Bronchiolitis

Question 1

What is Bronchiolitis?

Answer 1

Inflammation and infection in the bronchioles, the small airways of the lungs.

Question 2

What is the most common cause of bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV)

Question 3

When are the symptoms of bronchiolitis typically worse?

Answer 3

Day 3 or 4

Question 4

How long do symptoms tend to last in bronchiolitis?

Answer 4

7-10 days

Question 5

How long does it take patients to fully recover from bronchiolitis?

Answer 5

2-3 weeks

Question 6

What is bronchiolitis the main cause of?

Answer 6

Serious lower respiratory tract infection in children under 1 year.

Question 7

When is bronchiolitis more common?

Answer 7

In winter

Question 8

Who does bronchiolitis typically affect?

Answer 8

Children who are 3-6 months.

Question 9

What provides protection against RSV in new borns?

Answer 9

Maternal IgG

Question 10

When would bronchiolitis be more serious?

Answer 10

If the child had:
• bronchopulmonary dysplasia (e.g. Premature)
• Congenital heart disease
• Cystic fibrosis

Question 11

What is the main presentation of bronchiolitis?

Answer 11

Coryzal symptoms

Question 12

What other symptoms can Bronchiolitis present with?

Answer 12

• dry cough
• increasing breathlessness
• wheezing, fine inspiratory crackles (not always present)
• feeding difficulties associated with increasing dyspnoea

Question 13

What is not always present with bronchiolitis?

Answer 13

Wheezing, fine inspiratory crackles (not always present)

Question 14

What is the main thing to look out for with Bronchiolitis?

Answer 14

Respiratory distress

Question 15

What are signs of respiratory distress?

Answer 15

• Raised respiratory rate
• Use of accessory muscles of breathing,
• Intercostal and subcostal recessions
• Nasal flaring
• Head bobbing
• Tracheal tugging
• Cyanosis (due to low oxygen saturation)
• Abnormal airway noises

Question 16

Where are most children with Bronchiolitis managed?

Answer 16

At home

Question 17

What would be reasons to admit a child?

Answer 17

• apnoea (observed or reported)
• child looks seriously unwell to a healthcare professional
• severe respiratory distress,
• Respiratory rate of over 70 breaths/minute
• central cyanosis
• Clinical dehydration
• Oxygen saturation less than 92% when breathing air.
• Aged under 3 months or any pre-existing condition such as prematurity, Downs syndrome or cystic fibrosis

Question 18

A respiratory rate of what would indicate that a child should be admitted?

Answer 18

More than 70

Question 19

What oxygen saturation would suggest that the child should be admitted?

Answer 19

Less than 92% on air

Question 20

What investigation can be done for Bronchiolitis?

Answer 20

Immunofluorescence of nasopharyngeal secretions may show RSV

Question 21

What is the management of bronchiolitis?

Answer 21

Supportive management

Question 22

What is the supportive management for bronchiolitis?

Answer 22

humidified oxygen given via a head box if the oxygen saturations are persistently < 92%
Ensuring adequate intake- orally, via NG tube or IV fluids
Saline nasal drops and nasal suctioning- clear nasal secretions

Question 23

What is Palivizumab?

Answer 23

A monoclonal antibody that targets the respiratory syncytial virus.
A monthly injection is given as prevention against bronchiolitis caused by RSV
Given to high risk babies