RESP - Bronchiolitis

Question 1

Definition of Bronchiolitis.

Answer 1

Inflammation and infection in the bronchioles.

Question 2

What is Wheezing?

Answer 2

Whistling sound caused by narrowed airways, typically heard during expiration.

Question 3

What is Grunting?

Answer 3

Sound caused by exhaling with the glottis partially caused to increase positive end-expiratory pressure.

Question 4

What is Stridor?

Answer 4

High-pitched inspiratory noise caused by obstruction of the upper airway.

Question 5

Epidemiology of Bronchiolitis (3).

Answer 5

1. Commoner in Winter.
2. 0 - 1 year (2 years if premature).
3. Commonest cause of a serious LRTI in kids under 1.

Question 6

Protective Factor against Bronchiolitis.

Answer 6

Maternal IgG provides protection to newborns against RSV.

Question 7

Aetiology of Bronchiolitis (3).

Answer 7

1. RSV (Respiratory Syncytial Virus) - 75-80%.
2. Mycoplasma, Adenovirus, Secondary Bacterial Infection.
3. More severe if any sign of bronchopulmonary dysplasia e.g. CHD, CF.

Question 8

Clinical Features of Bronchiolitis (7).

Answer 8

1. Coryzal Symptoms (1st).
2. Respiratory Distress.
3. Dyspnoea, Tachypnoea.
4. Poor Feeding.
5. Mild Fever.
6. Wheeze and Crackles.
7. Dry Cough.

Question 9

Signs of Respiratory Distress in Kids (8).

Answer 9

1. Raised RR (above 70).
2. Use of Accessory Muscles.
3. Intercostal/Subcostal Recessions.
4. Nasal Faring.
5. Head Bobbing.
6. Tracheal Tugging.
7. Cyanosis.
8. Abnormal Airway Noises.

Question 10

Pathophysiology of Bronchiolitis.

Answer 10

SAME AS VIRAL-INDUCED WHEEZE PATHOPHYSIOLOGY.

Question 11

Investigations of Bronchiolitis (3).

Answer 11

1. Capillary Blood Gas : Rising pCO2 - airway collapse.
2. Capillary Blood Gas : Falling pH (Unable to buffer Acidosis).
3. Immunofluorescence of Nasopharyngeal Secretions : RSV.

Question 12

When do NICE recommend an immediate referral for a child with Bronchiolitis?

Answer 12

1. Apnoea.
2. Severe Respiratory Distress.
3. Central Cyanosis.
4. Persistent Low Oxygen Saturations.

Question 13

Management of Bronchiolitis (4).

Answer 13

1. Ensure Adequate Intake (Oral, NG, IV based on severity) but avoid overfeeding as full stomach can restrict breathing.
2. Saline Nasal Drops and Nasal Suctioning (especially prior to feed).
3. Supplementary Oxygen (if hypoxic).
4. Ventilatory Support (if required).

Question 14

Ventilatory Support in Bronchiolitis.

Answer 14

1. Optiflow/Airvo - High-Flow Humidified Oxygen via a Tight Nasal Cannula to deliver air and Oxygen with some added pressure continuously to prevent airway collapse and add PEEP to maintain airway at end of expiration.
2. CPAP using sealed nasal cannula to deliver much higher and more controlled pressures.
3. Intubation and Ventilation (Endotracheal tube into trachea).

Question 15

Prophylaxis in Bronchiolitis.

Answer 15

Palivizumab is a monoclonal antibody to target RSV - monthly injection administered in high-risk babies e.g. ex-premature, CHD. Passive Artificial Immunity.

Question 16

Prognosis of Bronchiolitis.

Answer 16

1. 50% experience full course and 50% get better spontaneously after coryza symptoms.
2. 1-2 days coryza; then chest (worst at day 3 or 4) and lasts until 7-10 days.
3. Children who have had Bronchiolitis as infants are more likely to have Viral Induced Wheeze as children.