Resp - bronchiolitis

Question 1

What happens in classic bronchiolitis - pathophysiology wise?

Answer 1

RSV virus comes into cells
immune defence chemokines lead to increased mucus production with walls thickening and making airways narrower

this can cause mucus plugs causing either:
1 - air cant get in, once the air in the alveoli has been absorbed it the alveolar sacs can collapse (called atelectasis
2- air can get in but not out - this causes air trapping and hyperinflation`

Question 2

Main and other causes of bronchiolitis?

Answer 2

RSV (80%)

parainfluenza, rhinovirus, adenovirus, influenza, human metapneumovirus

Question 3

What is RSV, how is it spread?

Answer 3

Respiratory syncytia virus
causes the formation of syncytia which is a group of cells which have been made to merge
RSV works by making the host cell translate its negative sense RNA into proteins

spread via droplets - coughing etc

Question 4

What time of the year is bronchiolitis most common?

Answer 4

Winter epidemics

December, January, February

Question 5

How old are most of the patients who get bronchiolitis

Answer 5

1-9months old

Question 6

presentation of bronchiolitis

Answer 6

coryzal symptoms first then
dry cough (+wheeze)
breathing difficulty -> feeding difficulty

increased RR and HR
recession (subcostal/intercostal)
hyperinflation of the chest
fine end inspiratory crackles 
exp. wheeze can be a bit on inspiration too

Question 7

what would make you admit a bronchiolitis patient to hospital?

Answer 7

apnoea
sats under 90% on air
not having enough fluids (half-75% normal intake)
severe respiratory distress (grunting, severe recession, RR>70

Question 8

investigations for bronchiolitis?

Answer 8

only pulse oximetry

only ABG/Chest-XRAY if respiratory failure

Question 9

treatment for standard bronchiolitis?

Answer 9

oxygen - humified

CPAP if required
fluids if required

Question 10

how would you manage a patient with bronchiolitis who also has cystic fibrosis

Answer 10

aggressive, wide spectrum antibiotics

chest physio

Question 11

who is at increased risk of bronchiolitis?

Answer 11

preterms
those who didnt breastfeed
those with neurological disorders inhibiting airway clearance

Question 12

sometimes it’s worth giving something to try to prevent bronchiolitis. what is is and who would you give it to?

Answer 12

palivizumab IM monthly - RSV monoclonal antibody

for high risk preterms, CF patients, chronic heart disease and immunodeficient patients