Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

Inflammation of the bronchioles, most common in infants under 6 months

If occurring in over 2 years old, they are likely to be ex-premature and have chronic lung disease.

Question 2

What is bronchiolitis in children over 2 associated with?

Answer 2

*premature birth
*Chronic lung disease

Question 3

What is the epidemiology of bronchiolitis?

Answer 3

It is the most common cause of a serious lower respiratory tract infection in < 1yr olds (90% are 1-9 months, with a peak incidence of 3-6 months). Maternal IgG provides protection to newborns against RSV.

Question 4

What is the pathophysiology of bronchiolitis?

Answer 4

epithelial necrosis with inflammation, causing oedema and mucus with partial airway obstruction.

Question 5

What is the most common cause of bronchiolitis?

Answer 5

RSV (Respiratory Syncytial Virus)

Less common causes include rhinovirus and bacterial infection

Other causes include Rhinovirus and may be secondary to bacterial infection.

Question 6

List the risk factors for developing bronchiolitis.

Answer 6

• Nursery attendance or older siblings
• Passive smoking
• Overcrowding
• Exclusive formula-feeding

More severe bronchiolitis is seen in infants with additional risk factors.

Question 7

Which infants are at risk for severe bronchiolitis?

Answer 7

• Prematurity or low birth weight
• Age < 12 weeks
• History of mechanical ventilation, chronic lung disease, congenital heart disease or neurological disease
• Immunocompromise
• Congenital defects of the airway
• Down’s Syndrome

Question 8

What are the signs of respiratory distress in bronchiolitis?

Answer 8

• Increased respiratory rate
• Use of accessory muscles
• Subcostal recessions
• Nasal flaring
• Head bobbing
• Tracheal tugging
• Cyanosis
• Abnormal airway noises

These signs indicate the severity of the condition.

Question 9

What are the presentation symptoms of bronchiolitis?

Answer 9

• Coryza symptoms
• Wet cough
• Dyspnoea Showing laboured breathing
• Tachypnoea
• Poor feeding
• Mild fever under 3
• Apnoea
• Wheeze

Symptoms typically worsen on day 3 or 4 and last 7-10 days.

Question 10

What is the time course of bronchiolitis?

Answer 10

bronchiolitis starts with corzyzal symptoms with chest symptoms for 1-2 days. Symptoms are worst on day 3 or 4 and lasts 7-10 days

Question 11

What is wheezing caused by?

Answer 11

expiration pathology from narrow airway

Question 12

What is stridor caused by?

Answer 12

inspiration pathology form obstruction of upper airway like croup

Question 13

What is grunting caused by?

Answer 13

exhaling with glottis partially closed to increase positive end-expiratory pressure

Question 14

What are patients with bronchiolitis at risk for?

Answer 14

dehydration from reduced oral intake and vomiting. It is assoicated strongly with otitis media in infants.

Question 15

What can be given for prevention of bronchiolitis in high risk infants?

Answer 15

palivuzumab monocloncal antibody is a monthly injection against RSV for high risk babies that are ex-premature or have congenital heart disease to provide passive immunity.

It provides passive immunity against RSV.

Question 16

What are the complications associated with bronchiolitis?

Answer 16

• Respiratory failure
• Dehydration
• Cough lasting weeks
• Bronchiolitis obliterans

Bronchiolitis obliterans is a rare chronic complication known as popcorn lung.

Question 17

What is bronchiolitis obliterans?

Answer 17

A rare, chronic complication of bronchiolitis, colloquially known as popcorn lung.

The bronchioles are injured due to infection (usually adenovirus) or causing build-up of scar tissue which obstructs the bronchioles, and impairs oxygen absorption in the body.potentially leading torespiratory failure

Question 18

What is the time course of bronchiolitis symptoms?

Answer 18

Starts with coryzal symptoms, worsens on day 3 or 4, lasts 7-10 days

Symptoms include runny nose, cough, and respiratory distress.

Question 19

Which features of bronchiolitis require immediate referral according to NICE?

Answer 19

• 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 20

Which features of bronchiolitis should necesssitate consideration of hospital referral according to NICE?

Answer 20

• 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 21

List the investigations for bronchiolitis.

