Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

Self-limiting, viral lower RTI affecting bronchioles causing inflammation, commonly following the common cold

Question 2

In what age does bronchiolitis occur?

Answer 2

• Usually <6 months, but sometimes up to 12 months

* If > 12 months, consider overlap with asthma

Question 3

What is the natural history of the illness?

Answer 3

Peak severity usually at around day 2-3 of illness with resolution over 7-10 days

Question 4

What are the most common causes of bronchiolitis?

Answer 4

• Rhinovirus - mild bronchiolitis
• RSV!!!** - severe bronchiolitis
• Bacteria rare

Question 5

What are some risk factors for bronchiolitis?

Answer 5

• Young, especially < 6 weeks
• Ex-premature infants
• CHD
• Neurological conditions
• Chronic respiratory illness
• Pulmonary HTN

Question 6

What are some symptoms associated with bronchiolitis?

Answer 6

• First symptoms same as common cold: runny nose, mild cough, stiffness
• Following symptoms include:
  
  • Dyspnoea + drawing in the chest with each breath
  • Cough mild and dry, and may persist for weeks
  • Respiratory noisese.g. wheezing
• Feeding difficulty
• +/- fever

Question 7

What are the most important exam findings in bronchiolitis?

Answer 7

• Increased WOB

* Widespread expiratory wheeze and fine, inspiratory crackles

Question 8

What are some exam findings that indicate increased WOB?

Answer 8

○ Increased RR - tachypnoea
○ Accessory muscle use (SCM, scalenes, trapezius, forward posture)
○ Retractions (intercostal, suprasternal, subcostal)
○ Nasal flaring and/or tracheal tug
○ Overinflated chest