Bronchiolitis Disease
BASICS
DESCRIPTION
Inflammation of the bronchioles, usually seen in young children, occasionally in high-risk adults. May be seasonal (winter and spring) and often occurs in epidemics. Usual course: insidious; acute; progressive.
- System(s) affected: Pulmonary
- Genetics: N/A
- Incidence/Prevalence in USA: Medical care provided to 1000-1500/100,000 annually. Estimated incidence is higher.
- Predominant age: newborn-2 years (peak age 2-6 months)
- Predominant sex: Male > Female
SIGNS AND SYMPTOMS
- Anorexia
- Cough
- Cyanosis
- Expiratory wheezing
- Apnea
- Fever
- Grunting
- Inspiratory crackles
- Intercostal retractions
- Noisy breathing
- Otitis media
- Pharyngitis
- Tachycardia
- Tachypnea
- Vomiting
CAUSES
- Respiratory syncytial virus
- Parainfluenza
- Adenovirus
- Rhinovirus
- Influenza virus
- Chlamydia
- Eye, nose, mouth inoculation
- Exposure to adult with URI
- Day care exposure (significant)
- Idiopathic (many adult cases)
RISK FACTORS
- Contact with infected person
- Children in day care environment
- Heart-lung transplantation patient
- Adults - exposure to toxic fumes, connective tissue disease
DIAGNOSIS
LABORATORY
- Arterial blood gas - hypoxemia, hypercarbia, acidemia
- Respiratory viral culture - positive
- Respiratory viral antigens - positive
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A
PATHOLOGICAL FINDINGS
- Abundant mucous exudate
- Mucosal - hyperemia, edema
- Submucosal lymphocytic infiltrate, monocytic infiltrate, plasmacytic infiltrate
- Small airway debris, fibrin, inflammatory exudate, fibrosis
- Peribronchiolar mononuclear infiltrate
SPECIAL TESTS
Infant pulmonary function studies - bronchodilator response
IMAGING
- Chest x-ray
- Focal atelectasis
- Air trapping
- Flattened diaphragm
- Increased anteroposterior diameter
- Peribronchial cuffing
DIAGNOSTIC PROCEDURES
N/A
TREATMENT
APPROPRIATE HEALTH CARE
- Most patients can be treated at home
- Inpatient indicated for patient with increased respiratory distress, cyanosis, and dehydration
GENERAL MEASURES
- Most critical phase is first 48-72 hours after onset. Treatment is usually symptomatic.
- Fluid at maintenance
- Mechanical ventilation in respiratory failure
- Isolation: contact; handwashing most important
- Antiviral agents for selected high-risk patients
- Cardio-respiratory monitoring
- Inhaled bronchodilators are commonly used, although efficacy has been hard to demonstrate in controlled studies
- Steroids may not change course - except in patients with reactive airway disease
SURGICAL MEASURES
N/A
ACTIVITY
- Avoid exposure to crowds, viral illness for 2 months
- Avoid smoke
DIET
- Frequent small feedings of clear liquids
- If hospitalized, may require intravenous fluids
PATIENT EDUCATION
Griffith: Instructions for Patients; Philadelphia, W.B. Saunders Co.
FOLLOW UP
PREVENTION/AVOIDANCE
- Hand washing
- Contact isolation of infected babies
- Persons with colds should keep contacts with infants to a minimum
- ´Palivizumab´ (Synagis), a monoclonal product, can be used for prevention in high-risk patients (28-32 weeks gestation and less than 6 months old; less than 28 weeks gestation and less than 12 months old; moderately severe BRD and up to two years old). Administer monthly (November thru March) 15 mg/kg IM. Single use vial of 100 mg and 50 mg.
- ´RSV immune globulin´, a human blood product, can also be used in at-risk patients. Monthly infusions of 750 mg/kg, November thru March, in a controlled setting. Avoid fluid overload. Vial is 50 mg/mL; infuse at 1.5-6 mL/kg/hr; monitor oximeter and vital signs.
- Both of these medications are quite expensive.
POSSIBLE COMPLICATIONS
- Bacterial superinfection
- Bronchiolitis obliterans
- Apnea
- Respiratory failure
- Death
- Increased incidence of RAD
EXPECTED COURSE AND PROGNOSIS
- In most cases, recovery is complete within 7-10 days
- Mortality statistics differ, but probably under 1%
- High-risk infants (BPD, CHD) may have prolonged course
MISCELLANEOUS
ASSOCIATED CONDITIONS
- Common cold
- Conjunctivitis
- Pharyngitis
- Otitis media
- Diarrhea
AGE-RELATED FACTORS
Pediatric: Most common in infants
Geriatric: N/A
Others: N/A
PREGNANCY
N/A
OTHER NOTES
N/A
ABBREVIATIONS
BPD = bronchopulmonary dysplasia
CHD = congenital heart disease
RAD = reactive airway disease
SPAG = small particle aerosol generator
Clinical Investigations
- Cardiology
- Dermatology
- General Destistry
- Cardiology
- Dermatology
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