Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

Lower respiratory tract infection affecting bronchioles
Affecting children aged 1 months - 12 months

Question 2

What is the most common causative organism of bronchiolitis?

Answer 2

Respiratory Synctial Virus

Question 4

Risk factors of bronchiolitis?

Answer 4

RF’s for all bronchiolitis?
Overcrowding
Passive smoking
Nursery attendance/older siblings
Exclusive formula feeding

Specific RF’s for severe bronchiolitis?
Prematurity / low birth weight
Age < 12 weeks
History of invasive ventilation, chronic lung disease, congenital heart disease, neurological condition
Down’s syndrome
Immunocompromised

Question 5

What is the incidence of bronchiolitis?

Answer 5

1 in 3 infants

Question 6

Symptoms of bronchiolitis?

Answer 6

Cough
Tachypnoea
Wheeze or crackles
Chest recession
Coryzal symptoms 1-3 days
Fever > 39C
Reduced oral intake
Apnoea

Question 7

Investigations for bronchiolitis?

Answer 7

Mostly clinical
Can do pulse oximetry, throat swab, CXR if focal signs or deterioration

Question 8

Management of bronchiolitis?

Answer 8

Admit to hospital if…
>60 breaths/min
Reduced oral intake (< 50% normal)
Clinical dehydration
O2 sats < 92%
Cyanosis
Apnoea
Respiratory distress (grunting, intercostal or subcostal recession, tracheal tugging)

Fluid and nutrition intake
If O2 sats < 90% and over 6 weeks old → give O2
If respiratory failure → CPAP
If very severe → Ribavirin antiviral

Question 9

How is bronchiolitis prevented in babies at high risk of acquiring severe bronchiolitis e.g. congenital heart disease?

Answer 9

Pavilizumab

Question 10

What is a complication of bronchiolitis?

Answer 10

Bronchiolitis obliterans - ‘popcorn lung’ chronic disease caused by scar tissue repair in bronchioles leading to more obstruction

Question 11

How long does bronchiolitis take to resolve?

Answer 11

Approx. 7 days
Cough takes 3 weeks to resolve