Acute bronchiolitis is the inflammation of the small airway tubes of the lungs that is known as the bronchioles. It’s an acute episode of obstructive lower airway disease that is caused by a viral infection in infants younger than 2 years of age (Nino, 2011). There are different types of viruses that cause the illness, such as adenovirus, influenza, parainfluenza, and the most common type of virus that is usually being the culprit is respiratory syncytial virus or commonly known by its abbreviation RSV. When the virus gets to the bronchioles, it will infect the respiratory epithelial cells of the bronchioles causing it to necrose, get inflamed and produces mucous and secretions. The mucous plug that is formed obstructs proper air flow, hence causing air trapped inside the lungs. As air exits the lungs, wheezing sounds can be heard. The disease is infectious, as it can spread through physical contact from one individual to another. Bronchiolitis are more common in those who are not been breastfed and who live in crowded areas (Nino, 2011), and in the case of Baby A, she stopped being given breastfeeding at the age of 4 months old.
Bronchiolitis is inflammation of the bronchioles, the smallest air passages of the lungs. It usually occurs in children less than two years of age and presents with coughing, wheezing, and shortness of breath. This inflammation is usually caused by respiratory syncytial virus. Treatment is typically supportive and may involve the use of nebulized epinephrine or hypertonic saline.
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Bronchiolitis
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Not to be confused with bronchitis.
Bronchiolitis
Classification and external resources
http://upload.wikimedia.org/wikipedia/commons/thumb/7/77/RSV.PNG/230px-RSV.PNG
An x ray of a child with RSV showing the typical bilateral perihilar fullness of bronchiolitis.
ICD-10
J21
ICD-9
466.1
DiseasesDB
1701
MedlinePlus
000975
eMedicine
emerg/365
MeSH
D001988
Bronchiolitis is inflammation of the bronchioles, the smallest air passages of the lungs. It usually occurs in children less than two years of age and presents with coughing, wheezing, and shortness of breath. This inflammation is usually caused by respiratory syncytial virus. Treatment is typically supportive and may involve the use of nebulized epinephrine or hypertonic saline.
Contents
1 Signs and symptoms
2 Causes
3 Diagnosis
4 Prevention
5 Management
5.1 Inhaled epinephrine
5.2 Inhaled hypertonic saline
5.3 Other medications
5.4 Non-effective treatments
6 Epidemiology
7 References
8 External links
Signs and symptoms
In a typical case, an infant under two years of age develops cough, wheeze, and shortness of breath over one or two days. The infant may be breathless for several days. After the acute illness, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheeze.
Causes
The term usually refers to acute viral bronchiolitis, a common disease in infancy. This is most commonly caused by respiratory syncytial virus[1] (RSV, also known as human pneumovirus). Other viruses which may cause this illness include metapneumovirus, influenza, parainfluenza, coronavirus, adenovirus, and rhinovirus.
Studies have shown there is a link between voluntary caesarean birth and an increased prevalence of bronchiolitis. A recent study by Perth’s Telethon Institute for Child Health Research has shown an 11% increase in hospital admissions for children delivered this way.[2]
Diagnosis
The diagnosis is typically made by clinical examination. Chest X-ray is sometimes useful to exclude pneumonia, but not indicated in routine cases.[3]
Testing for the specific viral cause can be done but has little effect on management and thus is not routinely recommended.[3] RSV testing by direct immunofluorescence testing on nasopharyngeal aspirate had a sensitivity of 61% and specificity of 89%.[4] Identification of those who are RSV-positive can help for: disease surveillance, grouping (“cohorting”) people together in hospital wards to prevent cross infection, predicting whether the disease course has peaked yet, reducing the need for other diagnostic procedures (by providing confidence that a cause has been identified).
Infant with bronchiolitis between the age of two and three months have a second infection by bacteria (usually a urinary tract infection) less than 6% of the time.[5]
Prevention
Prevention of bronchiolitis relies strongly on measures to reduce the spread of the viruses that cause respiratory infections (that is, handwashing, and avoiding exposure to those symptomatic with respiratory infections). In addition to good hygiene an improved immune system is a great tool for prevention. One way to improve the immune system is to feed the infant with breast milk, especially during the first month of life[6]. Immunizations are available for premature infants who meet certain criteria (some cardiac and respiratory disorders) such as Palivizumab (a monoclonal antibody against RSV). Passive immunization therapy requires monthly injections every winter.
Management
Treatment and management of bronchiolitis is usually focused on the symptoms instead of the infection itself (supportive therapies) since the infection will run its course and complications are typically from the symptoms themselves.[7]
Inhaled epinephrine
Nebulized and inhaled epinephrine (both racemic and levo(1)-epinephrine) has been shown to decrease hospitalization rates[8][9]. Sometimes inhaled hypertonic saline is used.
