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Paeds: Respiratory > Bronchiolitis > Flashcards

Bronchiolitis Flashcards

1
Q

What is the most common serious respiratory infection of infancy?

A

bronchiolitis

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2
Q

What proportion of all infants are admitted to hospital with bronchiolitis each year during the annual winter epidemics?

A

2-3%

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3
Q

What age of child is most commonly affected by bronchiolitis?

A

1-9 months

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4
Q

What is the most common cause of bronchiolitis and what are 5 further causes?

A
  1. Respiratory syncytial virus (RSV) - 80%
  2. Parainfluenza virus
  3. Rhinovirus
  4. Adenovirus
  5. Influenza virus
  6. Human metapneumovirus
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5
Q

What might lead to a more severe form of bronchiolitis?

A

co-infection with more than one virus, particularly RSV and human metapneumovirus

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6
Q

What is the natural course of bronchiolitis?

A

Initially coryzal symptoms, followed by dry cough and increasing breathlessness

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7
Q

What is often the reason for admission to hospital in bronchiolitis?

A

increasing dyspnoea causing feeding difficulty

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8
Q

What is a serious complication of bronchiolitis in young infants particularly?

A

recurrent apnoea

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9
Q

What are 3 groups of children at particular risk of severe bronchiolitis?

A
  1. Premature infants who develop bronchopulmonary dysplasia
  2. Underlying lung disease e.g. cystic fibrosis
  3. Congenital heart disease
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10
Q

What are 6 key findings on examination in bronchiolitis?

A
  1. Dry wheezy cough
  2. Tachypnoea and tachycardia
  3. Subcostal and intercostal recession
  4. Hyperinflation of the chest
  5. Fine end-inspiratory crackles
  6. High-pitched wheezes - expiratory > inspiratory
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11
Q

What are 9 causes of acute respiratory distress in an infant?

A
  1. Bronchiolitis
  2. Viral episodic wheeze
  3. Pneumonia
  4. Heart failure
  5. Foreign body
  6. Anaphylaxis
  7. Pneumothorax or pleural effusion
  8. Metabolic acidosis
  9. Severe anaemia
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12
Q

What is the one key investigation indicated in suspected bronchiolitis?

When is the only time 2 further investigations are indicated?

A

Pulse oximetry

CXR, blood gases ONLY if respiratory failure suspected

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13
Q

What are 4 conditions that mean hospital admission is indicated in bronchiolitis?

A
  1. Apnoea: observed or reported
  2. Persistent oxygen saturation of <90% when breathing air
  3. Inadequate oral fluid intake (50-75% of usual volume)
  4. Severe respiratory distress - grunting, marked chest recession, or respiratory rate over 70 breaths/minute
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14
Q

What are 4 aspects of the management of bronchiolitis?

A

Supportive treatment:

  1. Humidified oxygen via nasal cannulae or head box, concentration determined by sats
  2. Monitor for apnoea
  3. Fluids may be needed, NG tube or IV
  4. Assisted ventilation in form of non-invasive respiratory support with CPAP or mechanical ventilation - small percentage
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15
Q

What are 5 treatments that have not been shown to reduce severity or illness duration of bronchiolitis?

A
  1. Mist
  2. Nebulised hypertonic saline
  3. Antibiotics
  4. Corticosteroids
  5. Nebulised bronchodilators e.g. salbutamol or ipratropium
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16
Q

What extra measures should be taken when caring for a child with bronchiolitis and why?

A

Infection control measures - particularly good hand hygiene, cohort nursing, gowns and gloves

RSV highly infectious, so to prevent cross-infection to other infants in hospital

17
Q

How long does it take for most infants to recover from acute bronchiolitis infection?

A

2 weeks

18
Q

What proportion of infants who suffer with bronchiolitis will suffer from recurrent episodes of cough and wheeze?

A

as many as half

19
Q

What is a possible long term complication of bronchiolitis and which infective agent leads to this?

A

Adenovirus infection - following this, may result in permanent damage to airways called bronchiolitis obliterans

20
Q

What is a measure that can be used to prevent bronchiolitis?

A

Monoclonal antibody to RSV (palivizumab) - given monthly by IM injection, reduces hospital admissions in high-risk preterm infants

21
Q

What is a benefit and 3 disadvantages of the monthly IM RSV antibody injections to prevent bronchiolitis?

A

Benefit:

  1. Reduces hospital admissions in high-risk preterm infants

Cons:

  1. High NNT - 17 to avoid one admission
  2. High cost limits use
  3. Need for multiple intramuscular injections (monthly)

Paeds: Respiratory (7 decks)

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