Lower respiratory tract infection

Question 1

What is bronchiolitis

Answer 1

condition characterised by acute bronchial inflammation

RSV is most common pathogen

Question 2

What is the epidemiology of bronchiolitis

Answer 2

most common cause of serious lower resp tract infection in <1years old

higher incidence in winter

Question 3

What are some other causes of bronchiolitis

Answer 3

mycoplasma , adenoviruses

• can be secondary to a bacterial infection

Question 4

What may someone with bronchiolitis present with

Answer 4

coryzal symptoms precede-

dry cough
increasing breathlessness
wheezing, fine inspiratpry crackles

feeding difficulties associated with increasing breathlessness are often reason for hospital admission

Question 5

When is an immediate 999 referral needed

Answer 5

if any of following observed

• apnoea ( observed/reported)

-child looks seriously unwell

• severe respiratory distress OR resp rate >70 breaths per minute

-central cyanosis

-persistent oxygen saturation
< 92% when breathing air

Question 6

When should referral be considered?

Answer 6

resp rate >60 breaths per minute

difficulty with breastfeeding/inadequate oral fluid intake

clinical dehydration

Question 7

What investigations can be considered

Answer 7

Immunofluorescence of nasopharyngeal secretions may show RSV

Question 8

What is management

Answer 8

humidified oxygen is given via head box

NG feeding if children cannot take enough fluid/feed by mouth

Suction - if excessive upper airway secretion