Bronchiolitis

• An acute viral illness due to RSV

• The most common acute LRTI in infants

• Usual age 2 wks to 9 mths (up to 12 mths)

• Coryza then irritating cough

• Wheezy breathing often distressed ± signs of hypoxia

• Tachypnoea

• Hyperinflated (barrel-shaped) chest, usually subcostal recession

• High risk for complications—very young, cardiac disease

Auscultation

• Widespread fine inspiratory crackles (not with asthma)

• Frequent expiratory wheezes

X-ray: hyperinflation of lungs with depression of diaphragm

Virus identified by PCR on nasopharyngeal aspirate. Rapid RSV viral test now available. Assess blood glucose in all sick patients.

Management

Admission to hospital is usual, esp. with increasing respiratory distress (rate >50) and SpO₂ <94% reflected by difficulty in feeding. Consider specialist consultation.

• Minimal handling/good nursing care

• Observe colour, pulse, respiration, O₂ saturation (pulse oximetry)

• O₂ support—preferably warm and humidifed via nasal prongs: to maintain PaO₂ >90% (pref. 95%)

• Fluids IV or by nasogastric tube if unable to feed orally

• Antibiotics not indicated except if secondary bacterial infection