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Bronchiolitis
Bronchiolitis is a viral infection (mainly RSV) of the small airways in children under two; the diagnosis is clinical and treatment is supportive only — oxygen, fluids and nasal clearance.
Why it matters in the exam
Questions on this topic are almost always built on "what not to do": chest X-ray, blood tests, bronchodilators, steroids and antibiotics are not recommended routinely. Indications for admission (dehydration, low oxygen saturation, apnoea, severe work of breathing) are tested, as is recognition of the groups at risk of severe disease: preterm babies, significant heart disease, chronic lung disease and infants under 12 weeks.
A relatively new subject is prevention: nirsevimab — a long-acting monoclonal antibody given as a single dose before or at the start of the RSV season — and a maternal RSV vaccine at 32–36 weeks of pregnancy; monthly palivizumab remains mainly for high-risk groups where nirsevimab is unavailable. In Israel, drug eligibility is set by Ministry of Health circulars, and the current circular should be checked. In a saturation question, note that the AAP uses 90% and NICE uses 92%.
The natural course matters for the exam and for advising parents: symptoms usually worsen until days 3–5 and then improve, and the cough can last two to three weeks. An infant who was stable on day one may deteriorate over the next days, so the discharge decision includes an explanation of warning signs: laboured breathing, pauses in breathing, reduced drinking and fewer wet nappies.
Key points
- Bronchiolitis: a child under two, mainly RSV, in winter.
- The diagnosis is clinical; no routine X-ray or blood tests.
- Oxygen below 90% (AAP) or 92% (NICE), and fluids as needed.
- No bronchodilators, no steroids and no antibiotics.
- Prevention: nirsevimab for the infant, or a maternal vaccine at 32–36 weeks.
Summary table
| Issue | What is recommended | What is not recommended | Exam note |
|---|---|---|---|
| Diagnosis | Clinical: coryza, cough, wheeze or crackles, tachypnoea | Routine chest X-ray, blood count and viral testing | X-ray only if the diagnosis is uncertain or the illness is unusually severe |
| Oxygen | When saturation is below 90% (AAP) or below 92% (NICE) | Continuous monitoring in a stable infant | HFNC for increased work of breathing |
| Drugs | — | Salbutamol, epinephrine, steroids, antibiotics | Hypertonic saline: not in the ED; consider only in prolonged admissions |
| Support | Nasal suction, nasogastric or intravenous fluids if not feeding | Chest physiotherapy | Beware hyponatraemia with intravenous fluids: use isotonic fluids |
| Prevention | Nirsevimab for infants in their first season; maternal vaccine at 32–36 weeks | — | Monthly palivizumab for high-risk groups according to availability |
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Sources
- AAP Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis, 2014 (reaffirmed) — Diagnosis, treatment and prevention
- NICE guideline NG9: Bronchiolitis in children, 2015, updated 2021 — Assessment and management
- CDC/ACIP recommendations on nirsevimab and maternal RSV vaccination, 2023 — Prevention of RSV in infants
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.