Acute Bronchiolitis

Acute Bronchiolitis

1. Essentials for Dx

   • Insidious onset of cough and dyspnea
   • Irreversible airflow obstruction of PFT
   • Minimal findings on CXR
   • Risk Factors
     • Toxic fumes, viral infections, organ transplantation, connective tissue disease

2. Pathophysiology

   • Inflammation of bronchioles
   • VIRAL
     • Respiratory Syncytial Virus (RSV)
     • Other
       • Rhinovirus, adenovirus, influenza, parainfluenza

3. Risk Factors

   • Infants 2 mo.-2yr.
   • Other
     • <6 mo, exposure to cigarette smoke, lack of breastfeeding, premature birth (<37 weeks), crowded conditions

4. Presentation

   • Viral Prodrome
     • Fever, HA, nausea and vomiting, lethargy, myalgias; lasts 1-2 days
     • Followed by: Respiratory Distress
       • Wheezing, rales, tachypnea, nasal flaring, cyanosis, retractions

5. Diagnosis

   • CLINICAL Dx
   • Pulse Oximetry
     • Single best predictor in children
   • Nasal Washings
     • Using monoclonal antibody testing
   • No imaging
     • CXR shows as nonspecific

6. Management

   • Supportive care
     • Humidified O2, IV fluids, nebulized saline, cool mist humidifier, antipyretics
   • If severe
     • Mechanical Ventilation
   • Immunosuppressed or heart/lung disease
     • Ribavirin
   • Medications
     • Limited role
     • Beta-agonists
     • Nebulized racemic epinephrine
     • Corticosteroids*
       • *Not indicated unless hx of underlying reactive airway disease
   • Prevention
     • At High Risk: Palivizumab and HANDWASHING
       • -During the first year of life for children <29 weeks -Symptomatic chronic lung disease of prematurity -Coronary heart disease (CHD) -Neuromuscular difficulties, immunodeficiency

7. Prognosis/Complications

   • Various complications possible, including d/t tx
     • Various complications are possible including those caused by therapy. In most cases, the disease is mild and self-limited. 
   • RSV bronchiolitis in immunosuppressed infants
     • In immunosuppressed infants and those with preexisting heart or lung disease, RSV bronchiolitis can result in any of the following:
     • Acute ARDS, Bronchiolitis obliterans, CHF, Secondary infection, Myocarditis, Arrythmias Chronic lung disease