| ID | 387 |
|---|---|
| Name | ACUTE BRONCHIOLITIS |
| Cause | Bronchiolitis is usually caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by 2 years of age. Outbreaks of RSV infection often happen during the colder months of the year in some locations or the rainy season in others. A person can get it more than once. |
| Signs Symptoms | Runny nose, fever, stuffy nose, loss of appetite and cough are the first signs of the infection. Symptoms may worsen after a few days and may include wheezing, shortness of breath, and worsening of the cough. |
| Diagnosis | A chest X-ray may be needed to look for signs of pneumonia. A blood test may be needed to check white blood cell count for signs of infection |
| Investigations | Investigations: 1. Laboratory findings: WBC count may be normal or mild lymphocytosis. 2. Chest x-ray findings- increased lung markings due to interstitial infiltration, overinflation with increased translucency of the peripherial lungs & wide intercostal spaces. |
| Management | Management: Most of the children suffering from bronchiolitis are readily manageable as out patients with supportive therapy. Hospitalization is required in children younger than 2 months of age, or incase of severely sick children. Following supportive measure should be taken- 1. Propped up in a humid atmosphere. 2. Oxygen inhalation (at lest 40%). 3. Dehydration should be corrected; an adequate intake of fluid and nutrition should be ensured- can be given orally or through nasogastric tube. It is occasionally necessary to resort to i.v fluids. 4. If there is marked metabolic acidosis, the slow administration of i.v sodium bicarbonate (for dose see under acute diarrhoea) will improve the utilisation of oxygen and myocardial contractility. 5. Ribavirin- An antiviral agent, is effective in reducing the severity of bronchiolitis in the children under 2 years of age with severe infection by RSV. The drug is administered by continuous inhalation as a small particle mist (small particle erosol generator- SPAG) for 12-20 hr/24 hr for 3-5 days.13 6. Antibiotics- In bronchiolitis, antibiotic has no specific role. If there is suspicion of secondary bacterial infection, or where close clinical supervision is not possible, a course of broad-spectrum antibiotic can be given. 7. Corticosteroids have no proven role in bronchiolitis, but are often prescribed in severely ill infants in the hope of reducing inflammation and bronchospasm. 8. Digoxin is rarely necessary but may be indicated when there is increasing tachycardia and progressive liver enlargement (right-sided heart failure is, however, rare). 9. Use of bronchodilator: Although, the role of bronchodilator is uncertain, albuterol erosol, is advised to administer and to observe the response. 10. There is some evidence that ipratropium bromide 250mg in 2ml water given by face mask using a nebulizer may lead to significant improvement. |
| Introduction | Acute Bronchiolitis is a disease of the lower respiratory tract resulting from inflammatory obstruction of the small airways, and is characterized by the rapid development of respiratory distress & pulmonary overdistension. It occurs during the first 2 years of life & peak incidence at 6 month of age. The incidence is highest in winter. |
| History | |
| Etiology | Etiology: Viruses: Respiratory syncytial virus (most common), other viruses include parainfluenza, influenza, and adenovirus. Bacterial: No evidence of bacterial cause. |
| Clinical Features | Clinical feature: 1. Age- usually between 2-6 months; uncommon in the first month of life or after the age of 2 years. 2. Patient may come with 1-2 days of fever (may be mild or even absent), which rarely rises above 105°F 3. Common features are- rhinorrhoea and cough, followed by severe respiratory distress with wheezing or grunting along with subcostal and intercostal recession is marked after a coryzal onset of 1 to several days. The breathing pattern is usually shallow, with rapid respirations. Nasal flaring and cyanosis may be present. 4. Percussion note usually resonant. 5. Prolonged expiratory sound can be heard, and also wide spread fine crepitations with expiratory rhonchi. Sometimes, auscultatory findings are very scanty, despite severe dyspnoea. Table: Differentiating points between bronchiolitis & bronchopneumonia. Acute bronchiolitis Bronchopneumonia 1. Viruses are the main etiological 1. Viral and bacterial (about 10%) agents, the principle virus responsible is the respitaroty syncytial virus (RSV). 2. Pathology: interstitial 2. Widespread patchy consolidation occurs; pneumonitis occurs, with the inflammatory process commonly bronchiolar obstruction. involves the bronchioles & lower bronchi. 3. Age : usual between 3. Occurs in infancy and also in 2-6 months; uncommon in the first month of older ages. life or after the age of 2 yrs. 4. Proceeding history of 4. Also common in viral upper respiratory catarrh- pneumonia. Pneumococcus common; tends to and Staphylococcus are occur in epidemics. frequent primary pathogens. 5. Pleuritic pain usually 5. May occur. does not occur. 6. Cough may be present, dry. 6. Cough is severe, may precipitate vomiting. 7. Fever not common, rarely 7. Common, high fever may rises above 38°C (105°F) occur with or without convulsion. 8. Severe respiratory distress 8. May be present; depends on with wheezing or grunting degree of involvement. alongwith subcostal and intercostal recession is marked after a coryzal onset of 1 to several days. 9. Percussion note resonant. 9. Dull- but difficult to elicit. 10. Prolonged expiratory 10. Bronchial breath sound may sound can be heard, and also be heard alongwith fine crepitations. widespread fine crepitations with expiratory rhonchi. Sometimes, auscultatory findings are very scanty, despite severe dyspnoea. 11. Leucocytosis uncommon. 11. May occur. 12. On CxR : increased lung due to 12. Patchy widespread consolidations interstitial infiltration, overinflation marking occur; emphysematous with increased translucency bulle (pneumatocele) pathognomonic of the peripherial lungs, wide of staphylococcal pneumonia; intercostal spaces. abscess formation with fluid levels in the cavities. |
| Preventions | Clean your hands. Get recommended vaccines, such as the flu vaccine. Don't smoke and avoid secondhand smoke. |
| Treatment | Drink fluids but avoid caffeine and alcohol. Get plenty of rest. Take over-the-counter pain relievers to reduce inflammation, ease pain, and lower your fever. ... Increase the humidity in your home or use a humidifier. |
| Complications | Acute Exacerbation Increased cough. Change in sputum (either color or amount) Change in wheezing. Change in chest tightness. Fever. Increased respiratory rate (tachypnea) Fever (usually low grade) Anxiety. |
| Prognosis | Prognosis: Mortality rate from bronchiolitis is 1%. In some series more than 50% of survivors have continued to wheeze recurrently; the proportion developing asthma during the school years is probably about 10%. Bronchiectasis may occur; but there is increasing evidence of an association with lung function abnormality (ie. bronchial hyperreactivity, small air-ways dysfunction in older symptom-free children. Note: One should be very much cautious regarding fluid therapy, as there may occur inapropriate secretion of ADH and severe hyponatremia. |
| Types | acute and chronic |
| Classification | Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi (large and medium-sized airways) of the lungs. Other names: Chest cold |
| Observation | |
| Pathology |
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