Bronchitis in children

What is Bronchitis in Children? 

Bronchitis in children is the presence of inflammation in the large and medium-sized airways called bronchi that start from the trachea, end in the bronchioles, and carry air to and fro from the lungs. This inflammation may last for a few weeks or sometimes may last longer and is usually secondary to a viral infection, although some bacteria also can cause bronchitis, also known as Chest Cold. 

Is Bronchitis in Children a Medical Emergency? 

It is not a medical emergency. 

Types 

It may be classified as follows: 

• Acute bronchitis: This usually lasts for not more than 3 weeks. 
• Chronic bronchitis: This is a sputum producing cough that lasts for 3 months or more per year for at least 2 years. 

Other types of bronchitis that are seen are: 

• Eosinophilic bronchitis: Chronic dry cough with increased white blood cells 
• Protracted bacterial bronchitis: Chronic sputum producing cough seen in children 
• Plastic bronchitis: Seen in children and characterized by the presence of thickened mucus plugs in one lung blocking airflow, which causes the overinflation of the opposite lung 
• Aspergillus bronchitis: The bronchi are infected by fungi, and it can even affect individuals with a normal immune system 

Causes 

Acute bronchitis is usually caused by viral infections and sometimes by a few bacteria, such as M. pneumoniae or B. pertussis. Repeated attacks of acute bronchitis usually cause chronic bronchitis in children; it can also be caused by air and industrial pollution and is mainly associated with repeated exposure to cigarette 
smoke. 

Risk factors 

The risk factors for bronchitis in children include: 

• Exposure to cigarette smoke 
• Living in industrial areas and near factories 
• Weak immune system 
• Acid reflux 
• Allergies 

Signs & symptoms 

The symptoms and signs of bronchitis include:

• Cough 
• Sputum or phlegm, which may be white, yellow, grey, brown, green, or sometimes blood-tinged 
• Shortness of breath 
• Low-grade fever and chills 
• Tiredness and a general feeling of being unwell 
• Discomfort in the chest 

Diagnosis 

Diagnosis is established based on medical history, clinical evaluation, and the results of investigations, if any. 

Investigations 

The following investigations may be done to help with the diagnosis and management of chest cold: 

• Laboratory tests: 
  • CBP & ESR 
  • Sputum culture and sensitivity: To check for the presence of any bacteria that may be present, and the antibiotics that can be used to kill them 
  • Immunodeficiency testing: Serum immunoglobulins and IgG subclasses are measured 
• Chest X-ray: To evaluate the presence of possible conditions that could be responsible for cough and sputum production. 
• Pulmonary function tests: To evaluate the functional capacity of the lungs 
• Fiber optic bronchoscopy 

Management

The management of bronchitis in children depends on the severity of the symptoms and whether it is acute or chronic bronchitis. Most cases of acute bronchitis usually resolve by themselves and do not require any medical intervention. Chronic bronchitis may require some medical management. 

Medical management 

Adequate hydration must be ensured. 
The following may be used in the medical management of bronchitis: 

• Antibiotics/Antimicrobials: May be useful in the management of chronic bronchitis 
• Cough syrups and expectorants 
• Analgesics and Antipyretics: To help provide relief from fatigue and fever 
• Bronchodilators: Help in the relief of symptoms in chronic bronchitis
• Inhaled corticosteroids: In combination with bronchodilators, help to provide relief from chronic cough 
• Systemic corticosteroids: For children with chronic bronchitis who have sudden bouts of increased symptoms 
• Immunoglobulin replacement: In children with low immunity with chronic bronchitis 

Preventive measures 

Some measures that can be taken to get relief from the symptoms as well as to prevent acute attacks include: 

• Diet- Avoiding high calorie processed foods, having fresh vegetables and fruits, adequate protein in the diet 
• Keeping away from cigarette smoke 
• Wearing face masks to avoid inhalation of irritants 
• Sanitizing hands and maintaining good hygiene to avoid contracting infections 
• Pulmonary rehabilitation: It is useful in individuals who have reduced lung function 

Complications 

Acute bronchitis is usually self-limiting, and no major complications are associated with it. 
Chronic bronchitis can impact the quality of life due to the reduced lung function that may ensue. 
Some complications that can occur may include: 

• Bronchopneumonia 
• Acute Respiratory Failure 
• Bronchiectasis 

Prognosis 

The prognosis for a chest cold is generally good, especially in otherwise healthy children. The prognosis for chronic bronchitis with other comorbid conditions are generally associated with a poor quality of life. 

When to contact the doctor or hospital? / How to identify the emergency or complications? 

It is advisable to seek medical attention if the cough persists for more than 3 weeks and is accompanied by discoloured sputum or blood, high fever, and severe breathlessness. 

Indications for hospitalization if required 

Hospitalization is not required for this chest cold, but a severe increase in symptoms may warrant hospital admission for oxygenation and hydration.

Suggested clinical specialist/ Department to consult for this condition 

Specialists from the department of pediatric pulmonology will treat it.