Bronchiolitis
definition
acute inflammatory illness of the small airways of the lower respiratory tract
aetiology
viral
RSV
parainfluenza
influenza
<6mo
prematurity
heart or lung disease
NMD
immunodeficiency
pathophysiology
bronchiolar injury and consequent interplay between inflammatory and mesenchymal cells can lead to diverse pathologic and clinical syndromes
excessive mucus production
lymphocytic infiltration leading to submucosal oedema
inflammation, oedema, and debris result in obstruction of the bronchioles, leading to hyperinflation, increased airway resistance, atelectasis, and VQ mismatching
incidence
very common in < 2 y
seasonal
clinical
prognosis
self-limiting
7-10 day course
morbidity and mortality mostly in younger than 2
history
day 1-3
low grade fever
rhinorrhea
cough
day 4-6
respiratory distress
tachypnoea
hypoxia
examination
tachypnoea
hypoxia
intercostal recession
crackles or coarse breath sounds +/- wheeze
diagnosis
clinical
ancillary
?CXR - r/o pneumonia
nasopharyngeal aspirate - RSV
treatment
supportive
hydration
suctioning
supplemental 02
?bronchodilators if Hx or strong FHx of asthma
hospitalise if signs of severe illness are present
complications
ARDS
bronchiolitis obliterans
congestive heart failure
secondary infection