Bronchiolitis (causes, pathophysiology, signs and symptoms, treatment)

Summary

This transcript by Armando Hasudungan delves into bronchiolitis, a common respiratory tract infection in neonates caused primarily by respiratory syncytial virus (RSV). It highlights important distinctions between bronchiolitis and asthma, particularly in age groups, and explains the infection's pathophysiology, emphasizing airway inflammation and mucus production. The transcript describes symptoms like nasal flaring and wheezing and explains the varying severity of bronchiolitis. It underscores the clinical diagnosis of bronchiolitis without unnecessary investigations unless severe symptoms are present. Treatment is largely supportive, focusing on maintaining oxygenation and hydration, and excludes bronchodilators and corticosteroids for infants, contrary to older children who might benefit from them. It highlights the importance of monitoring of severe cases possibly requiring hospitalization and addresses potential complications such as dehydration and apnea.

Highlights

• Bronchiolitis primarily affects infants under two, and RSV is the main cause. 💔
• Distinguishing bronchiolitis from asthma is crucial for correct treatment approach. 🎯
• Bronchiolitis leads to airway obstruction, mainly through inflammation and mucus. 🌬️
• Symptoms can range from mild breathing difficulty to severe respiratory distress. ⚠️
• Treatment is supportive; severe cases might require oxygen therapy and hospitalization. 🏨

Key Takeaways

• Bronchiolitis is a common neonatal infection primarily caused by RSV and can be confused with asthma. 🤔
• The primary symptoms of bronchiolitis include wheezing, nasal flaring, and difficulty breathing due to inflammation. 😷
• The diagnosis is mainly clinical and treatment focuses on maintaining oxygen and hydration levels. 💦
• Supportive care is key for mild to moderate cases, while severe cases may need hospitalization. 🏥
• Complications like dehydration and apnea can occur, needing careful monitoring in high-risk infants. 👶

Overview

Bronchiolitis, often seen in infants under two, is characterized by inflammation of the bronchioles, primarily due to respiratory syncytial virus (RSV). It can be mistaken for asthma, making accurate diagnosis essential. This condition leads to airway narrowing and obstruction due to mucus production and swelling, making breathing difficult for affected infants.

Symptoms of bronchiolitis vary, ranging from mild to severe respiratory distress. Kids might experience signs like nasal flaring, coughing, wheezing, and difficulty feeding. Severe cases might show alarming symptoms such as apnea – temporary cessation of breathing. Diagnosing bronchiolitis is generally clinical, focusing on signs and symptoms rather than extensive testing.

Management of bronchiolitis focuses on supportive care, emphasizing oxygenation and hydration. While bronchodilators aren’t beneficial for infants, older children may benefit. Severe cases might require hospital admission for intensive support and monitoring, utilizing high flow nasal prongs or CPAP. Despite its challenging presentation, most cases resolve without severe complications.

Bronchiolitis (causes, pathophysiology, signs and symptoms, treatment) Transcription

