2d Respiratory Diseases (Bronchiolitis) Yen Flashcards
What is an overview of Bronchiolitis?
Defined as respiratory illness characterized by wheezing and airway obstruction. Causes include viral or bacterial infection. Results in inflammation of the small airways and bronchioles. Usually self-limiting, resolves without complications
What is the most common cause of Bronchiolitis?
RSV
What is the most common cause of illness and hospitalization in children under two years?
Bronchiolitis
What are the risk factors for severe Bronchiolitis?
Gestational age < 37 weeks. Age < 12 weeks. Chronic lung disease, congenital heart disease. Immunodeficiency. Passive smoking, crowded household. Daycare attendance, older siblings. High altitude > 2500m
How is severe Bronchiolitis defined?
Signs and symptoms associated with poor feeding and respiratory distress (tachypnea, nasal flaring, grunting, retractions or hypoxemia)
What is the management of Bronchiolitis like?
Most can be managed as outpatients. Severe disease requires hospitalization (nasal flaring, intercostal retractions, RR > 70, cyanosis, apnea, hypoxemia)
What is supportive care for Bronchiolitis (in/outpatient)?
Saline nose drops and nasal bulb suction helps relieve partial nasal obstruction. Provide adequate hydration, avoid risk of aspiration. IV fluids may be necessary. Dehydration occurs frequently because of increased needs and decreased intake
What is the pharmacological management for Bronchiolitis?
Bronchodilators (published results have been variable, most do not support it). Carefully monitor trial of bronchodilators as an option, continued only with objective clinical response
What are Glucocorticoids like for Bronchiolitis?
Reduces airway obstruction by decreasing bronchiolar swelling. AAP recommendation: not to use glucocorticoid steroids routinely
What is RSV Bronchiolitis?
Most common cause of lower respiratory tract infections in infancy and early childhood. Produces considerable morbidity and mortality. RSV produces an annual outbreak. Transmitted by droplets, large particles, and fomites
What are the two heterotype strains of RSV?
Group A (predominate, associated with more severe disease). Group B
Why does premature birth have an increased risk of RSV Bronchiolitis?
Altered airway anatomy. Absence of maternal antibody
What are the risk factors for RSV Bronchiolitis?
Household crowding. School-age siblings. Day-care attendance. Passive exposure to smoke. Malnutrition
What are the symptoms of RSV Bronchiolitis?
Wide spectrum of illness. Begins with cough, nasal congestion, fever, rhinorrhea. Otitis media is common
What are the symptoms seen more often in severe RSV Bronchiolitis?
Tachypnea. Dyspnea. Intercostal retractions. Difficulty breathing. Wheezing, rales, rhonchi. Apnea
What are the treatment goals for RSV Bronchiolitis?
The aim of treatment is to relieve respiratory distress, overcome airway obstruction, enhance mucociliary clearance, and return the child to normal respiratory status
What is the treatment like for RSV Bronchiolitis?
Effective therapy for RSV infection remains elusive. Therapeutic management: Supplemental oxygen, Bronchodilators (Albuterol, Epinephrine)
What is Corticosteroid use like with RSV Bronchiolitis treatment?
Efectiveness secondary to anti-inflammatory actions. Overall use of steroids in RSV remains controversial
What is Ribavirin use like for RSV Bronchiolitis?
Inhibits synthesis of viral proteins, slowing viral replication. Only licensed anti-viral preparation approved for treatment of RSV disease
What are some cautions with Ribavirin use?
Caution in mechanically ventilated patients. Teratogenic. Highly irritating!!!
What is Synagis (Palivizumab)?
Monoclonal antibody that binds to the F protein of RSV
Is it possible to have multiple infections with RSV in a single season?
Yes
How does Synagis (Palivizumab) work?
Blocks fusion of RSV to host cell membrane. Blocks fusion of infected host cells (syncytial formation). Reduces viral infectivity and cell-to-cell transmission of the virus
Synagis (Palivizumab) as prophylaxis against RSV Bronchiolitis?
Decreases RSV hospitalizations in premature infants
