bronchiolitis and bronchitis
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Transcript of bronchiolitis and bronchitis
BRONCHITIS &
BRONCHIOLITISQPT20303
Dr. Mohanad
Definition Acute bronchitis is acute infection of the
bronchial mucosa, without obstruction
ETIOLOGY:• Viral infection: 90% of cases• Respiratory Syncytial viruses –
parainfluenza, adenoviruses,• Bacteria Rarely; pneumococci, H.influenzae,
staphylococi and streptococci.
Clinical manifestation• Dry, hacking, unproductive cough • within 4-5 days the cough becomes productive• Sputum production (clear, yellow, green, or even blood-
tinged)• afebrile patient or low grade fever• Sore throat• Runny or stuffy nose• Headache• Muscle aches• Extreme fatigue• auscultation – rough high pitched rhonchi
Treatment Infants pulmonary drainage is facilitated by
frequent shifts in position Keep well hydrated, humidified air if possible Nasopharyngeal lavage with isotonic solution
(normal saline or Ringer lactate) Treat fever: Paracetamol > 38, 5 30 mg/kg/d: 4
doses Or buprofen 200 mg No antibiotics, antihistamines Expectorants in irritating and paroxysmal
coughing: Bromhexin (suspension, tabl.) , Ambroxol, Stoptussin (drops)
Evaluation of patients
Onset of dyspnea: stridor, wheezing Onset of general danger signs: convulsions
or abnormally sleepy Not able to drink, stopped feeding keel Patient don’t improve better after 5 days
Refer to hospital
Presence of general danger signs Fever > 39°C resistant to antipyretic
treatment Acute respiratory distress and cardiac failure Chronic cough > 30 days duration Hemoptysis
Acute Bronchiolitis Lower respiratory tract infection Common cause of illness in young children Common cause of hospitalization in young
children Associated with chronic respiratory
symptoms in adulthood May be associated with significant morbidity
or mortality
DIAGNOSIS Acute infectious inflammation of the
bronchioles resulting in wheezing and airways obstruction in children less than 2 years old
MICROBIOLOGYTypically caused by viruses
RSV-most common (50%)ParainfluenzaHuman MetapneumovirusInfluenzaRhinovirusCoronavirusHuman bocavirus
Occasionally associated with Mycoplasma pneumonia infection
Respiratory Syncytial Virus
• Ubiquitous throughout the world• Seasonal outbreaks
– Temperate Northern hemisphere: November to April, peak January or February
– Temperate Southern hemisphere: May to September, peak May, June or July
– Tropical Climates: rainy season
Parainfluenza
• Usually type 3, but may also be caused by types 1 or 2
• Epidemics in the early spring and fall
Influenza
• Very similar to RSV or Parainfluenza in symptoms
• Seasonal with similar distribution to RSV
• Usually epidemic in the Northern hemisphere January through April
Epidemiology
Typically less than 2 years with peak incidence 2 to 6 months
May still cause disease up to 5 years Leading cause of hospitalizations in infants
and young children Accounts for 60% of all lower respiratory
tract illness in the first year of life
Risk Factors of Severity Prematurity Low birth weight Age less than 6-12 weeks Chronic pulmonary disease Hemodynamically significant cardiac disease Immunodeficiency Neurologic disease Anatomical defects of the airways
Environmental Risk Factors
• Older siblings• Concurrent birth siblings• Native American heritage• Passive smoke exposure• Household crowding• Child care attendance• High altitude
Pathogenesis Viruses penetrate terminal bronchiolar cells--directly
damaging and inflaming Pathologic changes begin 18-24 hours after infection
Bronchiolar cell necrosis, ciliary disruption, peribronchial lymphocytic infiltration
Edema, excessive mucus, Sloughed epithelium lead to airway obstruction and
atelectasis Bronchiolar obstruction during expiration/ Air trapping and
over inflation Hypoxemia hypercapnia (CO2 retention, PaCO2>45mmHg,
PaO2 <90mmHg)
Clinical ManifestationsRespiratory signs
• Disease starting with signs of acute viral nasopharyngitis.
• Severe tachypnea >70-80 breaths/min• Spasmoid cough• Chest in drawing, intercostal, subcostal and xyphoid
retractions• Expiratory dyspnea, gasping, emphysematous chest,
on percussion – hyperresonance, very loud intensity• Diminished breath sound• Crepitations, Rhonchi, wheezing• Respiratory distress – dyspnea cyanosis
General signs
Fever (38-39°C) Febrile convulsions Vomiting, less appetite, dehydration Cyanosis, acrocyanosis Tachycardia, toxic myocard Diver and spleen below the costal margins
– result of depression of diaphragm in over inflation of lungs
EXAM
Tachypnea 80-100 in infants 30-60 in older children
Prolonged expiratory phase, rhonchi, wheezes and crackles throughout
Possible dehydration Possible conjunctivitis or otitis media Possible cyanosis or apnea
Diagnosis Clinical diagnosis based on history and
physical exam Supported by CXR: hyperinflation,
flattened diaphragms, air bronchograms, peribronchial cuffing, patchy infiltrates, atelectasis
Course Depends on co-morbidities Usually self-limited Symptoms may last for weeks but generally
back to baseline by 28 days In infants > 6 months, average hospitalization
stays are 3-4 days, symptoms improve over 2-5 days but wheezing often persists for over a week
Disruption in feeding and sleeping patterns may persist for 2-4 weeks
Hospitalization
• Children with severe disease• Toxic with poor feeding, lethargy,
dehydration• Moderate to severe respiratory distress
(RR > 70, dyspnea, cyanosis)• Apnea• Hypoxemia• Parent unable to care for child at home
TreatmentSupportive Care
Keep young infant to intensive care unite Humidified oxygen relieve hypoxemia• Antibiotics in secondary bacterial pneumonia Bronchodilating drugs – Salbutamol, Atrovent,
Terbutalin Antipyretics Oral intake and parenteral fluids to combat
dehydration Local corticosteroids: Beclometazon, Budesonid,
fluticazon
Respiratory Support
Oxygen to maintain saturations above 90-92%
Keep saturations higher in the presence of fever, acidosis, hemoglobinopathies
Wean carefully in children with heart disease, chronic lung disease, prematurity
Mechanical ventilation for pCO2 > 55 or apnea
Complications
Highest in high-risk childrenApnea
Most in youngest children or those with previous apnea
Respiratory failureAround 15% overall
Secondary bacterial infectionUncommon, about 1%, most in children requiring
intubation