Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

Bronchiolitis is an acute inflammatory condition of the bronchioles, most commonly affecting infants, leading to lower respiratory tract infection.

Question 2

What is the most common causative organism of bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV), responsible for approximately 75–80% of cases.

Question 3

Which age group is most commonly affected by bronchiolitis?

Answer 3

Infants under 1 year of age, particularly those aged 1–9 months, with peak incidence at 3–6 months.

Question 4

Why are newborns relatively protected from RSV infection?

Answer 4

Maternal IgG antibodies provide passive protection in early life.

Question 5

When is bronchiolitis most commonly seen?

Answer 5

During the winter months.

Question 6

What other pathogens can cause bronchiolitis?

Answer 6

Mycoplasma and adenoviruses; secondary bacterial infection may occur.

Question 7

Which children are at higher risk of severe bronchiolitis?

Answer 7

Premature infants, those with bronchopulmonary dysplasia, congenital heart disease, or cystic fibrosis.

Question 8

What symptoms typically precede the onset of bronchiolitis?

Answer 8

Coryzal symptoms such as runny nose and mild fever.

Question 9

What are the typical respiratory features of bronchiolitis?

Answer 9

Dry cough, increasing breathlessness, wheeze, and fine inspiratory crackles (which may not always be present).

Question 10

Why do infants with bronchiolitis often require hospital admission?

Answer 10

Feeding difficulties due to increasing respiratory distress are a common reason for admission.

Question 11

What features mandate immediate hospital referral according to NICE?

Answer 11

Apnoea, appearing seriously unwell, severe respiratory distress, central cyanosis, or persistent oxygen saturations below 92% in air.

Question 12

What signs indicate severe respiratory distress in bronchiolitis?

Answer 12

Grunting, marked chest recession, or respiratory rate over 70 breaths per minute.

Question 13

When should clinicians consider hospital referral for bronchiolitis?

Answer 13

Respiratory rate over 60 breaths per minute, poor feeding (50–75% of normal intake), or clinical dehydration.

Question 14

What investigation may confirm RSV infection?

Answer 14

Immunofluorescence testing of nasopharyngeal secretions.

Question 15

Are routine investigations usually required in bronchiolitis?

Answer 15

No, bronchiolitis is a clinical diagnosis and investigations are rarely needed.

Question 16

What is the mainstay of management for bronchiolitis?

Answer 16

Supportive care.

Question 17

When should oxygen be given in bronchiolitis?

Answer 17

If oxygen saturations are persistently below 92% on room air.

Question 18

How is oxygen typically delivered to infants with bronchiolitis?

Answer 18

Humidified oxygen via a head box.

Question 19

When is nasogastric feeding indicated in bronchiolitis?

Answer 19

If the infant is unable to maintain adequate oral intake due to respiratory distress.

Question 20

What role does suction play in bronchiolitis management?

Answer 20

It may be used to clear excessive upper airway secretions.

Question 21

Are bronchodilators, steroids, or antibiotics routinely indicated in bronchiolitis?

Answer 21

No, they are not routinely recommended unless there is another indication.

Question 22

What is the overall prognosis of bronchiolitis?

Answer 22

Most infants recover fully with supportive care, although symptoms may last several weeks.