Bronchiolitis

Question 1

Who usually gets bronchiolitis and when?

Answer 1

1 years old and younger

Usually in winter

Question 2

What is the aetiology of bronchiolitis?

Answer 2

Majority is viral - RSV, Human rhinovirus

Question 3

How does bronchiolitis present?

Answer 3

Hx
- Mild fever
- Cough 
- Wheeze
- Tachypnoea
Ex
- Increased WOB
- Fine inspiratory crackles 
- Wheeze
- Reduced oxygen saturation

Question 4

How is bronchiolitis managed?

Answer 4

Usually self limiting
Fluid resus if required
Oxygen +/- high flow

Question 5

How is bronchiolitis investigated?

Answer 5

• Nasopharyngeal aspirate
  ○ For viral immunofluorescence or PCR
  ○ For epidemiology and infection control, no mx implications

Question 6

What are the indications for hospitalisation in bronchiolitis?

Answer 6

SASS CICS

• Severe respiratory distress (grunting, severe recession, RR >70, nasal flaring)
• Apnoeic episodes
• Significant hypotonia
• Survivor of extreme prematurity
• Congenital heart condition, pre-existing lung disease, or immunodeficiency
• Intake less than 50% normal
• Cyanosis
• Social concerns

Question 7

What is the natural history of bronchiolitis?

Answer 7

Self limiting
Symptoms peak at 2-3 days
Usually resolved 7-10 days though cough may persist for weeks

Question 8

What are some markers of severe bronchiolitis?

Answer 8

Fatigue

SaO2 less than 90%, particularly if not responding

Question 9

When is it safe to discharge a child with bronchiolitis?

Answer 9

Feeding normally

Saturations normal

Question 10

What is the role of salbutamol in bronchiolitis?

Answer 10

No role

Question 11

What are some risk factors for bronchiolitis?

Answer 11

• Maternal smoking - the in utero affect more so than inhalation during infancy
• Pre-term delivery
• Chronic long term of prematurity
• Chronic cardiorespiratory diseases
• Immunodeficiency