Bronchiolitis typically begins with which symptoms and progresses to which?

• A. Lower airway symptoms first, then upper
• B. Upper respiratory symptoms followed by lower (tachypnea, cough, wheeze)
• C. Only GI symptoms
• D. Only skin symptoms

Answer: (B)

Bronchiolitis is a viral infection of the small airways that typically starts with upper respiratory symptoms and then progresses to lower airway involvement. In infants, you usually see nasal congestion, runny nose, possibly a low-grade fever, and cough first. Within a day or two, lower airway symptoms develop, such as rapid breathing (tachypnea), persistent cough, wheezing, and sometimes chest retractions or signs of feeding difficulty. This progression happens because the virus inflames and narrows the bronchioles, leading to increased work of breathing and wheeze as mucus and edema affect the smaller airways. Symptoms limited to the GI tract or skin don’t fit this respiratory pattern, and lower airway symptoms appearing before any upper symptoms aren’t typical for bronchiolitis.