Bronchitis

Question 1

Definitions

Answer 1

Acute infectious inflammation of the bronchioles resulting in wheezing and airways obstruction in children less than 2 years old

Question 2

Most common cause

Answer 2

RSV-most common
. November to April, peak January or February
( ‘11-5)

Question 3

RISK FACTORS OF SEVERITY managed at hospital

Answer 3

• Prematurity
• Low birth weight
• Age less than 6-12 weeks
• Chronic pulmonary disease
• Hemodynamically significant cardiac disease
• Immunodeficiency
• Neurologic disease
• Anatomical defects ALI of the airways

Question 4

CLINICAL FEATURES

Answer 4

• Begin with upper respiratory tract symptoms: nasal congestion, rhinorrhea, mild cough, low-grade fever

• Progress in 3-6 days to rapid respirations, chest retractions, wheezing
. Happy baby 👶🏻

Question 5

EXAM

Answer 5

• Tachypnea

– 80-100 in infants

– 30-60 in older children
🛑more the 70 ➡️ hospitalisation

• Prolonged expiratory phase, rhonchi, wheezes and crackles throughout
• Possible dehydration
• Possible conjunctivitis or otitis media
• Possible cyanosis or apnea

Question 6

DIAGNOSIS

Answer 6

• Clinical diagnosis based on history and physical exam
• Supported by CXR: hyperinflation, flattened diaphragms, air bronchograms, peribronchial cuffing, patchy infiltrates, atelectasis

Question 7

DIFFERENTIAL DIAGNOSIS

Answer 7

• 🛑Viral-triggered asthma
Family history of atopy,recurrent, respond to bronchodilators

• Bronchitis or pneumonia
• Chronic lung disease
• Foreign body aspiration
• Gastroesophageal reflux or dysphagia leading to aspiration
• Congenital heart disease or heart failure
• Vascular rings, bronchomalacia, complete tracheal rings or other anatomical abnormalities

Question 8

HOSPITALIZATION

Answer 8

• Children with severe disease
• Toxic with poor feeding, lethargy, dehydration
• Moderate to severe respiratory distress (RR

> 70, dyspnea, cyanosis)

• Apnea
• Hypoxemia
• Parent unable to care for child at home

Question 9

TREATMENT

Answer 9

• 🧿Supportive care
1-Saline nasal drops with nasal bulb suctioning
2- o2 (Oxygen to maintain saturations above 90-92%)
3- rest
4- Antipyretics
5- fluid for dehydration ( 2\3 of maintenance due to ⬆️ ADH in respiratory disease 🦠)
6-BRONCHODILATORS ( one trial with Albuterol or Epinephrin)
7- CORTICOSTERIODS (May be helpful in children with chronic lung disease or a history of recurrent wheezing , Prednisone, prednisolone, dexamethasone)

• 🧿Pharmacologic therapy

1- RIBAVIRIN May be useful in infants with confirmed RSV at risk for more severe disease
2-PALIVIZUMAB