Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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The Progression of Clinical Symptoms
Bronchiolitis usually develops in two stages over several days. It starts with symptoms like a common cold: runny nose, stuffy nose, and a mild fever (usually under 38.5°C). There may also be a dry cough and less interest in eating. This first phase lasts two to four days. As the virus moves deeper into the lungs, inflammation increases, and the cough becomes worse and may sound wet or tight. The main sign is trouble breathing, shown by very fast breathing. Infants may breathe more than sixty or seventy times a minute, much faster than normal. This rapid breathing helps them get enough oxygen when their airways are blocked.
When it becomes harder to breathe, infants use extra muscles to help. This shows up as retractions, where the skin pulls in around the ribs or neck with each breath.
These signs mean the baby is working very hard to breathe and may get too tired to keep up, which can lead to serious breathing problems.
A major concern with bronchiolitis is that babies can quickly become dehydrated. Babies mostly breathe through their noses, especially when feeding. If their nose is blocked with mucus, they have to stop feeding often to breathe, which makes them tired and frustrated, so they eat less. Fast breathing and fever also cause them to lose more water. This combination can lead to dehydration. Signs include a dry mouth, sunken soft spot on the head, no tears when crying, being very tired, and fewer wet diapers. Checking for dehydration is a key part of the exam at Liv Hospital.
As the airways get more blocked, the lungs cannot get enough oxygen into the blood. This causes low oxygen levels, called hypoxemia. In severe cases, the skin, lips, or nails may turn blue (cyanosis), which is a serious sign and needs immediate care. Sometimes, low oxygen does not cause visible color changes, so doctors use a pulse oximeter to check oxygen levels. Some babies, especially those born early or with low birth weight, may stop breathing for 20 seconds or more (apnea), sometimes before they even start coughing or wheezing.
Being born early is the biggest risk factor for severe bronchiolitis. Babies born before 37 weeks, especially before 28 weeks, have lungs that are not fully developed. Their airways are smaller, and they have fewer air sacs and less backup for moving air. Even a little swelling can block their airways. They also miss out on getting important antibodies from their mother, which mostly happens late in pregnancy, so their immune system is weaker. The earlier a baby is born, the higher the risk of needing hospital care or breathing support.
Babies who already have other health problems are at even higher risk and often get sicker with bronchiolitis.
Where a baby lives and what they are exposed to can affect their risk of getting bronchiolitis and how severe it is. Breathing in tobacco smoke is a major risk factor because it damages the lungs and makes symptoms worse. Even smoke on clothes can be harmful. Living in crowded homes or going to daycare increases the chance of catching viruses. Babies with older siblings who go to school are also at higher risk. Not being breastfed can make babies more likely to get sick, since breast milk provides important immune protection. Families with lower incomes may have higher hospitalization rates, possibly because of more exposure to risks and less access to care.
Age is a key risk factor for severe bronchiolitis. Babies between one and three months old are most at risk because their airways are smallest and their immune systems are still developing. As children grow, their airways get bigger and stronger, making blockages less likely. Boys are hospitalized for bronchiolitis more often than girls, possibly because their airways are a bit smaller or due to differences in hormones or lung development, though the exact reason is not clear.
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The illness typically starts with symptoms similar to a common cold, including a runny nose, mild fever, and nasal congestion, before progressing to a cough and breathing difficulties after a few days.
Signs of breathing trouble include fast breathing (tachypnea), flaring of the nostrils, grunting noises, and the chest sinking in at the ribs or neck (retractions) with each breath.
Babies breathe almost exclusively through their noses. When it is blocked with thick mucus, they cannot breathe and swallow at the same time, leading to exhaustion and refusal to feed.
Yes, exposure to cigarette smoke damages the lungs’ natural defenses, paralyzes cilia, and makes the airways more sensitive, leading to more severe symptoms and a higher risk of hospitalization.
Premature babies have smaller airways, less developed lung tissue, and lack the complete protection of antibodies transferred from their mothers during the end of pregnancy, making them more vulnerable.
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