Answer 21

• Immunofluorescence of nasopharyngeal secretions
• Pulse oximetry
• Throat swab for respiratory viruses
• Chest X-rays if focal chest signs Or deterioration is seen

These tests help confirm the diagnosis and assess severity.

Question 22

What is the management approach for bronchiolitis?

Answer 22

Largely supportive management by maximising oral intake with NG tube or IV fluids
Avoid over-feeding as full stomach can restrict feeding

Includes maximizing oral intake, NG tube or IV fluids, and supplementary oxygen.

Question 23

When is supplemental oxygen indicated for bronchiolitis?

Answer 23

sats below 92% via:
*head box, which is a clear plastic hood supplying a baby with warm and humidified oxygen, maintains a stable, controlled FiO2 around the baby’s face

• Ventilatory support
• Continuous airway pressure for severe respiratory failure

*Intubation and ventilation with endotracheal tube

Question 24

What are the signs of poor ventilation?

Answer 24

Rising pCO2 and falling pH

Question 25

What are the **abnormal airway noises** associated with bronchiolitis?

Answer 25

* Wheezing * Stridor * Grunting ## Footnote Wheezing indicates expiration pathology, stridor indicates inspiration pathology, and grunting increases positive end-expiratory pressure.

Question 26

What is the **differential diagnosis** for bronchiolitis?

Answer 26

* Foreign body aspiration * Pneumonia * Cardiac failure * Gastric reflux * Viral induced wheeze ## Footnote Each condition presents with distinct symptoms and requires different management.

Question 27

What is the **mortality rate** for high-risk infants with bronchiolitis?

Answer 27

Approximately 3% ## Footnote High-risk factors include chronic lung disease, immunodeficiency, and age under 3 months.

Question 28

What is the **peak incidence** age for bronchiolitis?

Answer 28

3-6 months ## Footnote 90% of cases occur in infants aged 1-9 months.

Question 29

Fill in the blank: **Bronchiolitis** has epithelial necrosis with inflammation, causing _______ and mucus with partial airway obstruction.

Answer 29

oedema ## Footnote This pathophysiology contributes to the respiratory distress seen in affected infants.

Question 30

How does Foreign body aspiration differentiate from bronchiolitis?

Answer 30

sudden onset and no Coryzal symptoms and is unilateral

Question 31

How does cardiac failure differentiate from bronchiolitis?

Answer 31

continual malformation like laboured breathing,tachycardia, poor growth and murmurs

Question 32

How does viral induced wheeze differentiate from bronchiolitis?

Answer 32

It presents in children 1-5 years old with coryzal symptoms like cough, fever and wheeze. There will be airway narrowing following viral illness, driven by bronchospasm.

Question 33

What is the treatment of viral induced wheeze?

Answer 33

supportive with B2 agonists like salbutamol

Question 34

How to differentiate asthma from bronchiolitis?

Answer 34

rare before 5 years old showing features of atopy liek recurrent wheeze and nocturnal cough. Onset is over hours and lasts 2-4 days, with supportive care using oxygen .

Question 35

Which conditions have worse risk for bronchiolitis?

Answer 35

Congenital eart disease Cystic fibrosis Down syndrome

Question 36

How to differentiate bronchiolitis and crop?

Answer 36

wheezing and fast breathing rather than stridor. While bronchiolitis can present with fever and cough, the presence of inspiratory stridor makes croup more likely

Question 37

What are the NICE guidance for considering hospital referral?

Answer 37

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 [see recommendation 1.3.3] and using clinical judgement) clinical dehydration.

Question 38

What are the admission criteria for bronchiolitis

Answer 38

*Apnoea (observed or reported) *Persistent oxygen saturation of <92% in air *Inadequate oral fluid intake (<50% of normal fluid intake) *Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute

Question 39

Which crackles are found in bronchiolitis?

Answer 39

Fine Inspiratory crackles due to excess airway secretions

Question 40

When do NICE say to suspected pneumoina instead?

Answer 40

Consider a diagnosis of pneumonia if the child has: high fever (over 39°C) and/or persistently focal crackles

Question 41

What feature requires immediate hospital admission?

Answer 41

Grunting