February 23, 2016 - Bronchiolitis Flashcards
Bronchiolitis
Inflammation of the bronchioles, the smallest air passages of the lungs.
It usually occurs in children less than 2 years of age, with the majority being aged between 3 and 6 months.
It presents with coughing, wheezing, and shortness of breath which can cause some difficulty in children with feeding or drinking. It is usually caused by the respiratory syncytial virus (RSV) in over 70% of cases and is more common in winter months.
Bronchiolitis and Obstruction
Bronchiolitis is an obstructive disease, like asthma.
Stridor
Is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchiol tree (but still upper respiratory).
You need to discover the cause.
Who Does Badly?
Premature babies (<32 weeks)
Congenital abnormalities
Genetic syndromes
Chronic disease
Neuromuscular disease
Age <6 weeks
Normal Infant RR
30-60 / minute
Epidemiology of Bronchiolitis
70% from RSV, 20% from parainfluenza / influenza / adenovirus.
Peak incidence of bronchiolitis is at 2-5 months of age.
RSV Infection
Most common cause of bronchiolitis is from RSV.
90% of people have been infected with RSV by the age of 2, but only 20% develop symptoms, 3% are hospitalized, and 0.002% die.
Clinical Course of Bronchiolitis
Incubation period of 2-8 days
URTI is during 1-3 days
Worsening lower airway disease from 3-5 days
Full recovery of 2-8 weeks
Treatment for Bronchiolitis
Oxygen
Supportive care
+/- steroids and epi
Outcomes of Bronchiolitis
RSV may increase the risk of long-term asthma.
Asthma vs. Bronchiolitis
The switch is around 9 months
Generally under 9 months is more likely to be bronchiolitis, and over 9 months is more likely to be asthma.
Ribavirin
A guanoside analog used to stop viral RNA synthesis and viram mRNA capping.
It is used to treat hepatitis C primarily, but can also be used to treat severe bronchiolitis caused by RSV.
