Module: Pharmacology and Therapeutics III, (Therapeutics part)
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This Presentation is for Educational Purpose. It has no commercial value associated with it.
2. Arwa M. Amin
What We will Discuss Today?
What is Bronchiolitis?
What is the pathogenesis of Bronchiolitis?
What are the common pathogens of Bronchiolitis?
What are the risk factors of Bronchiolitis?
What are the risk factors of Bronchiolitis Severity?
What are the Clinical Presentations of Bronchiolitis?
How to diagnose Bronchiolitis?
How to manage Bronchiolitis?
How to manage Sever Bronchiolitis?
3. Arwa M. Amin
Bronchiolitis
Bronchiolitis is an acute inflammatory injury of the bronchioles (smallest
air-passages in the lung).
Bronchiolitis is caused by acute Viral Infection (mainly the Respiratory
Syncytial Virus (RSV)).
Bronchiolitis is the common cause of LRTIs and hospitalization in infants.
It may occur in any age but severely affects
Infants and Children more than adults.
50% of infants are affected during their 1st year.
100% of children younger than 2 years.
Peak in infants (3 – 6) months
4. Arwa M. Amin
Pathogenesis of Bronchiolitis
Inflammation of the bronchioles due to viral infection (mostly RSV*).
This cause swelling and destruction of the epithelial lining of the
bronchioles, and the accumulation of mucus and inflammatory debris
in the Bronchioles. Eventually, it will lead to:
• Clogging of Bronchioles
• Narrowing and obstruction of the
airways
• Bronchospasm
• Difficultness of breathing
• Hyperpnoea**
• Emphysema***
• Barking cough
*RSV: Respiratory Syncytial Virus, **Hyperpnoea: increased depth and rate of breathing ***Emphysema: Destruction and enlargement of air-space
5. Arwa M. Amin
Bronchiolitis Viral Pathogens
Respiratory Syncytial Virus (RSV) is the main
pathogenic cause of Bronchiolitis (90% cases).
Other viral pathogens:
Parainfluenza viruses.
Adenovirus.
Influenza Virus.
Bacterial Infection: secondary pathogen in small
minority of cases.
RSV
Influenza virus Adenovirus
Parainfluenza
6. Arwa M. Amin
Risk factors of Bronchiolitis
Crowded areas where infected people might be present
Exposure to other infected Children
Males > Females
↑↑ Winter months.
Persist in early Spring
Exposure to cigarette smoke.
7. Arwa M. Amin
Risk factors of Bronchiolitis Severity
Severity of Bronchiolitis may increase in the following conditions:
Age < 6 months (particularly < 3 months), why?
Small airways in infants can’t accommodate mucosal edema.
Premature birth (< 37 weeks)
Low birth weight
Cardiopulmonary disease
e.g. Congenital Heart disease
e.g. Chronic Lung Disease
Tachypnea (RR > 70)
Immunocompromised children
Neurological disease
Malnutrition
RR: Respiratory Rate, Tachypnea: Abnormal rapid breathing
8. Arwa M. Amin
Clinical Presentations and Diagnosis of Bronchiolitis
Begins with URTIs symptoms (1 - 4 days)
Nasal congestion
Rhinorrhea
Mild Fever
Cough
URTIs: upper respiratory tract infections
Bronchiolitis Clinical signs and symptoms
Tachypnoea
Noisy breathing
Nasal flaring
Wheezing
Irritability
Loss of appetite
Vomiting after feeding
Diarrhea
Due to cough, vomiting, diarrhea, tachypnoea
and fever, affected infants suffer dehydration
and loss of fluids.
9. Arwa M. Amin
Clinical Presentations and Diagnosis of Bronchiolitis
Diagnosis depends on History and Physical Examination.
Physical Examination
Tachycardia
RR (40 – 80)/min in hospitalized infants
Wheezing and Respiratory rales
Mild Conjunctivitis
Otitis Media
Hypoxemia (↓ ↓ O2 reaching tissues)
Cyanosis (Blue lips or skin)
Laboratory Findings
RSV identification by PCR
WBCs Normal or slightly Elevated
RR: Respiratory Rate, RSV: Respiratory Syncytial Virus, PCR: Polymerase chain Reaction, WBC: White Blood Cells
10. Arwa M. Amin
Management of Bronchiolitis
Goal of Treatment:
To relief symptoms and provide supportive care
To treat dehydration
General Approach:
Bronchiolitis is Self Limiting.
Most of Bronchiolitis cases are Mild and can be resolved by it self.
Symptoms improves within 7 – 10 days.
Resolution in 28 days.
Bronchiolitis Treatment should focus on Supportive and Symptomatic
Treatment
No AB treatment for Bronchiolitis, unless bacterial pneumonia is clinically
suspected or otitis media.
AB: Antibiotics
11. Arwa M. Amin
Management of Bronchiolitis
Supportive Treatment of Bronchiolitis:
Encourage Bed Rest
Reassure adequate oral fluids intake to treat dehydration
Advice offering the child fluids frequently.
Symptomatic Treatment
If fever present, provide Antipyretic Therapy
Acetaminophen and/or Ibuprofen
Avoid using Aspirin; why?
Taking Aspirin in viral infected children may ↑↑ the risk of Reye’s
syndrome development
12. Arwa M. Amin
Management of Bronchiolitis
Symptomatic Treatment:
Bronchodilators (Nebulizer or Metered Dose Inhaler (MDI)
Recommended only if there is evidence of Bronchospasm or family
history of Asthma.
Short acting β2 agonist (e.g. Albuterol MDI or Nebulization)
Epinephrine Nebulization
13. Arwa M. Amin
Management of Severe Bronchiolitis
Patients with Severe Bronchiolitis may require Hospitalization
Treatment of Severe Bronchiolitis:
Oxygen Therapy
Intubation and Mechanical Ventilation
Intravenous IV fluids to treat dehydration
Antiviral Therapy in severely ill patients:
Ribavirin Aerosol Therapy (Via continuous Nebulization)