Bronchiolitis

• What age is bronchiolitis most prevelant?

  Under 2
• What is the peak incidence age of bronchiolitis?

  Betwee 3 and 6 months of age
• How does the respiritory rate differ in broncholitis?

  Usually increased
• Is hyperinflation present in bronchiolitis?

  Often present but hard to detect in infants aged <6 months
• Is a wheeze present in bronchiolitis?

  May be present
• Are crackles present in bronchiolitis? if so, describe them

  Yes, fine crackles throughout lung fields
• What causes bronchiolitis?

  Viral infection
• Which virus normally causes bronchiolitis?

  Respiratory syncytial virus
• What is bronchiolitis?

  INflammation and congestion in the small airways of the lung
• What are some symptoms of bronchiolitis and how may they present?

  Sneezing

  Runny / blocked nose

  Cough

  Slightly high temp

  Increased work of breathing

  Increased resp rate

  Pale or cyanosed

  Difficult to feed / vomiting after feeds

  Crackles +/- wheeze on auscultation

  Becoming irritable

  Lethargic

  Wet cough / vomiting after coughing
• How is bronchiolitis managed?

  Oxygen therapy

  Support feeding - may need NG tube
• How is bronchiolitis NOT managed?

  No antibiotics

  No bronchodilators

  No CXR routinely
• Why are bronchodilators not given?

  No beta 2 agonist receptor cells
• What may a capillary blood gas with a raised CO2 indicate in bronchiolitis?

  Further breathing support e.g. high flow oxygen
• What is bronchiolitis characterised by?

  Acute bronchiolar inflammation
• What is the pathogen responsible for 75-80% of cases?

  Respiratory syncytial virus
• What provides protection to newborns against RSV?

  Maternal IgG
• What season is there a higher incidence of bronchiolitis?

  Winter
• What is the main cause of bronchiolitis?

  Respiratory syncytial virus
• What are some other causes of bronchiolitis?

  Mycoplasma

  Adenoviruses
• What may cause bronchiolitis to become more serious?

  Bronchopulmonary dysplasia

  Congenital heart disease

  Cystic fibrosis
• What are some features of bronchiolitis?

  Coryzal symptoms

  Dry cough

  Increased breathlessness

  Wheeze

  Fine inspiratory crackles

  Feeding difficulties
• What may be the reason for hospital admission in bronchiolitis?

  Feeding difficulties and increasing dyspnoea
• What features do NICE reccommend an IMMEDIATE referral (usually by ambulance)?

  Apnoea

  Child looks seriously unwell to a healthcare professional

  Severe respiratory distress

  Central cyanosis

  Persistent O2 sats of less than 92% on air
• What are some signs of severe resp distress?

  Grunting

  Marked chest recession

  Resp rate >70 breaths per min
• What features of bronchiolitis do NICE recommend that a clinician CONSIDERS referring to hospital?

  Resp rate of >60 breaths per min

  Difficulty breastfeeding or inadequate oral fluid intake

  Clinical dehydration
• What are some investigations for bronchiolitis?

  Immunoflurescence of nasopharyngeal secretes
• Why is immunoflurescence of nasopharyngeal secretions done in bronchiolitis?

  May show RSV
• How is bronchiolitis managed?

  Largely supportive:

  • Humidified oxygen
  • NG feeding
  • Suction
• Why is humidified oxygen given and how?

  Why: if O2 sats are persistently < 92%

  How: Via head box
• Why is NG feeding done?

  If children cannot take enough fluid/feed by mouth
• Why is suction done?

  Used for excessive upper airway secretions