Bronchiolitis

Question 1

What is the process of bronchiolitis?

Answer 1

Acute bronchiolar inflammation

Question 2

What is the most common pathogen causing bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV)

Question 3

What is the relevant epidemiology of bronchiolitis?

Answer 3

Most commonly seen in infants <1yrs.

Question 4

What are the key clinical features of bronchiolitis?

Answer 4

Coryzal symptoms (mild fever) precede
Dry cough
Increasing breathlessness
Wheezing, inspiratory crackles (not always)
Feeding difficulties associated with dyspnoea often reason for hospital admission

Question 5

When will a child require an ambulance for bronchiolitis?

Answer 5

Apnoea (observed or reported)
Child looks seriously unwell
Severe respiratory distress - gruntinh, chest recession, RR over 70bpm
Central cyanosis
Persistent oxygen saturations less than 92% on air

Consider if:
RR over 60
Difficulity with oral inrake
Clinical dehydration

Question 6

What investigations should be done for bronchiolitis?

Answer 6

Immunofluorescence of nasopharyngeal secretions may show RSV

Question 7

What management may be used for bronchiolitis?

Answer 7

Nasal suction - saline nasal drops - bulb suction can clear nasal secretion especially before feeding
Oxygen -> typically nasal in route
Hydration -> adequate fluid intake, suggest smaller more frequent feeds if struggling