With thanks to Amutha for this article….
As winter approaches, most of us are very well aware that the bronchiolitis season is in full swing. Bronchiolitis is a lower respiratory tract infection – in the under 1s predominantly – that can cause fever, dry cough, nasal discharge and bilateral fine inspiratory creps ± wheeze. Most cases of bronchiolitis occur from November to March, when the viruses that can cause bronchiolitis are more common. It is also possible to get bronchiolitis more than once during the same winter season (1).
Treatment is largely supportive and many infants are managed at home if they are feeding adequately and do not have significant respiratory difficulty. Patients at high risk are ex-premature babies, those with congenital cardiac or respiratory diseases, immunodeficiency and babies < 3months of age (2). When seeing a child, we should focus our history and examination on risk factors, signs of dehydration and respiratory distress. This podcast provides an example of respiratory distress:
3% of children will present with severe illness and require admission (2). Map of Medicine (http://healthguides.mapofmedicine.com/choices/map/bronchiolitis1.html) defines “severe” as those with:
- poor feeding – less than half normal intake
- history of apnoea
- respiratory rate above 70breaths/minute
- presence of nasal flare and/or grunting
- severe chest wall recession
- marked use of accessory muscles
- marked intercostal and subcostal recession
- oxygen saturation (SaO2) 94% or less
There have been no therapies that have been consistently effective enough to change the current supportive management of bronchiolitis. The majority of trials show that bronchodilators do not provide benefit and their routine use is not recommended (3).
2. Scottish Intercollegiate Guidelines Network (SIGN). Bronchiolitis in children. A national clinical guideline. Edinburgh: SIGN; 2006. http://www.sign.ac.uk/pdf/sign91.pdf