Bronchiolitis

Question 1

What are ‘wheezes’ and when are they heard?

Answer 1

• musical continuous sounds from narrowed airways
• heard on EXPIRATION (airway obstruction)

Question 2

What is the age range for Acute Bronchiolitis?

Answer 2

</= 2 years old

Question 3

What is the pathophysiology of bronchiolitis?

Answer 3

bronchiolar obstruction with edema, mucus, and cellular debris

• dec. airway radius during expiration = expiratory wheezing, air trapping, lung hyperinflation

Question 4

What happens if airway obstruction becomes complete?

Answer 4

• air reabsorbed and child develops ATELECTASIS

Question 5

What is hypercapnia?

Answer 5

Increased carbon dioxide levels

PaCO2 > 42 mmHg

Question 6

What entity is responsible for > 50% of bronchiolitis cases?

Answer 6

RSV

Question 7

What is the most common diagnosis resulting in hospitalization of children younger than 1 year of age in the United States?

Answer 7

RSV Bronchiolitis

Question 8

When do Bronchiolitis symptoms typically peak?

Answer 8

Day 4-5 of infection

Question 9

What are 4 findings that should be asked about in FHx for patients with bronchiolitis?

Answer 9

1. Cystic Fibrosis
2. Immunodeficiencies
3. Asthma (1st degree)
4. other lung Dz

Question 10

What are the current recommendations for chest physiotherapy, corticosteroids, and nebulized albuterol in treating bronchiolitis?

Answer 10

NOT INDICATED

Question 11

What is the mainstay of treatment for hospitalized bronchiolitis? (3)

Answer 11

• oxygen support (NC, PPV, HFNC, etc) –> wean as tolerated
• maintenance IVFs (poor PO intake) –> IV or NG
• suction (nares or oropharynx)

Question 12

What is the goal oxygen saturation level for bronchiolitis patients?

Answer 12

> 90%

Question 13

What is the only marketed drug that targets RSV and is it indicated in standard bronchiolitis treatments?

Answer 13

Drug = Ribavirin

• NOT RECOMMENDED (expensive, hard to administer, minimal disease outcome impact)

Question 14

What is the median duration of symptoms in ambulatory patients?

Answer 14

14 days

Question 15

What is the best prophylactic prevention of bronchiolitis?

What option is available for prophylaxis of high-risk patients?

Answer 15

Best = meticulous hand hygiene (Wash those hands)

High-risk = Palivizumab (IM monoclonal Ab to RSV F protein)

Question 16

Broadly, what patient populations will likely be candidates for Palivizumab prophylaxis? (5)

Answer 16

1. premature
2. CHD
3. CLD
4. neuromuscular disease
5. immunodeficient

Question 17

How is RSV spread?

Answer 17

CONTACT-precautions

• spread by aerosols, contact with secretions, and fomites (indirect contact)

Question 18

How does racemic epinephrine work and is it indicated in the treatment of bronchiolitis?

Answer 18

MOA: activation alpha (vasoconstriction and fluid resorption and beta (bronchodilation)

• NOT ROUTINELY INDICATED –> bronchiolitis caused more by bronchOBSTRUCTION, not bronchoCONSTRICTION

Question 19

When should oral feeds be trialed in patients receiving HFNC support for bronchiolitis?

Answer 19

• initiate oral nutrition after the FIRST successful wean of HFNC flow rate

Question 20

What is the mechanism of action of High Flow Nasal Cannula support?

Answer 20

• washout of nasopharyngeal anatomic dead space
• replaces CO2-rich/O2-poor air in nasopharynx at end exhalation with CO2-free/O2-rich gas = improved oxygenation

Question 21

What is the initial rate of HFNC that should be started for bronchiolitic patients?

Answer 21

1-2L

Question 22

What is the risk of having asthma/wheezing later in life in children hospitalized for bronchiolitis?

Answer 22

4x higher risk