Bronchiolitis Flashcards
What is Bronchiolitis?
- illness in infants, beginning as an upper respiratory tract infection (URTI) that evolves with signs of respiratory distress, cough, wheeze, and often bilateral crepitations
What are the CO for Bronchiolitis?
- respiratory syncytial virus (RSV) - 80%
- human metapneumovirus (hMPV)
- adenovirus
- rhinovirus
- parainfluenza and influenza viruses
Which age groups are typically affected by Bronchiolitis?
- < 2 years
- peak in 3-6months old
What is the most common LRT infection in the first year of life in UK?
- bronchiolitis
What are the RF for Bronchiolitis?
- Older siblings.
- Nursery attendance.
- Passive smoke, particularly maternal.
- Overcrowding
What is a protective factor for Bronchiolitis?
- breastfeeding
What are the RF for severe disease ans cx of Bronchiolitis?
- Prematurity (<37 weeks)
- Low birth weight
- Mechanical ventilation when a neonate
- Chronic lung disease (eg, cystic fibrosis, bronchopulmonary dysplasia).
- Congenital heart disease
- Neurological disease with hypotonia and pharyngeal discoordination.
- Epilepsy
- Congenital defects of the airways.
- Down’s syndrome
How would you diagnose Bronchiolitis?
Consider Bronchiolitis in children under the age of 2 if;
- Hx of Coryzal sx
- Persistent cough and
- Either tachypnoea or chest recession (or both) and
- Either wheeze or crackles on chest auscultation (or both).
What features presented by the infant would you consider secondary care?
- respiratory rate is >60 breaths/minute
- inadequate fluid intake
- signs of dehydration
- child is less than 3 months of age or was born prematurely
- comorbidity
What features presented by the infant would you immediately refer to secondary care?
- Apnoea (observed or reported).
- Marked chest recession or grunting.
- Respiratory rate >70 breaths/minute.
- Central cyanosis.
- Oxygen saturation of less than 92%.
- The child looks seriously unwell to a healthcare professional
What are the differential diagnosis for Bronchiolitis?
- Viral-induced wheeze.
- Consider if there is wheeze but no crackles, a history of episodic wheeze, and/or a family or personal history of atopy.
- Pneumonia
- Consider if temperature is above 39°C and there are persistent focal crackles.
- Asthma.
- Bronchitis.
- Pulmonary oedema.
- Foreign body inhalation.
- Oesophageal reflux.
- Aspiration.
- Cystic fibrosis.
- Kartagener’s syndrome.
- Tracheomalacia/bronchomalacia.
- Pneumothorax.
What Ix would you order for Bronchiolitis?
- Pulse oximetry.
- Viral throat swabs for respiratory viruses (in secondary care)
How would you mx Bronchiolitis in primary heathcare?
Most infants with acute bronchiolitis will have mild, self-limiting illness
- assess current severity of illness
- monitor fluid input, nutrition and temperature control
- anti-pyretic if raised temp causing distress
How would you mx Bronchiolitis in secondary healthcare?
- oxygen and nasogastric feeding where necessary
- Upper airway suction if there is difficulty feeding or a history of apnoea
- (CPAP) - in those who have respiratory failure
