Module: Pharmacology and Therapeutics III, (Therapeutics part) Coordinator: Dr. Arwa M. Amin Mostafa Academic Level: Undergraduate, B.Pharmacy School: Dubai Pharmacy College Year of first presented in Class: 2018 This Presentation is for Educational Purpose. It has no commercial value associated with it.

1. LOWER RESPIRATORY TRACT INFECTIONS
BRONCHIOLITIS
ARWA M. AMIN MOSTAFA
PHD, M.PHARM CLINICAL PHARM, DIP MANGT, B.PHARM.

2. Arwa M. Amin
What We will Discuss Today?
 What is Bronchiolitis?
 What is the pathogenesis of Bronchiolitis?
 What are the common pathogens of Bronchiolitis?
 What are the risk factors of Bronchiolitis?
 What are the risk factors of Bronchiolitis Severity?
 What are the Clinical Presentations of Bronchiolitis?
 How to diagnose Bronchiolitis?
 How to manage Bronchiolitis?
 How to manage Sever Bronchiolitis?

3. Arwa M. Amin
Bronchiolitis
 Bronchiolitis is an acute inflammatory injury of the bronchioles (smallest
air-passages in the lung).
 Bronchiolitis is caused by acute Viral Infection (mainly the Respiratory
Syncytial Virus (RSV)).
 Bronchiolitis is the common cause of LRTIs and hospitalization in infants.
 It may occur in any age but severely affects
Infants and Children more than adults.
 50% of infants are affected during their 1st year.
 100% of children younger than 2 years.
 Peak in infants (3 – 6) months

4. Arwa M. Amin
Pathogenesis of Bronchiolitis
 Inflammation of the bronchioles due to viral infection (mostly RSV*).
 This cause swelling and destruction of the epithelial lining of the
bronchioles, and the accumulation of mucus and inflammatory debris
in the Bronchioles. Eventually, it will lead to:
• Clogging of Bronchioles
• Narrowing and obstruction of the
airways
• Bronchospasm
• Difficultness of breathing
• Hyperpnoea**
• Emphysema***
• Barking cough
*RSV: Respiratory Syncytial Virus, **Hyperpnoea: increased depth and rate of breathing ***Emphysema: Destruction and enlargement of air-space

5. Arwa M. Amin
Bronchiolitis Viral Pathogens
Respiratory Syncytial Virus (RSV) is the main
pathogenic cause of Bronchiolitis (90% cases).
Other viral pathogens:
Parainfluenza viruses.
Adenovirus.
Influenza Virus.
Bacterial Infection: secondary pathogen in small
minority of cases.
RSV
Influenza virus Adenovirus
Parainfluenza

6. Arwa M. Amin
Risk factors of Bronchiolitis
 Crowded areas where infected people might be present
 Exposure to other infected Children
 Males > Females
 ↑↑ Winter months.
 Persist in early Spring
 Exposure to cigarette smoke.

7. Arwa M. Amin
Risk factors of Bronchiolitis Severity
 Severity of Bronchiolitis may increase in the following conditions:
Age < 6 months (particularly < 3 months), why?
Small airways in infants can’t accommodate mucosal edema.
 Premature birth (< 37 weeks)
 Low birth weight
 Cardiopulmonary disease
e.g. Congenital Heart disease
e.g. Chronic Lung Disease
 Tachypnea (RR > 70)
 Immunocompromised children
 Neurological disease
 Malnutrition
RR: Respiratory Rate, Tachypnea: Abnormal rapid breathing

8. Arwa M. Amin
Clinical Presentations and Diagnosis of Bronchiolitis
 Begins with URTIs symptoms (1 - 4 days)
 Nasal congestion
 Rhinorrhea
 Mild Fever
 Cough
URTIs: upper respiratory tract infections
 Bronchiolitis Clinical signs and symptoms
 Tachypnoea
 Noisy breathing
 Nasal flaring
 Wheezing
 Irritability
 Loss of appetite
 Vomiting after feeding
 Diarrhea
 Due to cough, vomiting, diarrhea, tachypnoea
and fever, affected infants suffer dehydration
and loss of fluids.

9. Arwa M. Amin
Clinical Presentations and Diagnosis of Bronchiolitis
 Diagnosis depends on History and Physical Examination.
 Physical Examination
 Tachycardia
 RR (40 – 80)/min in hospitalized infants
 Wheezing and Respiratory rales
 Mild Conjunctivitis
 Otitis Media
 Hypoxemia (↓ ↓ O2 reaching tissues)
 Cyanosis (Blue lips or skin)
 Laboratory Findings
 RSV identification by PCR
 WBCs Normal or slightly Elevated
RR: Respiratory Rate, RSV: Respiratory Syncytial Virus, PCR: Polymerase chain Reaction, WBC: White Blood Cells

10. Arwa M. Amin
Management of Bronchiolitis
 Goal of Treatment:
 To relief symptoms and provide supportive care
 To treat dehydration
General Approach:
 Bronchiolitis is Self Limiting.
 Most of Bronchiolitis cases are Mild and can be resolved by it self.
 Symptoms improves within 7 – 10 days.
 Resolution in 28 days.
 Bronchiolitis Treatment should focus on Supportive and Symptomatic
Treatment
 No AB treatment for Bronchiolitis, unless bacterial pneumonia is clinically
suspected or otitis media.
AB: Antibiotics

11. Arwa M. Amin
Management of Bronchiolitis
 Supportive Treatment of Bronchiolitis:
Encourage Bed Rest
Reassure adequate oral fluids intake to treat dehydration
Advice offering the child fluids frequently.
Symptomatic Treatment
 If fever present, provide Antipyretic Therapy
 Acetaminophen and/or Ibuprofen
 Avoid using Aspirin; why?
 Taking Aspirin in viral infected children may ↑↑ the risk of Reye’s
syndrome development

12. Arwa M. Amin
Management of Bronchiolitis
 Symptomatic Treatment:
 Bronchodilators (Nebulizer or Metered Dose Inhaler (MDI)
Recommended only if there is evidence of Bronchospasm or family
history of Asthma.
Short acting β2 agonist (e.g. Albuterol MDI or Nebulization)
Epinephrine Nebulization

13. Arwa M. Amin
Management of Severe Bronchiolitis
 Patients with Severe Bronchiolitis may require Hospitalization
 Treatment of Severe Bronchiolitis:
 Oxygen Therapy
 Intubation and Mechanical Ventilation
 Intravenous IV fluids to treat dehydration
 Antiviral Therapy in severely ill patients:
Ribavirin Aerosol Therapy (Via continuous Nebulization)

14. Arwa M. Amin