Bronchiolitis

Question 1

What is Bronchiolitis

Answer 1

describes inflammation and infection in the bronchioles, the small airways of the lungs.

In toddlers/babies

Question 2

Most common cause of Bronchiolitis

Answer 2

Respiratory syncytial virus (RSV) is the most common cause.

Question 3

Bronchiolitis present

Answer 3

Coryzal symptoms. These are the typical symptoms of a viral upper respiratory tract infection: running or snotty nose, sneezing, mucus in throat and watery eyes.
Signs of respiratory distress
Dyspnoea (heavy laboured breathing)
Tachypnoea (fast breathing)
Poor feeding
Mild fever (under 39ºC)
Apnoeas are episodes where the child stops breathing
Wheeze and crackles on auscultation

Question 4

Signs of resp distress in child?

Answer 4

Raised respiratory rate
Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis (due to low oxygen saturation)
Abnormal airway noises

Question 5

Bronchiolitis course

Answer 5

usually starts as an upper respiratory tract infection (URTI) with coryzal symptoms. From this point around half get better spontaneously. The other half develop chest symptoms over the first 1-2 days following the onset of coryzal symptoms. Symptoms are generally at their worst on day 3 or 4. Symptoms usually last 7 to 10 days total and most patients fully recover within 2 – 3 weeks. Children who have had bronchiolitis as infants are more likely to have viral induced wheeze during childhood.

Question 6

Treatment Bronchiolitis

Answer 6

Typically patients only require supportive management. This involves:

Ensuring adequate intake. This could be orally, via NG tube or IV fluids depending on the severity. It is important to avoid overfeeding as a full stomach will restrict breathing. Start with small frequent feeds and gradually increase them as tolerated.
Saline nasal drops and nasal suctioning can help clear nasal secretions, particularly prior to feeding
Supplementary oxygen if the oxygen saturations remain below 92%
Ventilatory support if required
There is little evidence for treatments such as nebulised saline, bronchodilators, steroids and antibiotics.

Question 7

Signs of poor ventilation?

Answer 7

Rising pCO2, showing that the airways have collapsed and can’t clear waste carbon dioxide.
Falling pH, showing that CO2 is building up and they are not able to buffer the acidosis this creates. This is a respiratory acidosis. If they are also hypoxic, this is classed as type 2 respiratory failure.