[2] Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

A common LRTI that affects babies and young children under 2 years

Question 2

How sever are most cases?

Answer 2

Mild

Question 3

How long do mild cases last?

Answer 3

Clear up within 2-3 weeks

Question 4

Do mild cases require treatment?

Answer 4

No

Question 5

What is needed in sever cases?

Answer 5

Hospitalisation

Question 6

What is the causative pathogen in 80% of cases?

Answer 6

RSV

Question 7

What is RSV?

Answer 7

Respiratory Syncytial Virus

Question 8

What other organisms can cause bronchiolitis?

Answer 8

• Parainflueza virus
• Rhinovirus
• Adenovirus
• Influenza
• Human metapneumovirus

Question 9

What are the risk factors for developing bronchiolitis?

Answer 9

• Premature infants who develop bronchopulmonary dysplasia
• Underlying lung disease e.g. CF
• Congenital heart disease

Question 10

What are the initial symptoms in bronchiolitis?

Answer 10

Coryzal symptoms

Question 11

What symptoms follow the initial coryzal symptoms?

Answer 11

Dry cough and increasing wheezy breathlessness

Question 12

What is the main reason for hospital admission in bronchiolitis?

Answer 12

Feeding difficulty due to increasing dyspnoea

Question 13

What are the signs of bronchiolitis?

Answer 13

• High-pitched wheeze
• Tachypnoea
• Tachycardia
• Subcostal and intercostal recessions
• Hyperinflation of the chest
• Fine end-inspiratory crackles

Question 14

What is the only routine recommended investigation in bronchiolitis?

Answer 14

Pulse oximetry

Question 15

When may a CXR and blood gases be required in bronchiolitis?

Answer 15

When respiratory failure is suspected

Question 16

What are the differentials for bronchiolitis?

Answer 16

• Asthma
• Pneumonia
• Heart failure
• Allergic reaction
• Cystic fibrosis

Question 17

What are the indications for hospital admission?

Answer 17

• Apnoea
• Persistent SpO2 <90% on air
• Inadequate oral fluid intake
• Severe respiratory distress

Question 18

What constitutes inadequate oral intake?

Answer 18

50-75% normal volume

Question 19

What may indicate respiratory distress?

Answer 19

• Grunting
• Marked chest recession
• RR > 70

Question 20

What does management involve?

Answer 20

Supportive including:

• Humdified O2 via nasal cannulae
• Fluids
• Assisted ventilation - only in some cases

Question 21

How can fluids be given?

Answer 21

Via NG or IV

Question 22

What are the forms of assisted ventilation?

Answer 22

• Non-invasive CPAP

- Mechanical ventilation

Question 23

What ward management requirements are essential in managing patients with bronchiolitis?

Answer 23

Good infection prevention techniques

Question 24

Why are good infection prevention techniques required in bronchiolitis management?

Answer 24

RSV is highly infective

Question 25

What infection prevention techniques can be employed?

Answer 25

- Good hand hygiene - Cohort nursing - Gowns and gloves

Question 26

What prophylactic treatment can be given in children at high risk to reduce the number of hospital admissions?

Answer 26

IM Palivizumab

Question 27

What is Palivizumab?

Answer 27

A monoclonal antibody to RSV

Question 28

Why is Palivizumab not given to treat RSV?

Answer 28

It has a high number needed to treat and requires multiple IM injections

Question 29

What are the potential complications of bronchiolitis?

Answer 29

- Respiratory distress - Dehydration - Recurrent apnoea - Permanent damage to airways