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Know the differences between bronchiolitis and asthma

It is easy for parents, and even medical providers, to confuse bronchiolitis and asthma.

Both of these illnesses have several things in common, such as noisy or rapid breathing, fatigue, wheezing and coughing. These illnesses are also more common in childhood. Lastly, the viruses that cause bronchiolitis are the same viruses that can cause asthma flare ups.

However, the treatment for these diseases can be very different, so it is important to distinguish between the two.


Bronchiolitis is the inflammation of the throat and lungs caused by a viral infection in children usually less than 3 years old. Several viruses can cause bronchiolitis; a common one is Respiratory Syncytial Virus (RSV). The symptoms of bronchiolitis are usually the most severe in the youngest children such as infants younger than 6 months old.

The inflammation typically causes significant nasal congestion and swelling in the smaller airways of the lungs. This swelling can produce wheezing noises when your child is breathing forcefully.

Because this disease is caused by a virus, there is no medication that can cure it. Most cases of bronchiolitis can be managed at home with good nasal suctioning and parents encouraging good hydration. Often symptoms will improve in three to five days. Some children will require medical-grade suctioning and with their doctor’s permission they might visit a suctioning clinic once or twice a day for a few days. Fewer children still might require an admission to the hospital for closer monitoring and even a tiny amount of oxygen until their lung inflammation begins to heal.

Bronchiolitis can occur several times during childhood but thankfully it is usually more mild each episode. 

Bronchiolitis is a diagnosis a doctor can confidently make with only a thorough exam. In most cases there is no reason to do blood work or a chest x-ray. While tests exist to help doctors identify which virus your child may be infected with these tests are usually very uncomfortable for your child, results are not always accurate and the result will not change how your doctor manages the illness. Again, antibiotics are not helpful and may simply cause stomach upset.

Lastly, albuterol breathing treatments have been proven to not help children with bronchiolitis. Albuterol can have side effects of jitteriness, increased heart rate, anxiety and decreased oxygen levels in the blood. In fact, in studies, children with bronchiolitis who were given albuterol breathing treatments typically had a longer hospital stay than those who did not. While some parents reported an improvement in coughing this same benefit can be produced with a humidified air treatment while avoiding the side effects of albuterol.

For more about bronchiolitis, please watch the video far below.


Asthma is a chronic disease that can be triggered by cold viruses, allergies, exercise and even cold weather. Asthma occurs when the body’s own immune system is overactive and produces swelling and inflammation in the larger airways of the lungs.

Asthma can range from mild to severe. Some children and even adults will only have symptoms, such as wheezing or coughing, when exposed to their personal triggers. Others have asthma symptoms all year and need to be on several daily medications to prevent asthma attacks.

Unlike bronchiolitis, asthma typically occurs in children 4 years old and up. Some children will outgrow asthma while others will not. Asthmatics need to see their primary care doctor at least every six months, or more often if their symptoms are poorly controlled. 

Asthma can be managed with several types of medications, though again, it cannot be cured. Commonly albuterol breathing treatments are helpful in asthmatics with improvement in wheezing and oxygen levels. Some asthmatics will require steroids given as a liquid or in an inhaled form. Some medications can also reduce the immune system’s tendency to overreact. Any asthma attack can be deadly though so good control is always encouraged.

Why it matters

As you can see there are many reasons why a young child can have wheezing. However, proper treatment is important to avoid making either their brief illness or chronic disease worse. And of course, it is important to not label a child with an incorrect diagnosis. Having two to three wheezing illnesses in infancy should not mean a child is called an asthmatic for the rest of his or her life. A diagnosis of asthma on a child’s chart can impact their ability later in life to join the military, for example. 

Wheezing is a common part of childhood and your doctor is ready to help you and your child manage it successfully.

About Amy Seery MD