bronchiolitis and bronchitis lung disease children respiratory disease

1. BRONCHITIS
&
BRONCHIOLITIS
QPT20303
Dr. Mohanad

2. Definition
 Acute bronchitis is acute infection of the
bronchial mucosa, without obstruction
ETIOLOGY:
• Viral infection: 90% of cases
• Respiratory Syncytial viruses –
parainfluenza, adenoviruses,
• Bacteria Rarely; pneumococci, H.influenzae,
staphylococi and streptococci.

4. Clinical manifestation
• Dry, hacking, unproductive cough
• within 4-5 days the cough becomes productive
• Sputum production (clear, yellow, green, or even blood-
tinged)
• afebrile patient or low grade fever
• Sore throat
• Runny or stuffy nose
• Headache
• Muscle aches
• Extreme fatigue
• auscultation – rough high pitched rhonchi

5. Treatment
 Infants pulmonary drainage is facilitated by
frequent shifts in position
 Keep well hydrated, humidified air if possible
 Nasopharyngeal lavage with isotonic solution
(normal saline or Ringer lactate)
 Treat fever: Paracetamol > 38, 5 30 mg/kg/d: 4
doses
Or buprofen 200 mg
 No antibiotics, antihistamines
 Expectorants in irritating and paroxysmal
coughing: Bromhexin (suspension, tabl.) ,
Ambroxol, Stoptussin (drops)

6. Evaluation of patients
 Onset of dyspnea: stridor, wheezing
 Onset of general danger signs: convulsions
or abnormally sleepy
 Not able to drink, stopped feeding keel
 Patient don’t improve better after 5 days

7. Refer to hospital
 Presence of general danger signs
 Fever > 39°C resistant to antipyretic
treatment
 Acute respiratory distress and cardiac failure
 Chronic cough > 30 days duration
 Hemoptysis

8. Acute Bronchiolitis
 Lower respiratory tract infection
 Common cause of illness in young children
 Common cause of hospitalization in young
children
 Associated with chronic respiratory
symptoms in adulthood
 May be associated with significant morbidity
or mortality

10. DIAGNOSIS
 Acute infectious inflammation of the
bronchioles resulting in wheezing and
airways obstruction in children less than 2
years old

11. MICROBIOLOGY
Typically caused by viruses
RSV-most common (50%)
Parainfluenza
Human Metapneumovirus
Influenza
Rhinovirus
Coronavirus
Human bocavirus
Occasionally associated with Mycoplasma
pneumonia infection

12. Respiratory Syncytial Virus
• Ubiquitous throughout the world
• Seasonal outbreaks
– Temperate Northern hemisphere:
November to April, peak January or
February
– Temperate Southern hemisphere: May to
September, peak May, June or July
– Tropical Climates: rainy season

13. Parainfluenza
• Usually type 3, but may also be caused
by types 1 or 2
• Epidemics in the early spring and fall

14. Influenza
• Very similar to RSV or Parainfluenza in
symptoms
• Seasonal with similar distribution to
RSV
• Usually epidemic in the Northern
hemisphere January through April

15. Epidemiology
 Typically less than 2 years with peak
incidence 2 to 6 months
 May still cause disease up to 5 years
 Leading cause of hospitalizations in infants
and young children
 Accounts for 60% of all lower respiratory
tract illness in the first year of life

16. Risk Factors of Severity
 Prematurity
 Low birth weight
 Age less than 6-12 weeks
 Chronic pulmonary disease
 Hemodynamically significant cardiac disease
 Immunodeficiency
 Neurologic disease
 Anatomical defects of the airways

17. Environmental Risk Factors
• Older siblings
• Concurrent birth siblings
• Native American heritage
• Passive smoke exposure
• Household crowding
• Child care attendance
• High altitude

18. Pathogenesis
 Viruses penetrate terminal bronchiolar cells--directly
damaging and inflaming
 Pathologic changes begin 18-24 hours after infection
 Bronchiolar cell necrosis, ciliary disruption, peribronchial
lymphocytic infiltration
 Edema, excessive mucus,
 Sloughed epithelium lead to airway obstruction and
atelectasis
 Bronchiolar obstruction during expiration/ Air trapping and
over inflation
 Hypoxemia hypercapnia (CO2 retention, PaCO2>45mmHg,
PaO2 <90mmHg)

21. Clinical Manifestations
Respiratory signs
• Disease starting with signs of acute viral
nasopharyngitis.
• Severe tachypnea >70-80 breaths/min
• Spasmoid cough
• Chest in drawing, intercostal, subcostal and xyphoid
retractions
• Expiratory dyspnea, gasping, emphysematous chest,
on percussion – hyperresonance, very loud intensity
• Diminished breath sound
• Crepitations, Rhonchi, wheezing
• Respiratory distress – dyspnea cyanosis

22. General signs
 Fever (38-39°C)
 Febrile convulsions
 Vomiting, less appetite, dehydration
 Cyanosis, acrocyanosis
 Tachycardia, toxic myocard
 Diver and spleen below the costal margins
– result of depression of diaphragm in over
inflation of lungs

23. EXAM
 Tachypnea
 80-100 in infants
 30-60 in older children
 Prolonged expiratory phase, rhonchi,
wheezes and crackles throughout
 Possible dehydration
 Possible conjunctivitis or otitis media
 Possible cyanosis or apnea

24. Diagnosis
 Clinical diagnosis based on history and
physical exam
 Supported by CXR: hyperinflation,
flattened diaphragms, air bronchograms,
peribronchial cuffing, patchy infiltrates,
atelectasis

26. Course
 Depends on co-morbidities
 Usually self-limited
 Symptoms may last for weeks but generally
back to baseline by 28 days
 In infants > 6 months, average hospitalization
stays are 3-4 days, symptoms improve over 2-
5 days but wheezing often persists for over a
week
 Disruption in feeding and sleeping patterns
may persist for 2-4 weeks

27. Hospitalization
• Children with severe disease
• Toxic with poor feeding, lethargy,
dehydration
• Moderate to severe respiratory distress
(RR > 70, dyspnea, cyanosis)
• Apnea
• Hypoxemia
• Parent unable to care for child at home

28. Treatment
Supportive Care
 Keep young infant to intensive care unite
 Humidified oxygen relieve hypoxemia
• Antibiotics in secondary bacterial pneumonia
 Bronchodilating drugs – Salbutamol, Atrovent,
Terbutalin
 Antipyretics
 Oral intake and parenteral fluids to combat
dehydration
 Local corticosteroids: Beclometazon, Budesonid,
fluticazon

29. Respiratory Support
 Oxygen to maintain saturations above 90-
92%
 Keep saturations higher in the presence of
fever, acidosis, hemoglobinopathies
 Wean carefully in children with heart disease,
chronic lung disease, prematurity
 Mechanical ventilation for pCO2 > 55 or
apnea

30. Complications
Highest in high-risk children
Apnea
Most in youngest children or those with previous
apnea
Respiratory failure
Around 15% overall
Secondary bacterial infection
Uncommon, about 1%, most in children requiring
intubation