Which of the following signs is not typical of bronchiolitis in infants?

• A. Productive cough
• B. Wheezing
• C. Crackles
• D. Decreased breath sounds

Answer: (A)

Bronchiolitis in infants is an inflammatory process of the small airways that leads to narrowing and increased work of breathing. The usual exam findings reflect this airway involvement: wheezing from narrowed airways, crackles from inflammation and secretions in the small airways, and sometimes decreased breath sounds if there is significant obstruction or air trapping. The cough tends to be dry or nonproductive in the acute phase because the mucus buildup in bronchiolitis is not typically coughed up in large amounts.

So, the sign that isn't typical is a productive cough—infants with bronchiolitis are more likely to have a dry or nonproductive cough rather than a chest cough with lot of sputum. If substantial sputum production is clearly present, other diagnoses such as pneumonia or a bacterial bronchitis might be considered.