Bronchiolitis

Question 1

Kye points - bronchiolitis

Answer 1

Bronchiolitis is a clinical diagnosis. Investigations are not indicated
The goal of management is to maintain hydration and oxygenation. Medication beyond simple analgesia is not indicated
Infants with a history of prematurity or cardiopulmonary disease are at higher risk of deterioration and are more likely to require admission
Use nasal prong oxygen for persistent SpO2 <90%. High flow nasal prong (HFNP) therapy should be reserved for failure of nasal prong supplemental oxygen

Question 2

EPID bronchioliits

Answer 2

<12mo
Peak severity is usually at around day 2-3 from the onset of increased work of breathing, with resolution over 7-10 days, but disease course may vary
It is self-limiting, usually requiring no treatment or intervention
A cough may persist for weeks

Question 3

Hx - bronchiolitis

Answer 3

Bronchiolitis typically begins with a coryzal prodrome followed by onset of one or more of:

Cough
Fever
Difficulty feeding
Apnoeic episodes
Unsettledness/irritability

Question 4

Risk factors for more serious illness - bronchioitis

Answer 4

Chronic lung disease
Congenital heart disease
Chronic neurological conditions
Gestational age <37 weeks, or chronological age at presentation <10 weeks
Growth restriction
Indigenous ethnicity
Immunodeficiency
Exposure to cigarette smoke
Trisomy 21

Question 5

Examination- bronchiolitis

Answer 5

Tachypnoea
Use of accessory muscles
Bilateral wheeze and/or fine crepitations
Hypoxia
See assessment of severity of respiratory conditions

Question 6

Ix bronchioliits

Answer 6

In most children with bronchiolitis, no investigations are required or recommended
Investigations should only be undertaken when there is deterioration or diagnostic uncertainty (eg cardiac murmur with signs of congestive cardiac failure)

Chest X-ray (CXR) is not indicated and may lead to unnecessary treatment with antibiotics. CXRs cannot discriminate between viral and bacterial infections and are poorly reproducible in this age group
Blood tests are not indicated (including blood gas, FBE, blood cultures)
Virological testing (nasopharyngeal swab or aspirate) is not indicated in the management of individual children and should not be used to guide treatment

Question 7

Mng bronchiolitis

Answer 7

https://www.rch.org.au/clinicalguide/guideline_index/Bronchiolitis/