Dr. Habibur Rahman & Dr. Pretty

1. Bronchiolitis in children
BY
DOCTOR BANZIR HOSSAIN PRETTY
CIMC

2. What is bronchiolitis
 It is an acute viral Infection of the bronchioles and
is characterized by cough, respiratory distress, and
wheeze that used to Start following an episode of
viral upper respiratory catarrah.

3. Incidence
 Commonly in children less than 2 years beacause of their
narrow airways with the peak incidence of 2-6 months.
 Children who haven’t breast feed
 Who live in crowded environment
 Whose mothers smoke cigarettes are at Greater risk
 Highest incidence occur in winter and early spring.

4. Organism causing bronchiolitis
 More than 50% child are affected due to respiratory synctial
virus (RSV)
 Parainfluenza virus
 Adeno virus
 Meta pneumovirus
 Mycoplasma sometimes

5. Risk factor
 Prematurity
 Not breast feeding
 Over crowding
 Passive smoking
 Indoor air pollution
 Low socio economic status

6. Pathogenesis of broncjiolitis

7. Pathogenesis Of bronchiolitis
 Infammation in bronchiole wall gives rise to
 Swelling of the wall of bronchioles
 Profuse secretion of mucous with narrowing of bronchiole lumen This causes
 Increase resistance to airflow particularly during expiration
 Air trapping and alveolar hyperinflation and raised pressure in alveoli this causes
1. Hypoventilation
2. Compromised pulmonary circulation
that’s ultimately leads to Hypoxaemia, CO2 retention, respiratory acidosis

8. Clinical features
Clinical manifestation
 Sudden onset of cough
 Respiratory distress
 Wheeze

9. Examination finding
 Dyspnoeic
 Flarring of alae nasi
 Cyanosis
 Head nodding
 Occasional grunting

10. Respiratory findings
 Inspection Fast breathing, suprasternal Recession, Chest indrawing,
hyperinflated chest
 Palpation no findings
 Percussion hyper-resonant
 Auscultation breath sound is vesicular with prolonged expiration
and wide spread ronchi, sometimes crepitation must be present.
 SpO2 level low

11. Diagnosis
 Based on clinical features
 Investigation are
1. Chest x-ray
2. CBC- unremarkable
3. Serum electrolyte, ABG (when disease is in serious condition)

12. Chest xray findings
1. Hypertrancluceny -
more blackish lung
2. Hyperinflation -
horizontal ribs,
Depression of domes of
diaphragm

13. Differential diagnosis
 Viral triggered bronchial asthma
 Bronchopneumonia
 Congestive cardiac failure
 Foreign body aspiration
 Cystic fibrosis

14. Treatment
 Counsel the parents about the nature of disease. Mainly the treatment relies
on the severityof the Disease
 Moderate case / Home care (Hospital admission is not required)
1. Keep the babys head in upright position
2. Clean the baby’s nose by cotton soaked in normal saline
3. Continue usual Feeding
4. Bath or sponge the baby with lukewarm water
5. If the baby’s condition deteriorating then come to Hospital immediately

15. Hospital admission criteria
 respiratory rate >70breaths/min
 Spo2 <95%
 Apnea
 Atelactasis onCXR
 Not able to feed
 age <2-3 months

16. Treatment
 Severe cases
1. Immediate hospitaliazation
2. Humidified Oxygen inhalation 4-6litre/min through the head box
3. NPO, appropriate fluid should given.
4. Nebulization with hypertonic salin (3%NaCl) can be given
5. Monitoring the patients specially spO2 by pulse oxymetry
6. Ventilatory support if there is any respiratory distress
7. Although there is no conclusive benefit other options are Dexamethasone i/v only severe
cases, Antibiotic has no role if there is no secondary infection.

17. Complications
 Apnea - most in youngest children or those having
previous history of apnea
 Respiratory failure – around 15% of cases may devlope
respiratory failure
 Secondary bacterial infection – about less than 1% of
cases
 Viral triggered asthma

18. Prognosis
 In most cases patient spontaneously recover within 48-72 hours of
illness does required hospitalization
 Overall Mortality rate is less than 1%
 30-50% of the patients may develop asthma
 Patients will have predominantly asthma if there is family history
Of asthma or atopic Disorder.

19. Prevention
 Vaccination

20. Parents education
 Cough maybe persist 2-4 week
 Theres maybe Increase episode of wheeze in future
 Avoidance Of cigarette smoking Exposure
 The Following information should be carried to the parents if they are giving treatment in
home they should check the red flag sign
1. Worsening of breathing
2. Reduced fluid intake
3. Apnea or cyanosis
4. Exhaustion