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Bronchiolitis (Clinical presentation (Coryza, Cough (dry), Fever, Wheeze,…
Bronchiolitis
Clinical
presentation
Coryza
Cough (dry)
Fever
Wheeze
Breathlessness
Feeding difficulty
Epidemiology
Commonest lung infection
in infants
Winter
Children 1-9m
Diagnosis
Examination
Respiratory
Subcostal/intercostal recession, hyperinflation, tacypnoea,
dry cough, wheeze, crackles, apnoea, cyanosis
Investigations
Bedside
Obs (sats, RR, HR, BP, temp)
Swab
Nasopharyngeal: RSV Ab ELIZA
Imaging
CXR: hyperinflation, atelectasis, consolidation
History
PMH
Risk factors e.g. CHD, CLD,
immunodeficiency
PC/HPC
Coryza then dry cough, then SOB
Wheeze, apnoea, feeding issues
POH
Bloods, scans, growth, gestation,
delivery, weight, complications
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Current meds, allergies
SH
Living arrangements, school/nursery,
parental smoking status
Pathophysiology
Mechanism
RSV infects the lower airways increasing mucus production, desquamation and bronchiolar obstruction
Leads to pulmonary hyperinflation and atelectasis
Agents
Commonest cause is RSV
Other causes e.g. mycoplasma, parainfluenza, adenovirus, influenza. rhinovirus
Management
Medical
Oxygen
Indication: hypoxia
MOA: humidified via head box, aim >92%
Bronchodilators
Indication: wheeze
E.g. salbutamol, ipratropium, adrenaline
Ventilation
Indcation: severe distress, apnoea
E.g. CPAP, mechanical
Antivirals
Indication: immunodeficiency, CHD, CLD
E.g. ribavirin
Conservative
Information, advice, support
Admit to hospital if inadequate oral intake,
respiratory distress, hypoxia, apnoea
Hygeine control (hand hygeine, gowns, gloves)
NGT (if tachypnoea)
Monitoring for apnoea
Risk factors
<6m old
Underlying medical conditions
(CHD, CLD, immunodeficiency, lung disease)
Complication
Recurrent apnoea
Bronchiolitis obliterans
Permenant airway damage (rare)
Prognosis
Self limiting <2wk for most
50% recurrent cough and wheeze
Definition
Acute viral infection of bronchioles
causing cough and SOB in children
Prevention
mAb therapy
Indication: at risk i.e. preterm, oxygen dependency
E.g. palivizumab IM monthly for 5m