthy children who did not get vaccinated. In premature infants, only 0.6% needed to be hospitalized for RSV versus 4.1%. Although the percentages seem relatively low, millions of infants are diagnosed with RSV yearly. Cutting hospitalizations by ½ is enormous. I would encourage parents with a child under eight months to get vaccinated against the RSV virus since it can cause a significant burden on families emotionally and financially. Infants under six months are especially at a high risk of severe disease requiring hospitalization. Developing RSV under 6 months can increase their risk of developing asthma later in life.

There is a second RSV vaccine, which is given to pregnant women who are 32 to 36 weeks pregnant. It is called Abryso. It is also given as a one-time dose. It can decrease the risk of newborn infants under six months needing hospitalization by 69%.

Arexvy is the third RSV vaccine. This one is geared toward adults aged 60 and older. It’s given as a one-time dose as well. This can decrease the risk of having severe disease by 83%, which is very significant. In adults, especially those with COPD, RSV is a significant cause of hospitalization, death, or intubation. I firmly believe that patients with a history of heart issues, diabetes, and especially those with COPD get vaccinated against RSV. I would also strongly encourage older adults who spend considerable time with school-aged children to get vaccinated.