BRONCHIOLITIS

Acute inflammatory obstructive disease of small airways (bronchioles) common in children less than 2 years.

Causes

  • Mainly viral (often respiratory syncitial virus, RSV)
  • Mycoplasma

Clinical features

  • First 24-72 hours: rhinopharyngitis with dry cough
  • Later tachypnoea, difficulty in breathing, wheezing (poorly responsive to bronchodilators)
  • Cough (profuse, frothy, obstructive secretions)
  • Mucoid nasal discharge
  • Moderate or no fever
  • Criteria for severity: child < 3 months, worsening of general condition, pallor, cyanosis, respiratory distress, anxiety, respiratory rate >60/minute, difficulty feeding, SpO2 < 92%

Differential diagnosis

  • Asthma
  • Pneumonia, whooping cough
  • Foreign body inhalation
  • Heart failure

Investigations

  • Clinical diagnosis
  • X-ray: Chest (to exclude pneumonia)
  • Blood: Haemogram

Management

Mild-moderate bronchiolitis

Wheezing, 50-60 breaths/minute, no cyanosis, able to drink/feed

  • Treat the symptoms (possibly as an out-patient)
    • Nasal irrigation with normal saline
    • Small, frequent feeds
    • Increased fluids and nutrition
    • Treat fever (paracetamol)

Severe bronchiolitis

Wheezing, fast breathing > 60 breaths/min, cyanosis

  • Admit and give supportive treatment as above
  • Give humidified nasal oxygen (1-2 litres/min)
  • Salbutamol inhaler 100 micrograms/puff: 2 puffs with spacer, every 30 minutes or nebulisation
    salbutamol 2.5 mg in 4 ml normal saline.

    • If symptoms improve, continue salbutamol every 6 hours
    • If symptoms non-responsive, stop the salbutamol
  • Nebulise Adrenaline 1:1000, 1 ml diluted in 2-4 ml normal saline every 2-4 hours
  • Give as much oral fluids as the child will take: e.g. ORS. Use NGT or IV line if child cannot take
    orally

    • Give basic total fluid requirement of 150 ml/kg in 24 hours plus extra to cover increased losses due
      to illness

Note

  • Antibiotics are usually not needed for bronchiolitis since it is viral.
  • Steroids are not recommended

Prevention

  • Avoid exposure to cold and viral infections
  • Proper handwashing after contact with patients