Bronchiolitis (1A)

Question 1

What is the common age group affected by bronchiolitis?

Answer 1

Infants aged 1-12 months (peak incidence 3-6 months old)

Question 2

What is the most common causative organism of acute bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV)

Question 3

What is acute bronchiolitis?

Answer 3

Infection of the small airways (bronchioles)

Question 4

How does acute bronchiolitis usually present?

Answer 4

Course of symptoms:
1 - first coryzal symptoms
2 - after 1-2 days - chest symptoms (dry cough)
3 - worst symptoms at 3-4 days
4 - symptoms last 7-10 days
5 - full recovery at 2-3 weeks

Question 5

What are some examination findings you may see in acute bronchiolitis?

Answer 5

• tachypnoea (RR>60)
• wheeze or crackles on chest auscultation (or both)
• chest recession
• Fever (in around 30% of cases, usually <39°C).
• Poor feeding (typically after 3 to 5 days of illness).
• intermittent apnoea without other clinical signs in young infants (in particular those under 6 weeks of age).

Question 6

How would you treat uncomplicated bronchiolitis?

Answer 6

Supportive treatment:
1) paracetamol/ibuprofen
2) regular fluids
3) safety net - high RR, fluid intake decreases, less responsive, worsening/persistent fever
4) advise parents to avoid smoking

Question 7

When would you consider admission for children with acute bronchiolitis?

Answer 7

Admission if any of following:
- apnoea
- persistent oxygen <92%
- reduced oral fluid intake/dehydration (50-75% of usual feeding volume)
- central cyanosis
- persistent respiratory distress – grunting, chest recession, RR>60, nasal flaring

Question 8

What are signs of respiratory distress in babies?

Answer 8

• increased RR (>60)
• use of accessory muscles when breathing
• intercostal/subcostal recession
• nasal flaring
• head bobbing
• grunting
• tracheal tugging
• cyanosis
• abnormal airway noises (e.g.- stridor, grunting, wheeze)

Question 9

A 4-month-old boy is brought to the emergency department by his concerned mother. She says that she first noticed he had a mild fever and runny nose around 5 days ago, and over the last few days, he appears to have become more breathless and is grunting when he breathes. She is particularly concerned because she struggles to get him to feed and reports that his nappies are not as wet as normal. On examination, you notice chest recessions, wheeze and bilateral inspiratory crackles.

Given the likely diagnosis, what is the most appropriate treatment?
A) Admit for intravenous (IV) antibiotics
B) Admit for salbutamol nebulisers
C) Admit for supportive treatment
D) Discharge home with advice
E) Discharge home with oral antibiotics

Answer 9

C) Admit for supportive treatment