• 00:00 - 00:30 bronchiolitis is inflammation of the bronchioles and is often caused by a viral infection notably respiratory syncytial virus RSV bronchiolitis is the most common respiratory tract infection of neonates and is usually self-limiting a major source of confusion of treatment is differentiating a viral bronchiolitis to asthma in summary bronchiolitis is usually seen in infants less than two
• 00:30 - 01:00 years old and asthma is seen in older children the main causative agents is the respiratory syncytial virus other causes include Rhino virus and parainfluenza virus the respiratory tract begins with the nasal cavity and oral cavity oxygen inhaled travels through this area the upper respiratory tract and then down the lower respiratory tract the lower respiratory tract begins with the larynx the lounge continues to become the trachea and then
• 01:00 - 01:30 the trachea bifurcates into the bronchi and in smaller bronchi and then bronchioles before terminating as an alveolus a normal bronchial have smooth muscle cells around it which help in contraction of the bronchial the inside of the bronchioles are lined by mucus produced by goblet cells bronchiolitis is inflammation of the bronchioles something similar called bronchitis is
• 01:30 - 02:00 inflammation of the bronchi and typically affects older people who smoke and not infants in bronchiolitis the changes include narrowing of the Airways due to mucous hypersecretion cell wall thickening and smooth muscle contraction these findings are also seen in patients who have asthma and in infants around two years old bronchiolitis can often be
• 02:00 - 02:30 mistaken as asthma bronchiolitis also causes air trapping where oxygen can be inhaled but gets trapped in the lower respiratory tract in the alveolus due to surrounding inflammation this causes difficulty breathing for the infant respiratory syncytial virus is the major cause of prompt colitis a single-stranded RNA virus it is spread
• 02:30 - 03:00 through airborne droplets or direct contact with respiratory secretions a respiratory syncytial virus infection begins with replication of the virus in the nasal pharynx causing coral symptoms a lower especially tract infection can begin one to three days later the virus spreads to the bronchioles where small bronchioles epithelium line the small Airways if a lower respiratory tract infection
• 03:00 - 03:30 occurs the virus causes an inflammatory response immune cells infiltrate the area the inflammatory response causes edema increased mucus production from goblet cells and eventually necrosis and regeneration of these epithelial cells this leads to small airway obstruction air trapping and increased airway
• 03:30 - 04:00 resistance these pathological features lead to the signs in bronchiolitis bronchiolitis can be mild moderate or severe depending on the clinical presentation infants with mild to moderate bronchiolitis typically our technique have a fever and have signs of increased work of reading such as nasal flaring tracheal tug intercostal
• 04:00 - 04:30 recessions and abdominal breathing on auscultation they can have inspiratory crepitations and a wheeze severe bronchiolitis is concerning and the infants appears very unwell they can have a very high respiratory rate or a low respiratory rate and even apnea which are episodes where they stop breathing all together there is severe grunting and maybe cyanosis and paleness
• 04:30 - 05:00 as well the child has difficulty feeding taking in less than 50% or normal feeds all these features are concerning and all these features indicates severe bronchiolitis risks factors for severe bronchiolitis or those with high risk of illness include the young especially less than six weeks old premature infants or low wait for gestation immunodeficient infants and those with
• 05:00 - 05:30 congenital heart disease neurological conditions and rick Roenick respiratory illness the differential diagnosis is important especially if an infant presents with recurrent bronchiolitis or has a severe respiratory tract infection differential diagnoses include acute asthma viral induce trees pneumonia congestive heart failure and pertussis the diagnosis of wrong colitis is
• 05:30 - 06:00 clinical an infant or child less than two years of age presenting with initial symptoms and signs of upper respiratory tract infections followed by a cough tachypnea in spiritual connotations and wheeze is likely to have bronchiolitis there is usually no role in investigations unless the infants has a severe bronchitis or something else is expected management is largely supportive focusing on maintaining
• 06:00 - 06:30 oxygenation and hydration of the patient evidence suggests no benefit from bronchodilators or coracoid use in infants with the first episode of bronchiolitis mild bronchiolitis is easily managed at home important to encourage oral intake moderate bronchiolitis with increased work of breathing can be monitored in the hospital and paracetamol and ibuprofen can be given for temperature and for symptom relief oxygen can be given to
• 06:30 - 07:00 maintain oxygen saturation above 92 it's important to encourage oral hydration and if not consider nasogastric feeding bronchodilators and corticosteroids again are not recommended for infants with bronchiolitis for older children you can consider bronchodilators for symptom relief if oxygen levels are still low consider high flow nasal prongs severe bronchiolitis will require oxygen via
• 07:00 - 07:30 high flow nasal prongs or even a continuous positive airway pressure CPAP nasogastric tube or IV cannulation is important to keep up with the fluids children will require admission to hospital and potentially further investigations persistent hypoxemia will require ICU referral most cases of bronchiolitis resolve without complications however some complications
• 07:30 - 08:00 can include dehydration apnea but particularly in infants born prematurely and then obviously secondary bacterial infections