Flashcards in Respiratory Medicine - Bronchiolitis Deck (7):
What is Bronchiolitis?
1. Bronchiolitis is a condition characterised by acute bronchiolar inflammation.
2. Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases.
3. NICE released guidelines on bronchiolitis in 2015
Epidemiology of Bronciolitis?
1. Most common cause of a serious lower respiratory tract infection in < 1yr olds (90% are 1-9 months,
2. With a peak incidence of 3-6 months).
3. Maternal IgG provides protection to newborns against RSV
higher incidence in winter
Causes of Bronciolitis
1. Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases
2. Other causes: mycoplasma, adenoviruses
3. May be secondary bacterial infection
more serious if bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
Clinical signs of Bronchiolitis?
1. Coryzal symptoms (including mild fever) precede:
2. Dry cough
3. Increasing breathlessness
4. Wheezing, fine inspiratory crackles (not always present)
5. Feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
What are the NICE recommendations for immediate referral (usually by 999 ambulance)?
1. Apnoea (observed or reported)
2. Child looks seriously unwell to a healthcare professional
3. Severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
4. Central cyanosis
5. Persistent oxygen saturation of less than 92% when breathing air.
NICE recommend that clinicians 'consider' referring to hospital if any of the following apply?
1. A respiratory rate of over 60 breaths/minute
2. Difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume 'taking account of risk factors and using clinical judgement')
3. Clinical dehydration.