Bronchiolitis is a common disease for children. After watching this slide you will be able to know about bronchiolitis. To get health services to visit our Facebook pages. https://www.facebook.com/medicalstudyandhealthtips/

1. Presented by
Md Sujan Hossain
DMF(State Medical Faculty)

2. Outline
Definition
Epidemiology
Etiology
Risk Factor
Pathogenesis
Clinical Features
Examination of Chest
Investigations
Diagnosis
Assesment of Severity
Differential Diagnosis
Complication
Management

3. Definition:-
 It is an acute viral infection of the bronchiole and is
characterized by cough, respiratory distress and
wheeze resulting in inflammatory obstruction.

4. Epidemiology:-
Occurs in children less than 2 years of age, mostly
between 2-6 months.
Highest incidence in winter, rainy season and early
spring occurs sprodically and epidemically.
Leading cause of hospitalizations in infants and young
children.
Commonest cause of lower respiratory tract infection
in infancy.

5. Etiology:-
Typically caused by viruses:
i. Respiratory Syncital virus
ii. Influenza virus
iii. Parainfluenza virus
iv. Human metapneumo virus
v. Rhino virus
vi. Corona virus
Occasionaly associated with mycoplasma pneumonia
infection.
Fig: Some viruses

6. Risk Factor:-
 Prematurity
 LBW
 Winter season
 Low socio-economic status
 Non breast feeding
 Crowded environment
 Passive smoking
 Indoor air pollution

7. Pathogenesis:-
 This infection of bronchioles gives rise to
Inflammatory swelling of walls of bronchioles.
Profuse mucous secretion.
Narrowing of lumen of bronchioles &
Air trapping in alveoli.
In bronchiolitis the airways becomes obstructed from
swelling of the bronchiole walls.

8. Clinical Features:-
 Severe respiratory distress
 Poor feeding
 Wheeze
 Cough
 Noisy respiration
 Low grade fever or no fever
 Sleeping difficulty
 Tachypnoea
 Apnoea
 Cyanosis
Fig:-A patient with acute bronchiolitis

9. Examination of chest:-
 Inspection:
 Fast breathing
 Suprasternal recession
 Chest indrawing
 Hyper inflated chest
 Palpation:
 No characteristic finding
 Percussion:
 Hyper resonant
 Auscultation:
 Breath sound is vesicular with prolong expiration
 Widespread rhonchi
 Sometimes fine crepitations may present

10. Investigations:-
X-ray of chest:
The characteristic findings are:
 Hypertranslucency: (More blackish lung fields)
 Hyperinflation: (depression of the dome of diaphragm and horizonatal
ribs)
 Increased hilar bronchial marking
CBC,CRP: Unremarkable
Fig:- A chest x-ray of bronchiolitis patient

11. Diagnosis:-
Based on clinical features &
relevant investigations.

12. Assesment of severity:-
Mild Moderate Severe
Behaviour Normal Intermittent
irritability
Increasing
irritability/Lethargy
Respiratory Rate Normal Increased Markded increase
Feeding Normal May have difficulty Unable to feed
Oxygen No requirement
SaO2 (>93%)
Mild hypoxaemia
SaO2 (90-93%)
Hypoxaemia
SaO2 (<90%)
Apnoeic episodes None May have Prolonged apnoeas

13. Differential Diagnosis:-
oPneumonia
oAsthma
oCongestive Heart Failure
oForeign body aspiration
oCystic Fibrosis

14. Complications:-
Most Common complicatios are:
 Apnoea
 Rspiratory Failure
 Secondary Infection

15. Management:-
Mild cases:
Counsel parent about the disease:
 Usually auto limiting disease in 5-7 days.
 Future chance of recurrent wheeze.
Home Care:
 Head up position
 Normal feeding
 Cleaning nose with normal salaine drop
 Bathing with lukewarm water
 Advice when to return hospital

16. Moderate Cases:-
Hospitalization:
 Oxygen inhalation: continued until
clinical improvement.
Nebulization with
Salbutamol,Budesonide
Normal feeding or NG Feeding
Supporative management

17. Severe cases:-
Hospitalization:
 Oxygen inhalation
Monitoring oxygen saturation by pulse oxymeter.
When severe respiratory distress & falling oxygen
saturation giving ventilator support.
NPO & give IV fluid.
Supporative management.

18. Although having no conclusive
benefits but other treatments are:
Steroids:
Parenteral dexamethasone may be tried only in severe
cases.
Antibiotics:
No role in bronchiolitis ( given only when secondary
bacterial infection is suspected)

19. Cluster clues to clinical diagnosis
Bronchiolitis:
 Age up to 2 years, peak 2-6 months
 Runny nose
 Fast breathing
 Respiratory distress
 Afebrile/ low grade fever
 Wheeze
 Normal blood count
 CXR-hypertranslucency and hyperinflation

20. Mind that:-
Laughing, coughing and
wheezing in a lap baby is
bronchiolitis
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21. Thank
You