Bronchiolitis physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Presentation
In a typical case, an infant under twelve months of age develops cough, wheeze, and shortness of breath over one or two days. The diagnosis is made by clinical examination. Chest X-ray is sometimes useful to exclude pneumonia, but not indicated in routine cases.
Testing for specific viral cause (e.g. RSV by nasopharyngeal aspirate) is common, but has little effect on management. Identification of RSV-positive patients can be helpful for:
- disease surveillance
- grouping ("cohorting") patients together in hospital wards as to prevent cross infection
- predicting whether the disease course has peaked yet
- reducing the need for other diagnostic procedures (by providing confidence that a cause has been identified).
The infant may be breathless for several days. After the acute illness, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheeze.
There is a possible link with later asthma: possible explanations are that bronchiolitis causes asthma by inducing long term inflammation, or that children who are destined to be asthmatic are more susceptible to develop bronchiolitis.