Bronchiolitis Flashcards
Is bronchiolitis an URTI or LRTI?
LRTI
What is bronchiolitis?
It is acute bronchiolar inflammation
What is the most common causative organism associated with bronchiolitis?
Respiratory syncytial virus (RSV) infection
What are the six risk factors of bronchiolitis?
Infants < 1 Years Old
Ex-Premature Infants
Congenital Heart Disease
Chronic Lung Disease
Respiratory Tract Infections
Winter Period
What is the peak age at which bronchiolitis tends to develop?
3-6 months old
What three respiratory tract infections are associated with bronchiolitis?
RSV
Mycoplasma
Adenovirus
What is a protective factor against RSV, and therefore bronchiolitis?
Maternal IgG
What are the nine clinical features of bronchiolitis?
Coryzal Features
Dry Cough
Mild Fever < 39°C
Dyspnoea
Feeding Difficulties
Wheeze, Fine Inspiratory Crackles
Tachypnoea
Respiratory Distress Features
Apnoeas
What are the four typical corzyal features?
Runny nose
Sneezing
Mucus in throat
Watery eyes
What is a wheeze?
It refers to a whistling sound caused by narrowed airways, typically heard during expiration
What does a wheeze indicate about the source of infection?
It is less likely to be a bacterial agent
What are the eight respiratory distress clinical features?
Tachypnoea
Accessory muscle use
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noses
What are the three accessory muscles?
Sternocleidomastoid
Abdominal
Intercostal
What are apnoeas?
They are periods in which breathing stops
Describe the typical clinical presentation course of bronchiolitis
The onset is related to an upper respiratory tract infection (URTI), resulting in the development of coryzal features
Following onset, patient will then develop respiratory features after 1-2 days
These features usually persist for a period of 7-10 days, peaking on day 3 or 4
In most cases, how is bronchiolitis diagnosed?
Clinically
How can we confirm a diagnosis of bronchiolitis?
We can conduct a nasopharyngeal aspirate to allow immunofluorescence testing
This confirms the presence of RSV infection
How is bronchiolitis typically managed?
It can be managed at home, with safety netting advice on when to seek further medical attention
What are the five immediate referral indications?
Tachypnoea > 70bpm
Apnoea
Severe Respiratory Distress
Central Cyanosis
Saturation < 92% On Air
What are the three referral consideration indications?
Tachypnoea > 60bpm
Feeding Difficulties (<50-75% Intake)
Clinical Dehydration
What are the four supportive management options for bronchiolitis?
Nasogastric Feeding
Saline Nasal Drops & Nasal Suctioning
Humidified Oxygen (Sats < 92%)
Ventilatory Support
How is nasal suctioning used to manage bronchiolitis?
It clears nasal secretions, which is important before feeding
What four management options of bronchiolitis have little evidence of effectivity?
Nebulised saline
Bronchodilators
Steroids
Antibiotics
What is palivizumab?
It is a monoclonal antibody that targets RSV
How can palivizumab be used as bronchiolitis prophylaxis?
It can be administered as a monthly injection in individuals who are at high risk of bronchiolitis development, such as those who are ex-premature and those with congenital heart disease.
Why is palivizumab not considered a true vaccine?
This is due to the fact that it doesn’t stimulate the infant’s immune system
It provides passive protection by circulating the body until the virus is encountered, at which point it works as an antibody and activates the immune system to fight the virus
Why does palivizumab need to be administered monthly?
The levels of circulating antibodies decreases over time
What is a common complication of bronchiolitis?
Viral induced wheeze in childhood
