1. بسم الله الرحمن الرحيم

2. BronchiolitisBronchiolitis By Hana ’ a M.N. Tashkandi

3. Bronchiolitis Definition Epidemiology Agents Clinical picture Investigations Differential diagnosis Indications for Hospitalization Management

4. Definition Acute viral infection of the bronchioles, characterized by wheezing.

5. Epidemiology It is a common LRT illness of children < 2y.o. (due to there small airways).

6. Agents RSV 50% others: # Para influenza virus # adenovirus # influenza virus # rhinovirus # Mycoplasma (infrequent)

7. Clinical Picture @ Symptoms: rhinorrhea, sneezing, cough, & low grade fever followed several days by rapid breathing & wheezing with poor feeding. @ Sings: sings of respiratory distress

8. Investigations CBC  usually normal unless there is 2ry bacterial infection. CXR  air trapping (may show peribronchial thickening, atelectasis & infiltration)

9. Investigations (cont.) ABG  Hypoxemia 2ry to V/Q mismatch. Hypercapnia (in severe cases). @ RSV may be identified on nasopharyngeal section by PCR, culture, or antigen assay.

10. D.D. @ Asthma @ Pneumonia @ Heart failure @ Foreign body aspiration @ GER @ Cystic fibrosis

11. Indications for Hospitalization 1> young age < 6m. 2> moderate to marked respiratory distress. (sleeping RR >= 50-60 / min.) 3> hypoxemia (Po2 < 60 mmHg or O2 sat < 92% on room air.) 4> occurrence of apnea. 5> inability to tolerate oral feeding. 6> lacking of appropriate care at home.

12. Indications for Hospitalization (cont.) 7> high risk pt. such as: * pt. with chronic lung disease e.g.: bronchopulmonary displasia. * pt. with congenital heart disease (partially if association PHT) * pt. with neuromuscular weakness. * pt. with immune deficiency $.

13. Management # Supportive: * fluids. * antipyretic. * humified O2. * bronchodilator ?? # Administration of Ribavirin aerosol. # Intubation & mechanical ventilation.

14. Complications # Apnea. # Respiratory failure. # Atelectasis. # O.M. # 2ry bacterial infection. # Complications of mechanical ventilation.

15. Thank you Hana ’ a Tashkandi