Respiratory Medicine - Bronchiolitis Flashcards
1
Q
What is Bronchiolitis?
A
- Bronchiolitis is a condition characterised by acute bronchiolar inflammation.
- Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases.
- NICE released guidelines on bronchiolitis in 2015
2
Q
Epidemiology of Bronciolitis?
A
- Most common cause of a serious lower respiratory tract infection in < 1yr olds (90% are 1-9 months,
- With a peak incidence of 3-6 months).
- Maternal IgG provides protection to newborns against RSV
higher incidence in winter
3
Q
Causes of Bronciolitis
A
- Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases
- Other causes: mycoplasma, adenoviruses
- May be secondary bacterial infection
more serious if bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
4
Q
Clinical signs of Bronchiolitis?
A
- Coryzal symptoms (including mild fever) precede:
- Dry cough
- Increasing breathlessness
- Wheezing, fine inspiratory crackles (not always present)
- Feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
5
Q
What are the NICE recommendations for immediate referral (usually by 999 ambulance)?
A
- Apnoea (observed or reported)
- Child looks seriously unwell to a healthcare professional
- Severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
- Central cyanosis
- Persistent oxygen saturation of less than 92% when breathing air.
6
Q
NICE recommend that clinicians ‘consider’ referring to hospital if any of the following apply?
A
- A respiratory rate of over 60 breaths/minute
- Difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
- Clinical dehydration.
7
Q
Investigation and Management?
A
- Immunofluorescence of nasopharyngeal secretions may show RSV
- Humidified oxygen is given via a head box
