How to Diagnose Bronchiolitis

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1Observing the Symptoms of Bronchiolitis

2Getting a Medical Diagnosis

3Diagnosing Severe Bronchiolitis

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Tips and Warnings

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References

Article Summary

Bronchiolitis is an illness of the respiratory tract, usually caused by a viral infection in the bronchioles, which are passageways that allow air to enter the lungs. The most common cause of bronchiolitis is the respiratory syncytial virus, or RSV. The illness can be tricky to diagnose, but the good news is that it’s relatively easy to cure. Bronchiolitis can affect anyone, but it is more common in infants, young children, the elderly, and individuals who are immune-deficient. If bronchiolitis is suspected, the sick individual should see a doctor immediately. If the case of bronchiolitis is difficult to diagnose, the doctor may need to perform an x-ray or a nasal swab.

Steps

Method 1

Method 1 of 3:

Observing the Symptoms of Bronchiolitis

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   Watch for cold-like symptoms. Bronchiolitis often begins with symptoms that resemble those of the common cold or the flu, followed by wheezing or difficulty breathing. Although these symptoms progress as bronchiolitis worsens, the illness will be easier to cure if you catch the symptoms early on. Look for:

   • A runny or stuffy nose
   • A persistent cough
   • Wheezing
   • Difficulty breathing
   • In some cases, a slight fever, usually no higher than 102 °F (39 °C)
2. 
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   See if the symptoms worsen over 2 days. While the symptoms of bronchiolitis can be caused by several different illnesses, including a cold or the flu, the patient should see a doctor if symptoms worsen to get a proper diagnosis and treatment. Otherwise, their condition can continue to worsen.

   • The individual's nose will become increasingly runny, their cough will become more noticeable, and the fever will rise.
   • You might also notice a decrease in appetite or activity level.
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   Observe if the person develops a wheezing cough. As the symptoms of bronchiolitis become more severe, the person's cough will worsen. The final breaths of the cough will also turn into a wheeze. The person may also experience difficulty breathing.

   • The telltale wheeze will most often sound like a high-pitched squeaking sound when the person exhales. Wheezes are typically not noticeable when the person inhales. However, you may not hear the wheezing, especially if the congestion is severe. If you're worried this is the case, put your ear up to the person's chest to listen for wheezing.
   • If you have a sick child, you can check for trouble breathing by looking at the child's chest. Take off their shirt and watch the rise and fall of their chest as the child breathes. If the child is having trouble breathing, you will see the rib cage more clearly as the child inhales.
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   Check your infant’s ears for infection. Infants with bronchiolitis often simultaneously develop an ear infection. Watch your infant’s behavior to determine if they have an ear infection. Infants with ear infections will tug or scratch at their ears, or may have difficulty sleeping. You may also notice liquid draining from their infected ears.

   • The ear infection will likely make your infant cranky and irritable.
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Method 2

Method 2 of 3:

Getting a Medical Diagnosis

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   Take the person to an urgent care center. As with any medical diagnosis, you’ll need a doctor to make a diagnosis and prescribe treatment. Take the person to an emergency care provider if their breathing has become strained or labored, or if their wheeze has worsened. Many urgent care centers are open 24 hours a day.

   • Some emergency care centers prioritize children, so you may get immediate treatment.
   • You can call your doctor if you think you can get in that day. When speaking to the receptionist over the phone, explain that the situation is urgent and you’d like an appointment today. If that's not possible, visit an urgent care center immediately.
   • The doctor will be able to prescribe medication to help clear up the respiratory infection. They will also likely offer immediate nebulizing treatment to help the patient breathe better.
2. 
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   Seek medical attention if the individual displays severe symptoms. With a serious infection, symptoms can quickly worsen. Don’t panic, but take them to an urgent care center immediately. They need to see a doctor, but their symptoms are still completely treatable. Even if the person doesn’t show strained or labored breathing, take them to the doctor promptly if they display any of these symptoms:

   • Vomiting
   • Fast, shallow breaths
   • Decreased fluid intake, or, in infants, fewer wet diapers
   • Refusing to eat, or breathing too fast to be able to eat
   • Lethargic behavior
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   Describe the patient's behavior and medical history to the doctor. The doctor will need a full background to make a diagnosis. Describe the symptoms to the doctor, including how long they have been ill, how sever their cough is, and whether they’ve had a fever or ear infection. You can help the doctor further by answering their questions about the person's medical history.

   • For example, the doctor may want to know if they are frequently exposed to secondhand smoke, have a history of allergies or asthma, or are on any medications.
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   Agree to medical tests that the doctor advises. In most cases, the doctor will be able to diagnose bronchiolitis by doing a physical exam and reviewing the patient’s medical history. They might also use a painless finger clamp sensor to measure the amount of oxygen in your blood. However, don’t be alarmed if they recommend doing other tests, such as:

   • Chest x-rays
   • Blood tests or cell cultures
   • In rare cases, a nasal swab (e.g., to rule out other possible causes for the symptoms, such as a coronavirus infection)
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Method 3

Method 3 of 3:

Diagnosing Severe Bronchiolitis

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   Call the doctor immediately if you note symptoms of severe bronchiolitis. Unlike most cases, severe bronchiolitis can be life-threatening, although it's still treatable. Infants with severe bronchiolitis will usually need to be treated in a nearby hospital, and may be kept overnight, depending on the severity of their infection. Infants at risk for severe bronchiolitis include those who:

   • Were born prematurely
   • Have a chronic lung or heart disease
   • Have a weak immune system
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   Inspect the lips and skin for a blue tone or paleness. Blue skin and lips—a condition known as cyanosis—is a symptom of severe cases of bronchiolitis. Cyanosis indicates that the person's respiratory passages are so blocked that not enough oxygen is reaching their extremities. While cyanosis isn’t an emergency in itself, it needs to be treated by a doctor.

   • On dark skin tones, lips and skin may look pale rather than blue.
   • Call a doctor immediately if you notice that the person's lips and skin are blue or pale. The person likely needs immediate medical care.
3. 3
   Check for rapid, shallow breathing. If someone with bronchiolitis is struggling to breathe, get medical attention immediately. Watch out for difficulty breathing or very fast, shallow breaths (e.g., more than 60 breaths per second).

   • You might hear the person gasping or wheezing loudly, or see the muscles around their ribcage contracting hard.
4. 
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   Observe the person for pauses in their breathing. Long pauses between breaths—or periods of time when the person isn’t breathing at all—are signs of apnea. Apnea is a symptom of severe bronchiolitis and can be life threatening. If the person experiences apnea, reassure them and ask them to focus on their breathing. Then seek emergency care.

   • Apnea occurs most frequently in infants who were born prematurely or who are less than 2 months old.
   • Seek emergency care if your child experiences apnea.
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Tips

• The bronchioles of infants and young children are smaller than in teens and adults, and so become infected more easily. Children contract bronchiolitis most commonly before they turn 2, and often when they’re between 3 and 6 months.
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• Cases of bronchiolitis peak during the cold winter months.
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• The symptoms of bronchiolitis can be difficult to tell apart from symptoms of the flu or the common cold. This similarity may lead your doctor to misdiagnoses your child’s bronchiolitis at first.
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