Persistent runny nose, mild fever, shortness of breath with asso- ciated dry cough and wheeze. On examination accessory muscles are being used and there are fine end inspiratory crackles on the chest

a. This is a presentation of acute bronchiolitis. It is most commonly seen in those children under the age of 6 weeks or in those with chronic respiratory, cardiac or neurological deficits. The commonest causative organism is the respiratory syncitial virus which accounts for 75% of cases. Those infants in respiratory distress may require non-invasive ventilation in the acute phase in addition to inhaled bronchodilators and there is some evidence for the use of ribavirin; a nucleoside analogue. Longterm consequences may include an obstructive bronchiolitis.