Bronchiolitis

Question 1

Causes of bronchiolitis

Answer 1

• 80%- respiratory syncitial virus (detected through PCR of nasal secretions)
• Remaining:
  
  • human metapneumovirus
  • parainfluenza virus
  • rhinovirus
  • adenovirus
  • influenza
  • mycoplasma pneumoniae
• Dual infection with RSV and HMP = severe bronchiolitis

Question 2

Natural history of bronchiolitis

Answer 2

• 90% = 1-9 months
• Rare after 1 year
• Annual winter epidemics
• Coryzal symptoms –> dry cough–> increasing breathlessness
• Admission to hospital often with poor feeding and increasing dyspnoea
• Most at risk = premature (bronchopulmonary dysplasia)

Question 3

Clinical features of bronchiolitis

Answer 3

• Coryzal symptoms precede dry cough
• Poor feeding and dyspnoea
• Recurrent apnoea = serious complication
• LISTEN
  
  • sharp, dry cough
  • fine-end inspiratory crackles
• LOOK
  
  • subcostal and intercostal recession
  • hyperinflation of chest (prominent sterum, liver displacement downwards)
• MONITOR
  
  • tachycardia
  • tachypnoea
  • cyanosis/ pallor

Question 4

Treatment of acute bronchiolitis

Answer 4

• Humidifed O2- % decided on according to sats
• Mist, Abx, steroids, nebuliased bronchodilators (salbutamol/ ipratropium)
• IV fluids
• Assisted ventilation- nasal/ facemask/ full ventilation

Question 5

Advice to parents about how to care for child with bronchiolitis

Answer 5

• Most infants recover from acute infection within 2 weeks
• Half will have recurrent episodes of cough and wheeze
• Rarely (adenovirus) permenant damage to the airways- bronchiolitis obliterans
• monoclonal AB to RSV (palivizumab) reduces no. of hospital admissions in high-risk pre-term infants