Duration of RSV Bronchiolitis
In most children with RSV bronchiolitis, the illness lasts approximately 1 week, with 90% of children becoming cough-free by day 21 and mean cough resolution occurring between 8-15 days. 1
Typical Clinical Course
The acute phase of RSV bronchiolitis follows a predictable pattern:
- Initial upper respiratory symptoms (fever, rhinorrhea, congestion) last 2-4 days 2
- Lower respiratory symptoms (increasing cough, wheezing, increased respiratory effort) then develop 2
- Total illness duration is typically 1 week in most patients 3
- Cough resolution occurs with a mean time of 8-15 days, with 90% of children cough-free by day 21 1
Important Clinical Thresholds
Symptoms persisting beyond 4 weeks represent a different clinical problem and should not be considered typical acute bronchiolitis. 1 This is sometimes termed "post-bronchiolitis syndrome" and requires evaluation according to pediatric chronic cough guidelines rather than acute bronchiolitis management. 1
Fever Duration Specifically
- Fever typically resolves within 5 days in viral respiratory infections including RSV 4
- Fever persisting beyond 5 days should prompt evaluation for secondary bacterial complications such as acute otitis media (present in 50-62% of bronchiolitis cases) or urinary tract infection 4
Clinical Implications for Management
Bronchiolitis is self-limiting in most children, requiring only supportive care during the acute 1-2 week illness period. 1, 2 The American Academy of Pediatrics guidelines emphasize that:
- Most children recover within 1-2 weeks 5
- Treatment remains primarily supportive with oxygen supplementation and fluid management as needed 2, 3
- Bronchodilators, corticosteroids, hypertonic saline, and antibiotics are generally not useful for acute illness 2
Common Pitfall to Avoid
Do not treat persistent cough beyond 4 weeks as if it were still acute bronchiolitis. 1 Children with chronic cough (>4 weeks) after acute viral bronchiolitis should be managed according to CHEST pediatric chronic cough guidelines, which includes evaluating for cough pointers and considering 2 weeks of antibiotics targeted to common respiratory bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) if wet or productive cough is present. 1