Bronchitis in children

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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 and ends 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, that 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 in Children is usually caused by viral infections, and sometimes by a few bacteria such as M. pneumoniae, or B. pertussis. Chronic Bronchitis in Children is usually caused by repeated attacks of acute bronchitis; it can also be caused by air and industrial pollution and is mostly 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 in Children 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

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

Diagnosis

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

Treatment options

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 in Children may require some medical management.

Medical management

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
  • Bronchodilators: Help in the relief of symptoms in chronic bronchitis
  • Systemic corticosteroids: For children with chronic bronchitis who have sudden bouts of increased symptoms
  • Inhaled corticosteroids: In combination with bronchodilators help to provide relief from chronic cough
  • Analgesics and Antipyretics: To help provide relief from fatigue and fever
  • Immunoglobulin replacement: In children with low immunity

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

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

  • 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: Is useful in individuals who have a reduced lung function

Complications

Acute bronchitis is usually self-limiting and there are no major complications 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:

  • Bronchiectasis
  • Bronchopneumonia
  • Acute Respiratory Failure

Prognosis

The prognosis for Chest cold is generally good, especially in otherwise healthy children. The prognosis for chronic Bronchitis in Children with other comorbid conditions is 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

It will be treated by specialists from the department of pediatric pulmonology.

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