Bronchiolitis Initial Assessment

Clinical Presentation

Signs and Symptoms  

The symptoms of bronchiolitis are usually worst on the third to fifth day of illness and then improve gradually. The symptoms are usually preceded by upper respiratory infections. There is initially sneezing, mild rhinorrhea, nasal obstruction, and cough. Patients may progress to respiratory distress with wheezing, crackles, irritability, shortness of breath, and tachypnea. A lower respiratory tract infection (mainly bronchiolitis and pneumonia) should be suspected with increased respiratory rate. There may also be anorexia and fever (<39⁰C). Other diagnoses should be considered first in the presence of an axillary temperature of ≥39⁰C.  

Physical Examination

Findings on physical exam include wheezes or fine respiratory crackles with prolonged expiratory phase of breathing, barely discernible breath sounds due to bronchiolar obstruction (suggesting severe disease), and a palpable liver and spleen due to hyperinflation of the lungs.

Diagnosis or Diagnostic Criteria

Bronchiolitis is diagnosed based on the patient’s history and presentation.  

Diagnostic criteria for bronchiolitis include, but are not limited to, the following:

• Exposures to persons with viral upper respiratory tract infection
• Preceding upper respiratory illness
• Signs of lower respiratory illness which may include wheezing, retractions, O₂ desaturation, nasal flaring, and other signs and symptoms described above
• Apnea, especially in premature or low birth-weight infants
• Signs of dehydration