Bronchiolitis

1. SECTION 1
ACUTE
BRONCHIOLITIS

2. Introduction
Common disease of lower
respiratory tract in infants
Common age group: 1-3
months
Common during winter

3. Etiology
Viral
RSV - >50%
Para influenza 1,2,3
Adeno virus
Non-viral
Mycoplasma
No bacterial etiology

4. Epidemiology
100,000-126,000 children
<1 yr - hospitalized
annually in the US because
of RSV infection
Males – non breast fed
babies
Older family members

5. Pathophysiology

6. Pathophysiology
Bronchiolar obstruction
Minor bronchial wall
thickening
Resistance α
Air trapping & overinflation
1
radius4

7. Clinical features
Happy wheezer
Preceded by URTI, Mild to
mod. fever(101-2°F)
Gradual onset of wheezy
cough, dyspnea
Tachypnea interfere feeds,
apnea in very young infants

8. Wheezy cough

9. Clinical features
Physical examinations
Tachypnea doesn’t correlate
to the lung findings
Increased work of breathing
Hyperinflated chest
Predominant wheeze
Palpable liver & spleen

10. Bronchiolitis

11. Investigations
Chest – X – Ray:
Hyperinflated lungs with
patchy atelectasis
Flat diaphragm
Increased peri-hilar
bronchovascular markings

13. Investigations
WBC count: Normal
(without lymphopenia)
Diagnosis:
Healthy infant first time
wheeze during winter

14. Differential
diagnosis
Bronchial asthma- family
history atopy
CCF- suck rest suck cycle
FB aspiration- sudden
onset, choking episode
Bacterial pneumonia- sick
child

15. Course & Prognosis
Highest risk (cough &
dyspnea) – first 48 to 72 hrs
Death is due to
Uncompensated respiratory
acidosis
Apnea
Severe dehydration

16. Course & Prognosis
Risk factors for severe
disease- age <12 wk,
preterm birth, or
underlying comorbidity
such as cardiovascular,
pulmonary, neurologic, or
immunologic disease

17. Treatment
Hospitalize - hypoxia,
inability to take oral
feedings, apnea, extreme
tachypnea
Supportive therapy- IV
fluids, humidified oxygen,
careful monitoring

18. Treatment options
available
1. Inhaled epinephrine: some clinical
improvement
2. Inhaled bronchodilators – no use
3. Inhaled anti-cholinergics- no use
4. Hypertonic saline nebulization- some
clinical improvement
5. Steroids- No role
6. Antibiotics – no role, Mycoplasma
suspected- Macrolides
7. Antiviral- Palivizumab, Ribavirin-

19. Prevention
Meticulous hand washing

20. STRIDOR AND
ALTB
Section 2

21. Stridor
Harsh, high-pitched
respiratory sound, which is
usually inspiratory but can
be biphasic- sign of upper
airway obstruction

22. Causes
 Acute Onset
ALTB
Epiglottitis
Foreign body
Retropharyngeal
abscess
Bacterial trachiitis
Peritonsillar abscess
 Chronic
Vascular ring
Laryngomalacia
Vocal cord
dysfunction

23. ALTB
 Causes- Viruses-
Parainfluenza virus 1,2,3
Inflammation of Larynx,
trachea and bronchus

24. C/F
 Upper respiratory tract infection-
rhinorrhea, pharyngitis, mild cough,
and low-grade fever for 1-3 days
 Characteristic “barking” cough,
hoarseness, and inspiratory stridor-
worse at night and often recur with
decreasing intensity for several days and
resolve completely within a week
 Agitation and crying- aggravate
 Not ill looking

25. Croup

26. Investigations
 X ray- Steeple sign
Croup is a clinical
diagnosis and does not
require a radiograph of the
neck

27. Steeple sign

28. Treatment
Nebulized Adrenaline- moderate or
severe croup- used as often as every
20 min
Oral dexamethasone used a single
dose of 0.6 mg/kg, a dose as low as
0.15 mg/kg may be just as effective
Intramuscular dexamethasone and
nebulized budesonide have an
equivalent clinical effect

29. Complications
 15% children with croup- complications
 Hypoxia and low oxygen saturation only
when complete airway obstruction
imminent
 Child who is hypoxic, cyanotic, pale, or
obtunded- immediate airway
management
 Bacterial tracheitis in some

30. Epiglottitis
Bends
forward
Tripod
position
Drooling
Toxic child

31. Epiglottitis

32. Thumb sign

33. Croup vs
epiglottitis
 Inflammation of LTB-
Caused by virus-
Parainfluenza
 Usually mild
 No fever at
presentation- non
toxic child
 X ray neck AP-
Steeple sign
 Treatment-
Nebulized
 Inflammation of
epiuglottis- Caused
by bacteria-
H.influenzae
 Serious illness
 High fever at
presentation- toxic
child
 X ray neck lateral-
Thumb sign
 Treatment- may need