Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

a condition characterised by acute bronchiolar inflammation. Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases.

Question 2

Causes of bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases.

• other causes: mycoplasma, adenoviruses
• may be secondary bacterial infection
• more serious if bronchopulmonary dysplasia (e.g. Premature),congenital heart diseaseor cystic fibrosis

Question 3

Features of bronchiolitis

Answer 3

• coryzal symptoms (including mild fever) precede:
• dry cough
• increasing breathlessness
• wheezing, fine inspiratory crackles (not always present)
• feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

Question 4

NICE recommend immediate referral (usually by 999 ambulance) if they have any of the following:

Answer 4

• apnoea (observed or reported)
• child looks seriously unwell to a healthcare professional
• severe respiratory distress, for examplegrunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
• central cyanosis
• persistent oxygen saturation of less than 92% when breathing air.

Question 5

NICE recommend that clinicians ‘consider’ referring to hospital if any of the following apply

Answer 5

• a respiratory rate of over 60 breaths/minute
• difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
• clinical dehydration.

Question 6

Investigation of bronchiolitis?

Answer 6

immunofluorescence of nasopharyngeal secretions may show RSV

Question 7

Management is largelysupportive…

Answer 7

• humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
• nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
• suction is sometimes used for excessive upper airway secretion