2. What is bronchiolitis
It is an acute viral Infection of the bronchioles and
is characterized by cough, respiratory distress, and
wheeze that used to Start following an episode of
viral upper respiratory catarrah.
3. Incidence
Commonly in children less than 2 years beacause of their
narrow airways with the peak incidence of 2-6 months.
Children who haven’t breast feed
Who live in crowded environment
Whose mothers smoke cigarettes are at Greater risk
Highest incidence occur in winter and early spring.
4. Organism causing bronchiolitis
More than 50% child are affected due to respiratory synctial
virus (RSV)
Parainfluenza virus
Adeno virus
Meta pneumovirus
Mycoplasma sometimes
5. Risk factor
Prematurity
Not breast feeding
Over crowding
Passive smoking
Indoor air pollution
Low socio economic status
7. Pathogenesis Of bronchiolitis
Infammation in bronchiole wall gives rise to
Swelling of the wall of bronchioles
Profuse secretion of mucous with narrowing of bronchiole lumen This causes
Increase resistance to airflow particularly during expiration
Air trapping and alveolar hyperinflation and raised pressure in alveoli this causes
1. Hypoventilation
2. Compromised pulmonary circulation
that’s ultimately leads to Hypoxaemia, CO2 retention, respiratory acidosis
10. Respiratory findings
Inspection Fast breathing, suprasternal Recession, Chest indrawing,
hyperinflated chest
Palpation no findings
Percussion hyper-resonant
Auscultation breath sound is vesicular with prolonged expiration
and wide spread ronchi, sometimes crepitation must be present.
SpO2 level low
11. Diagnosis
Based on clinical features
Investigation are
1. Chest x-ray
2. CBC- unremarkable
3. Serum electrolyte, ABG (when disease is in serious condition)
12. Chest xray findings
1. Hypertrancluceny -
more blackish lung
2. Hyperinflation -
horizontal ribs,
Depression of domes of
diaphragm
14. Treatment
Counsel the parents about the nature of disease. Mainly the treatment relies
on the severityof the Disease
Moderate case / Home care (Hospital admission is not required)
1. Keep the babys head in upright position
2. Clean the baby’s nose by cotton soaked in normal saline
3. Continue usual Feeding
4. Bath or sponge the baby with lukewarm water
5. If the baby’s condition deteriorating then come to Hospital immediately
15. Hospital admission criteria
respiratory rate >70breaths/min
Spo2 <95%
Apnea
Atelactasis onCXR
Not able to feed
age <2-3 months
16. Treatment
Severe cases
1. Immediate hospitaliazation
2. Humidified Oxygen inhalation 4-6litre/min through the head box
3. NPO, appropriate fluid should given.
4. Nebulization with hypertonic salin (3%NaCl) can be given
5. Monitoring the patients specially spO2 by pulse oxymetry
6. Ventilatory support if there is any respiratory distress
7. Although there is no conclusive benefit other options are Dexamethasone i/v only severe
cases, Antibiotic has no role if there is no secondary infection.
17. Complications
Apnea - most in youngest children or those having
previous history of apnea
Respiratory failure – around 15% of cases may devlope
respiratory failure
Secondary bacterial infection – about less than 1% of
cases
Viral triggered asthma
18. Prognosis
In most cases patient spontaneously recover within 48-72 hours of
illness does required hospitalization
Overall Mortality rate is less than 1%
30-50% of the patients may develop asthma
Patients will have predominantly asthma if there is family history
Of asthma or atopic Disorder.
20. Parents education
Cough maybe persist 2-4 week
Theres maybe Increase episode of wheeze in future
Avoidance Of cigarette smoking Exposure
The Following information should be carried to the parents if they are giving treatment in
home they should check the red flag sign
1. Worsening of breathing
2. Reduced fluid intake
3. Apnea or cyanosis
4. Exhaustion
