Treating respiratory syncytial virus — nothing works
It’s that time of year again in the PICU, time for a winter outbreak of respiratory syncytial virus (RSV). RSV is extremely common and highly infectious: its attack rate, meaning the chances of a susceptible person getting the infection if exposed to a case, is among the highest of any virus. Estimates are that as many as 125,000 infants each year are hospitalized with RSV, with many, many more infected less severely. The peak age for those children needing a hospital is between two and five months. It is so common that by early childhood virtually all of us have been infected at least once.
Much of the time RSV causes the symptoms of a cold — cough, runny nose, sometimes a low-grade fever. But in very young children, particularly infants, RSV can cause severe pneumonia or bronchiolitis. The latter disorder is an inflammation of the tiniest of the lung’s air tubes, or bronchioles. This inflammation blocks off the little tubes, making it difficult for air to get in, or most characteristically, to get the air out. Babies with severe RSV often need oxygen and some need mechanical ventilators to breathe for them as we wait out its course until it passes.
Every parent asks: can we do anything to treat this illness, make the symptoms better, make it go away faster? Sadly, the answer is no. I’ve been taking care of children with RSV for 30 years, and I’ve seen a long list of things tried — breathing treatments, anti-viral medicines, steroids, medicines intended to open up the small airways. None of them work. The research of the past few years is conclusive — all we can do is wait for the infection to pass, meanwhile supporting breathing as needed with oxygen, clearing the lungs of mucous, and sometimes a mechanical breathing machine in severe cases.
Sachin on 
Dr.Johnson,
Thanks for the detailed information about RSV. My toddler has been suffering from wheezing for the past one month and she’s been put on albuterol and budesonide. We give her the breathing treatment twice daily and she feels better after the treatment. The pediatrician diagnosed her condition as RSV infection but how long does the infection last?
How long should we put her on the medication? Do we have to take a chest x-ray? Will the steroid affect her in the long run?
Looking forward to your reply.
Thank you
Sangy
Hi Sangy:
The thing with RSV is that sometimes the effects of the infection — the wheezing — can persist for several weeks or more after the infection itself if long gone. So she may need to be on the medications for a few months, and may get worse wheezing again if she gets another viral respiratory infection.
There’s good data about inhaled steroids (i.e. budesonide) and there are no long term effects — it’s not like taking steroids by mouth.
Thank you for the information. My son has been diagnosed for the second time with RSV. The first time was last January at 4 months old. He was hospitalized for a week. This time (15 months old) we ended up in the ER last night after coughing for 2 weeks and a high fever (105.5). Although the doctor told us that this case should be milder on our son, I am still concerned.
How common is it for children to get diagnosed with RSV more than once? Is it typically easier the second time? If so, is that because the child is older, or because they have some anitbodies to it (not sure if that would be the correct terminology)? How likely is my son to get it again (whether it be this season, or future ones)?
Thank you so much for the information.
Amy in NC
Hi Amy:
Getting RSV again (typically during the next winter season) is not uncommon. As your doctor said, subsequent cases are usually not as severe. A main reason for this is that RSV is generally worse in infants, so an older child, such as a toddler, tends to have less trouble. Unfortunately, immunity to RSV is not very good, which is one reason why we’ve been unable to develop a vaccine against it. Adults who are exposed to small children typically get RSV every few years or so.
Thank you for this article regarding RSV. My five year old daughter was in the hospital for hypoxia, fever, and cough this past week. She was put on oxygen, breathing treatments, and steroids. The test came back showing that it was indeed RSV. Since she is already ‘older’, if she were to get it again do you think it would be as bad?
Thank you!
Monica
Hi Monica:
Yes, later cases, especially in older, otherwise healthy children, are generally less severe. Most of the time it’s just a cold.
Thank you very much for all these articles on RSV! Very informative indeed!
Having two kids aged 5 and 2, we’ve experienced these symptoms almost every year during the colder months, but the virus has never been explained to me like this before!
I do have one question, the paed prescribed Augmentin (for my 2yr old, 3ml twice daily for 10days) to treat a recurring cough and sinus infection (persistent cough throughout the day, runny stuffy nose) and two days on, she’s developed a wheeze which she did not have before. She’s battling to talk properly, having to stop and take deep breaths and cough in between.
I feel like her symptoms have intensified since she started the antibiotic. Could this be an allergic reaction to the antibiotic (I’ve read that wheezing can be a side effect) or was this going to happen anyway and it all part of the infection.
Thank you
Thanks for your comment. I hope that you’ll understand that I can’t really give specific medical advice over the internet. I can say that persistent wheezing for many months after an RSV infection is common.