A 7 month old male child presented with cough, cold and fast breathing for 3 days. Examination and investigations confirmed acute bronchiolitis. He was treated with amoxicillin, nebulization, oxygen and supportive medications. His symptoms improved over 3 days and he was discharged on medications including levosalbutamol and zinc supplements. Bronchiolitis is a common viral infection in infants caused mainly by RSV that leads to airway inflammation and obstruction.

1. CASE PRESENTATION ON
ACUTE BRONCHIOLITIS
SUBMITTED BY
METI.BHARATH KUMAR
16DK1T0014
Pharm.D INTERNSHIP

2. DEMOGRAPHIC DETAILS
• NAME: Abhayaram
• AGE: 7 months
• GENDER: male
• WEIGHT: 6 kgs
• DEPARTMENT: paediatrics
• UNIT: children unit- ll
• IP NO: 48725
• DOA: 14/9/21
• DOD: 18/9/21
• CONSULTANT PHYSICIAN:Dr.likitha P.G

3. SUBJECTIVE EVIDENCE
• A 7 months male child was admitted in the pediatrics department
unit-ll with the chief compliants of,
cough,cold, fast breathing since 3 days.
cough: insidous onset,gradually progressive ,no diurnal
variation,
fever : since 3 days intermittent
PAST HISTORY: no similar complaints in the past.

4. OBJECTIVE EVIDENCE
COMPLETE BLOOD PICTURE:
HGB: 9.0
WBC: 9.8
RBC: 3.4
PLT: 330
CX-RAY : bronchiolitis conformed

5. ASSESSMENT
• Based on the subjective and objective evidence the case is confirmed
as “ Acute bronchiolitis”.

6. PLAN OF TREATMENT
MONITOR VITALS DAY 1
• O/E pt is c/c
• Fever,cough,cold since 3 days
• Accepting expressed BF-well
• PV: N
• RR:51/min
• HR: 136 bpm
• CVS: s1s2+ve
• CNS: AF flat open
• Crt: < 3 sec
• P/A: soft
Rx
• 1.guarded oral feeds
• Inj.amoxiclav 240 mg IV BD
• Neb with 3 % NS Q6H
• O2 inhalation via nasal prongs
@21/min
• Kufril drops 1ml-1ml
• Syrup.pct 3 ml PO TID
• w/f increase RD
• Syrup zinc 2.5 ml-2.5 ml

7. PLAN OF TREATMENT
MONITOR VITALS DAY 2
• Accepting expressed BF-well
• PV: N
• RR:52/min
• HR: 136 bpm
• CVS: s1s2+ve
• CNS: AF flat open
• Crt: < 3 sec
• P/A: soft
Rx
• 1.guarded oral feeds
• Inj.amoxiclav 240 mg IV BD
• Neb with 3 % NS Q6H
• O2 inhalation via nasal prongs
@21/min
• Kufril drops 1ml-1ml
• Syrup.pct 3 ml PO TID
• w/f increase RD
• Syrup zinc 2.5 ml-2.5 ml

8. PLAN OF TREATMENT
MONITOR VITALS DAY 3
• No fresh complaints
• Accepting expressed BF-well
• PV: N
• RR:52/min
• HR: 136 bpm
• CVS: s1s2+ve
• CNS: AF flat open
• Crt: < 3 sec
• P/A: soft
Rx
• 1.guarded oral feeds
• Inj.amoxiclav 240 mg IV BD
• Neb with 3 % NS Q6H
• O2 inhalation via nasal prongs
@21/min
• Kufril drops 1ml-1ml
• Syrup.pct 3 ml PO TID
• w/f increase RD
• Syrup zinc 2.5 ml-2.5 ml

9. DISCHARGE MEDICATION
• Syrup.ambroxyl.HCL 2.5 ml - 2.5 ml BD
• Syrup.pct 3 ml sos
• Syrup. Zinc 2.5 ml -2.5 ml BD

10. DRUG CHART
S.NO GENERIC NAME BRAND NAME INDICATION DOSE ROA FREQUENCY
1 Ambroxyl
levosalbutamol
Kufril LS Reduce cough 1 ml PO BD
2 Amoxicillin+potas
sium
amoxyclav Reduce
infection
240 mg IV BD
3 acetaminophen paracetamol Reduce fever 3 ml PO SOS
4 Syrup zinc zinkos To increase
haemoglobin
2.5 ml PO BD

11. PHARMACEUTICAL CARE ISSUES
• No pharmaceutical care issues found the prescription was rational.

12. DISCUSSION
• Bronchiolitis is a viral lung infection that causes inflammation in the
smallest air passages in your lungs called bronchioles. Although it’s
generally a childhood condition, bronchiolitis can also affect adults.
• Inflammation of your bronchioles can cause a blockage of oxygen in
your airways that leads to symptoms such as coughing or trouble
breathing. Bronchiolitis generally causes mild illness, but serious cases
can progress to lung failure.
• Bronchiolitis and bronchitis are both viral infections of your lungs, but
they affect different structures.
• Bronchitis is an infection of your bronchi.bronchiolitis is an infection
of the smaller bronchioles.

13. CLINICAL MANIFESTATIONS
• runny nose
• fever
• stuffy nose
• loss of appetite
• cough
Over the next several days, symptoms often get worse before gradually getting better. They might
include:
• shortness of breath
• wheezing
• worsening cough that may be raspy
• brief pauses in breathing
• irritability
• vomiting after eating
• having fewer wet diapers than usual
• fatigue

14. CAUSES
• Respiratory syncytial virus
(RSV)
• Adenoviruses
• Influenza viruses
RISK FACTORS
• not being breastfed
• being born prematurely or born
with a heart or lung condition
• having a suppressed immune
system
• being exposed to cigarette smoke
• being in crowded places where
the virus is present, like daycare
centers

16. DIAGNOSIS
• physical exam and medical history
evaluation, including potential
environmental exposures.
• imaging testing, including chest X-
rays or a CT scan.
• spirometry, which measures how
much and how quickly you take in
air with each breath.
• arterial blood gas tests measure
how much oxygen and carbon
dioxide are in your blood.
TREATMENT
• Many cases of viral bronchiolitis
are mild and clear up without
treatment.
• For more severe cases in infants,
hospitalization may be necessary.
• A hospital can provide oxygen and
intravenous fluid treatments.

17. PREVENTION AND PATIENT
COUNSELLING
• Keep them away from people who are sick with infectious diseases,
especially when your child is younger than 2 months.
• Regularly disinfect surfaces and toys your child often comes into
contact with.
• Fully wash and dry your child’s utensils.
• Wash your child’s hands frequently, especially before and after feeding
and after they touch their nose or mouth.
• Keep your child away from secondhand smoke.