The Unseen Symphony: Kofi's Breath

Kofi was usually a ball of energy. At three years old, he loved running through the house with his toy trucks, laughing as he chased the family dog, Max. But on a cold January morning, Kofi was unusually still. He lay curled up on the couch, his cheeks flushed, and his breathing quick and shallow. His mother, Damira, gently pressed her hand to his forehead.

“He’s burning up,” she whispered, worry in her voice.

For the past two days, Kofi had a runny nose and a mild cough, which Damira had assumed was a common cold. But that morning, his breathing changed—it sounded fast and wheezy, and his chest pulled in with each breath. When he refused to eat breakfast and seemed too tired to play, Damira called their pediatrician immediately.

At the clinic, Dr. Ponce listened carefully with her stethoscope. She watched Kofi’s chest rise and fall rapidly and noted the soft, high-pitched wheeze escaping from his tiny lungs.

“His oxygen level is lower than normal,” Dr. Ponce said, showing Damira the pulse oximeter reading. “And he’s working hard to breathe—see how his nostrils flare and the skin under his ribs pulls in with each breath? These are signs of respiratory distress.”

Damira’s eyes widened. “What’s causing it?”

“I suspect Respiratory Syncytial Virus, or RSV,” Dr. Ponce replied gently. “It’s a common virus, especially in young children. In older kids and adults, it can cause mild cold-like symptoms. But in babies and toddlers like Kofi, RSV can inflame the small airways deep in the lungs, leading to bronchiolitis.”

Damira had heard of bronchiolitis but didn’t fully understand it. Dr. Ponce explained further. “Our respiratory system starts with the upper airways—the nose, nasal cavity, pharynx, and larynx. These parts warm and moisten the air and trap particles. Then the air moves into the lower respiratory tract—through the trachea, into the bronchi, which split into smaller bronchioles, and finally into the alveoli. That’s where gas exchange happens.”

Dr. Ponce drew a quick diagram on her notepad. “In RSV, the virus attacks the epithelial cells lining the bronchioles. The tissue swells, and mucus builds up, narrowing the airways. For little ones with tiny bronchioles, even slight inflammation can make it very hard to breathe.”

“So, his airways are blocked?” Damira asked.

“Yes,” Dr. Ponce nodded. “And that’s why he’s wheezing and breathing fast. His body is trying to get oxygen in and carbon dioxide out, but the narrowed bronchioles are making it difficult.”

Dr. Ponce recommended that Kofi be admitted to the pediatric unit at the nearby hospital for observation, fluids, and respiratory support. Damira agreed without hesitation.

Kofi was placed in a small hospital bed with soft sheets decorated with cartoon animals. A nurse gently applied nasal prongs to deliver humidified oxygen. Damira sat nearby, holding his hand and watching the steady beeping of the monitors.

A respiratory therapist named Kalil came in to evaluate Kofi. “We’re going to use a nebulizer to help open his airways,” he explained. “It’s like a mist that carries medication deep into his lungs.”

Kalil held the mask over Kofi’s face while the machine hissed softly. After the treatment, Kofi’s breathing improved slightly, but he was still working hard. Kalil pointed out the use of Kofi’s accessory muscles—his neck and chest muscles were visibly straining to draw in each breath.

“Normally, during inhalation, the diaphragm contracts and flattens, increasing the thoracic cavity’s volume,” Kalil explained to Damira. “This causes a drop in pressure, so air flows into the lungs. The intercostal muscles between the ribs also lift the chest up and out. In exhalation, the muscles relax, and the lungs recoil to push air out. But with bronchiolitis, exhalation is more difficult because of the obstruction. So kids like Kofi have to work harder, and you can see those extra muscles being used.”

Damira listened intently, learning more about how the lungs worked than she ever had before. “So, the inflammation is making it harder for him to exhale?”

“Yes,” Kalil confirmed. “And that’s what causes the wheezing—you’re hearing air squeezing through narrowed bronchioles.”

Later, Dr. Ponce returned to review Kofi’s progress. “Let’s talk about what happens in the alveoli—the tiny air sacs at the end of the respiratory tree,” she said. “Each alveolus is surrounded by capillaries. Oxygen from the air in the alveoli diffuses across a thin membrane into the blood, where it binds to hemoglobin in red blood cells. At the same time, carbon dioxide diffuses out of the blood into the alveoli to be exhaled. This is called external respiration.”

She continued, “When inflammation blocks the bronchioles, not enough air reaches the alveoli. That means less oxygen gets into the blood, and carbon dioxide builds up. Kofi’s low oxygen levels show us that his gas exchange is being affected.”

Damira nodded slowly. “And what happens if he doesn’t get enough oxygen?”

“Every cell in the body needs oxygen to make energy,” Dr. Ponce explained. “If cells don’t get enough, Kofi might become more tired, his heart might beat faster, and in serious cases, organs can be affected. That’s why we monitor oxygen levels and support his breathing until his lungs recover.”

Over the next two days, Kofi continued to receive oxygen therapy and frequent nebulizer treatments. He drank fluids through a straw shaped like a giraffe and slowly began to eat small bites of applesauce and toast. His oxygen saturation levels started to improve, and his breathing rate decreased.

Kalil brought in a bubble wand and encouraged Kofi to blow bubbles to exercise his lungs. “It’s fun, but also helpful,” he told Damira with a smile. “Blowing helps him practice exhaling fully.”

By the third day, Kofi no longer needed supplemental oxygen. His wheezing had lessened, and his energy was returning. Damira was relieved to see her little boy giggling again, chasing bubbles across the hospital room.

Before discharge, Dr. Ponce sat down with Damira to go over what to expect. “RSV usually runs its course in about one to two weeks, but Kofi might have a lingering cough for a while. If he has any signs of trouble breathing again—fast breathing, flaring nostrils, wheezing, or if he becomes lethargic—you should bring him in right away.”

She added, “RSV is very contagious, especially during winter. Handwashing, disinfecting surfaces, and avoiding close contact with sick people are the best ways to protect kids.”

Damira thanked the team, grateful for their care and all she had learned about her son’s lungs.

Back home, Damira noticed how much more aware she had become of Kofi’s breathing. She understood that his body had its own defense system. His nasal cavity and upper airways had mucus and tiny hairs called cilia to trap dust and pathogens. The epiglottis helped prevent food from going into his trachea. The rib cage and sternum protected his lungs, and the pleural membranes allowed the lungs to move smoothly inside the chest.

Damira was amazed by how all these parts worked together like a team—and how RSV could disrupt that teamwork by targeting the bronchioles. She realized that even at three years old, Kofi’s body had shown strength, resilience, and the power to heal.