Bronchiolitis

Question 1

What is Bronchiolitis?

Answer 1

Bronchiolitis is a viral infection of the bronchioles (the smallest air passages in the lungs), most commonly caused by the respiratory syncytial virus

Question 2

Who does Bronchiolitis normally affect?

Answer 2

• Normally affects children under the age of 2
• 33% will affect bronchiolitis in the first year of there life
• Mainly occurs during the winter and spring months

Question 3

What is the Pathophysiology of Bronchiolitis?

Answer 3

• 1.Proliferation of goblet cells causing excess mucus production
• 2.IgE- medicated type 1 allergic reaction causing inflammation
• 3.Bronchiolar constriction
• 4.Infiltration of lymphocytes causing submucosal oedema
• 5.Infiltration of cytokines and chemokines
• The combination of 1.mucus, 2.oedema, 3.increased cells in the bronchioles leads to 1.hyperinflation, 2.increased airway resistance, 3.atelectasis, 4. V/Q mismatch

= Bronchiolitis

Question 4

What are the Risk Factors for Bronchiolitis?

Answer 4

-1. Breast fed for less than 2 months
- 2. Smoke exposure
- 3. Having siblings who attend nursery or school
- 4. Chronic lung disease

Question 5

What are the clinical features of Bronchiolitis?

Answer 5

• History symptoms over 2-5days: low grade fever, nasal congestion, rhinorrhoea, cough and feeding difficulty
• Examination: Tachypnoea, grunting, nasal flarring, intercostal and subcostal recessions, inspiratory crackles, expiratory wheeze, hyperinflated chest and cyanosis

Question 6

What are the differential diagnosis for Bronchiolitis?

Answer 6

• Pneumonia
• Croup
• Cystic Fibrosis
• Heart Failure
• Bronchitis

Question 7

What laboratory investigations would you do for Bronchiolitis?

Answer 7

• Nasopharyngeal aspirate
• Blood and urine culture
• FBC
• ABG

Question 8

What Imaging investigations would you do for Bronchiolitis?

Answer 8

• CXR (features seen: 1.Hyperinflation, 2.Focal Atelectasis, 3.Air trapping, 4.Flattened diaphragm, 5.Peribronchial cuffing)

Question 9

What are the symptoms for an urgent hospital referral for bronchiolitis?

Answer 9

• Apnoea
• Child looks seriously unwell
• Severe respiratory distress (grunting, marked recessions, RR >70)
• Central Cyanosis
• Oxygen Sats <92%

Question 10

What are the symptoms for a hospital referral?

Answer 10

• RR >60
• Inadequate fluid intake (50-75% of usual volume)
• Clinical dehydration

Question 11

What is the immediate hospital managment?

Answer 11

• 1.Give oxygen if sats <92% in room air
• 2.Give fluids via nasogastric if inadequate oral intake
• 3.Consider CPAP if impending respiratory failure
• 4.Perform upper airway suctioning if there are upper airway secretions or apnoea

Question 12

When can discharge be considered?

Answer 12

When the child is:
- Clinically Stable
- Taking adequate oral fluids
- Maintaining sats >92% for more than 4 hours

Question 13

What is not considered in Bronchiolitis?

Answer 13

• Antibiotics
• Steroids
• Bronchodilators

Question 14

What are the complications of Bronchiolitis?

Answer 14

• Hypoxia
• Dehydration
• Fatigue
• Respiratory Failure
• Persistent cough/ wheeze
• Bronchiolitis Obliterans (airways become permanently damaged due to inflammation and fibrosis)