Inhaled hypertonic saline
Inhaled hypertonic saline (3%) appears to be effective in improving clinical outcomes and shortening the duration of hospital stay[3].
Other medications
Currently other medications do not yet have evidence to support their use[9].
Non-effective treatments
Ribavirin is an antiviral drug which does not appear to be effective for bronchiolitis.[10] Antibiotics are often given in case of a bacterial infection complicating bronchiolitis, but have no effect on the underlying viral infection.[10] Corticosteroids have no proven benefit in bronchiolitis treatment and are not advised.[10] DNAse has not been found to be effective.[11]
Epidemiology
90% of the patients are aged between 1 and 9 months old. Bronchiolitis is the most common cause of hospitalization up to the first year of life. It is epidemic in winters.
References
^ Smyth RL, Openshaw PJ (July 2006). “Bronchiolitis”. Lancet 368 (9532): 312-22. doi:10.1016/S0140-6736(06)69077-6. PMID 16860701.
^ http://www.abc.net.au/news/2011-10-31/elective-caesarean-heightens-respiratory-risk/3611358
^ a b c Zorc, JJ; Hall, CB (2010 Feb). “Bronchiolitis: recent evidence on diagnosis and management”. Pediatrics 125 (2): 342-9. doi:10.1542/peds.2009-2092. PMID 20100768.
^ Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L et al. (2004). “Diagnosis and testing in bronchiolitis: a systematic review”. Arch Pediatr Adolesc Med 158 (2): 119-26. doi:10.1001/archpedi.158.2.119. PMID 14757603.
^ Ralston, S; Hill, V, Waters, A (2011 Oct). “Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review.”. Archives of pediatrics & adolescent medicine 165 (10): 951-6. doi:10.1001/archpediatrics.2011.155. PMID 21969396.
^ Belderbos ME, Houben ML, van Bleek GM, et al. (February 2012). “Breastfeeding modulates neonatal innate immune responses: a prospective birth cohort study”. Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology 23 (1): 65-74. doi:10.1111/j.1399-3038.2011.01230.x. PMID 22103307.
^ Wright, M; Mullett CJ, Piedimonte G et al. (October 2008). “Pharmacological management of acute bronchiolitis”. Veterinary Research 4 (5): 895-903. PMC 2621418. PMID 19209271.
^ Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC et al. (2011). “Epinephrine for bronchiolitis.”. Cochrane Database Syst Rev (6): CD003123. doi:10.1002/14651858.CD003123.pub3. PMID 21678340.
^ a b Hartling, L; Fernandes, RM, Bialy, L, Milne, A, Johnson, D, Plint, A, Klassen, TP, Vandermeer, B (2011 Apr 6). “Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis”. BMJ (Clinical research ed.) 342: d1714. doi:10.1136/bmj.d1714. PMC 3071611. PMID 21471175.
^ a b c Bourke, T; Shields, M (2011 Apr 11). “Bronchiolitis”. Clinical evidence 2011. PMID 21486501.
^ “BestBets: Do recombinant DNAse improve clinical outcome in an infant with RSV positive bronchiolitis?”.
External links
Bronchiolitis. Patient information from NHS Direct
Bronchiolitis in children – A national clinical guideline PDF (1.74 MB) from the Scottish Intercollegiate Guidelines Network
Diagnosis and Management of Bronchiolitis from the AAP
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Nursing Assessment
The patient was Baby A, a female Malay patient who was 9 months and 29 days of age on admission. On admission, her weight was 8.6kg and her height was 73cm. She had a blood pressure of 105/ 73 mmHg, a pulse rate of 156/ min, a respiratory rate of 32 breaths/ min, and her oxygen saturation level was 96% under room air. Initially she started to having a fever and coughing,
Planning
Nursing Diagnosis #1: Ineffective breathing pattern
Nursing Goals #1:
Nursing Interventions #1:
Nursing Evaluation #1:
Nursing Diagnosis #2:
Nursing Goals #2:
Nursing Interventions #2:
Nursing Evaluation #2:
Nursing Diagnosis #3:
Nursing Goals #3:
Nursing Interventions #3:
Nursing Evaluation #3:
Pharmacological aspect of nursing care
Investigations
Respiratory Virus DFA Test:
NPA for Virus +
Adenovirus –
Influenzae A –
Influenzae B –
Parainfluenzae 1 –
Parainfluenzae 2 –
Parainfluenzae 3 –
RSV +
Test Methodology: NPM
Nursing Implementation
Discharge
Discharge Summary
Patient Education