The Indian Journal of Pediatrics

, Volume 78, Issue 11, pp 1396–1400

Approach to a Child with Lower Airway Obstruction and Bronchiolitis

  • Sudhanshu Grover
  • J. Mathew
  • Arun Bansal
  • Sunit C. Singhi
Symposium on PGIMER Protocols on Respiratory Emergencies


Lower airway obstruction can occur at the level of trachea, bronchi or bronchioles. It is characterized clinically by wheeze and hyperinflated chest, apart from other signs of respiratory distress. Common causes include bronchiolitis, asthma, pneumonia, laryngotracheo-bronchitis, congenital malformations and foreign body inhalation. Bronchiolitis usually occurs in children aged 2 months to 2 years. It is most commonly caused by respiratory syncytial virus infection. The diagnosis is mainly clinical, and investigations have a very limited role. Humidified oxygen and supportive therapy are the mainstays of treatment. A trial of inhaled epinephrine or parenteral steroids may be considered for non-responders. It is usually associated with good outcome.


Children Lower airway obstruction Wheeze Bronchiolitis 


  1. 1.
    Kumar N, Singh N, Locham KK, Garg R, Sarwal D. Clinical evaluation of acute respiratory distress and chest wheezing in infants. Indian Pediatr. 2002;39:478–83.PubMedGoogle Scholar
  2. 2.
    Tan TN, Lim DLC, Chong YS, Lee BW, Van Bever HP. Prevalence of eczema symptoms in the second year of life. J Allergy Clin Immunol. 1078;2004:113.Google Scholar
  3. 3.
    Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. NEJM. 1995;332:133–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Singhi SC, Mathew JL, Jindal A. Clinical Pearls in Respiratory Diseases. Indian J Pediatr. 2010 Dec 14.[Epub ahead of print] doi:10.1007/s12098-010-0270-3.
  5. 5.
    Poddar U, Singhi S, Ganguli NK, Sialy R. Water electrolyte homeotasis in acute bronchiolitis. Indian Pediatr. 1995;32:59–65.PubMedGoogle Scholar
  6. 6.
    Bush A, Thomson S. Acute bronchiolitis. BMJ. 2007;335:1037–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Mathew JL. What works in bronchiolitis? Indian Pediatr. 2009;46:154–8.PubMedGoogle Scholar
  8. 8.
    Hartling L, Wiebe N, Russell K, Patel H, Klassen TP. Arch Pediatr Adolesc Med. 2003;157:957–64.PubMedCrossRefGoogle Scholar
  9. 9.
    Ray MS, Singh V. Comparison of nebulised adrenaline versus salbutamol in wheeze associated respiratory infections in infants. Indian Pediatr. 2002;39:12–22.PubMedGoogle Scholar
  10. 10.
    Bertrand P, Aranibar H, Castro E, Sanchez I. Efficacy of nebulised epinephrine versus salbutamol in hospitalized infants with bronchiolitis. Pediatr Pulmonol. 2001;31:284–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Menon K, Sutcliffe T, Klassen TP. A randomized trial comparing the efficacy of adrenaline with salbutamol in the treatment of acute bronchiolitis. J Pediatr. 1995;126:1004–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2006;3:CD001266.PubMedGoogle Scholar
  13. 13.
    Flores G, Horwitz RI. Efficacy of b2 agonists in bronchiolitis: a reppraisal and meta-analysis. Pediatrics. 1997;100:233–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Mathew JL. Hypertonic saline nebulization for bronchiolitis. Indian Pediatr. 2008;45:987–9.PubMedGoogle Scholar
  15. 15.
    Teeratakulpisarn J, Limwattananon C, Tanupattarachai S, et al. Efficacy of dexamethasone injection for acute bronchiolitis in hospitalized children: a randomized, double-blind, placebo-controlled trial. Pediatr Pulmonol. 2007;42:433–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Garrison MM, Christakis DA, Harvey E, et al. Systemic corticosteroids in infant bronchiolitis: a meta-analysis. Pediatrics. 2000;105:E44.PubMedCrossRefGoogle Scholar
  17. 17.
    Bentur L, Shoseyov D, Feigenbaum D, et al. Dexamethasone inhalations in RSV bronchiolitis: a double-blind, placebo-controlled study. Acta Paediatr. 2005;94:866–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Plint AC, Johnson DW, Patel H, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009;360:2079–89.PubMedCrossRefGoogle Scholar
  19. 19.
    American Academy of Pediatrics. Subcommittee on diagnosis and management of bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118:1774–93.CrossRefGoogle Scholar
  20. 20.
    American Academy of Pediatrics. Chapter on respiratory syncytial virus. In: Pickering LK, editor. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village: American Academy of Pediatrics; 2009. p. 560–4.Google Scholar
  21. 21.
    Hartling L, Russell KF, Patel H, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2004;1:CD003123.PubMedGoogle Scholar
  22. 22.
    Ventre K, Randolph AG. Ribavirin for respiratory syncytial virus infection of the lower respiratory tract in infants and young children. Cochrane Database Syst Rev. 2007;1:CD000181.PubMedGoogle Scholar
  23. 23.
    Thia LP, McKenzie SA, Blyth PB, et al. Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child. 2008;93:45–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Basco WT. Predicting which pediatric bronchiolitis patients can be safely discharged from the ED. Pediatrics. 2008;121:680–8.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2011

Authors and Affiliations

  • Sudhanshu Grover
    • 1
  • J. Mathew
    • 1
  • Arun Bansal
    • 1
  • Sunit C. Singhi
    • 1
  1. 1.Department of Pediatrics, Advanced Pediatrics CentrePostgraduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations