Bronchiolitis, obstructive bronchitis

1. Big picture

Bronchiolitis and obstructive bronchitis / wheezy bronchitis are common pediatric causes of wheeze, cough, tachypnea, and respiratory distress, especially in infants and toddlers.

The core exam distinction:

Bronchiolitis
= first viral lower airway obstruction in an infant, usually RSV
= small airway edema + mucus plugging
= supportive care only

Obstructive bronchitis / wheezy bronchitis
= recurrent viral-triggered wheeze in infant/toddler
= “infant/toddler asthma-like” picture
= consider asthma tendency if recurrent, atopic, or bronchodilator-responsive

The examiner wants you to avoid the classic trap:

Do not treat bronchiolitis like asthma. Routine salbutamol, corticosteroids, adrenaline, antibiotics, chest physiotherapy, and ribavirin are not indicated in typical bronchiolitis.

Modern bronchiolitis guidelines emphasize that diagnosis is clinical and treatment is supportive: oxygen if needed, hydration, minimal handling, feeding support, and monitoring for apnea or respiratory failure. NICE states that bronchiolitis occurs in children under 2 years, peaks at 3–6 months, and is diagnosed by coryzal prodrome followed by persistent cough plus tachypnea/recession and wheeze or crackles. ([NICE][1])

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