Bronchiolitis Flashcards
What is bronchiolitis?
Bronchiolitis is a viral lower resipiratory tract infection which affects children under the age of 12 months. After 12 months of age, there is overlap with asthma.
Who gets bronchiolitis?
Affects 50% of infants in first 2 years of life. Most common LRTI in infants. Peak incidence at 6 months. Increased incidence of asthma later in life.
What are the main pathogens which cause bronchiolitis?
Respiratory Syncytial Virus (>50%), Parainfluenza, Influenza, Rhinovirus, Adenovirus, M. pneumoniae (rare)
Why is time course important to ascertain in a patient suspected/diagnosed with bronchiolitis?
In bronchiolitis, the time course is correlated with the severity of the symptoms. Peak severity is around day 2-3 and resolution of the illness takes 7-10 days. The cough itself can take weeks to resolve. Once the patient’s time course is ascertained, management and advice to the parents can vary based on this.
What are the risk factors associated with severe bronchiolitis?
Young, especially less than 6 weeks Ex-premature infants Congenital Heart Disease Neurological Conditions Chronic Respiratory Illness Pulmonary HTN
What are the clinical features on history associated with bronchiolitis?
Prodrome of URTI with cough and fever
Feeding difficulties, irritable
Increased work of breathing
What are the clinical features found on examination?
The findings on examination vary depending on how severe the bronchiolitis is. Generally there will be:
1) Increased work of breathing
2) Widespread wheeze and creptiations
3) +/- fever
4) Decreased O2 Saturation
5) Signs of dehydration
What are the clinical signs of increased work of breathing?
Tachypnoea Tracheal Tug Subcostal Recession Intercostal Recession Abdominal Breathing Nasal Flare Head Bobbing Need for Oxygenation
What are the three categories of severity of bronchiolitis? What is different between the categories?
There is mild, moderate and severe bronchiolitis. The parameters which are observed are behaviour, respiratory rate, accessory muscle use, feeding, O2 and apnoeic episodes.
Behaviour: normal -> some/intermittent irritability -> increasing irritability/lethargy, fatigue
Respiratory Rate: normal -> increased respiratory rate, tracheal tug, nasal flaring -> marked increase or decrease in RR, tracheal tub, nasal flaring
Accessory Muscle Use: None -> moderate chest wall retraction -> marked chest wall retraction
Feeding: Normal -> difficulty/reduced feeing -> reluctant/unable to feed
Oxygen: SaO2>93% -> SaO2 90-93% -> SaO2 Brief Apnoeas -> Frequent/Prolonged Apnoeas
Do you need investigations for patient with suspected bronchiolitis? If so, what are they?
No investigations are required. If diagnostic uncertainty (?pneumonia or ?CCF) then CXR may be required. CXR will show hyperinflation, peribronchial thickening, and often patchy areas of consolidation and collapse.
When do you admit a patient with bronchiolitis?
Hypoxia: O2 saturation less than 92% therefore needing O2
Increased WOB consistent with Severe Bronchiolitis
Significantly decreased feeding
If increased risk factors are present such as: young infant (less than 6 months) ), premature baby, Hx of chronic lung infections, neurological conditions, haemodynamically significant cardiac disease.
What is the management of each degree of severity of bronchiolitis?
Mild – Managed at home, advice re: expected course of illness
Moderate – Managed in hospital, Administer O2 to get SaO2>92%, consider requirement for maintenance fluid, 1-2hrly observations
Severe – Cardiorespiratory monitoring, supplemental O2 + fluids, child may need CPAP/ventilation so transfer to HDU/ICU must be considered.
Do you use bronchodilators in bronchiolitis?
Nope. It has not been shown to alter the course of the illness.
What are the discharge requirements for a patient being treated for bronchiolitis?
- Maintaining adequate oxygenation
2. Maintaining adequate oral intake
