Professional Documents
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A(K)
Ridwan M Daulay, Dr, SpA(K)
Wisman Dr, Sp.A
Bronchiolitis
Bronchioles inflammation
Clinical syndromes:
Pathology
Bronchiolitis
neutrophils
Sub mucosal edematous
No destruction of collagen, muscle, or elastic
tissue
Pathophysiology
Edema + accumulation of mucous & cellular
debris narrow of peripheral airway partially /
totally occluded over distention / atelectasis
Bronchiolitis
Etiology
Predominantly RSV (Respiratory Syncytial
Virus)
Other viruses : rhinovirus, adenovirus,
influenza virus, parainfluenza virus, entero
virus, etc.
Severity
Prematurity
OR 1.84
Underlying medical condition
OR 2.84
Group A RSV strain
OR 3.26
Age < 3 mo
OR 4.39
Bronchiolitis
Diagnosis
Etiological diagnosis
Microbiologic examination
Clinical diagnosis
Signs and symptoms
Age
Resource of infection epidemic of RSV
Laboratory finding
Radiological examination
Bronchiolitis
Clinical Manifestations : mild rhinorrhea,
Bronchiolitis
Radiologic examination
diffuse hyperinflation
flat diaphragm,
Intercostal space >
retrosternal space >
pCO2
Bronchiolitis
Laboratory finding
Microbiologic examination
WBC : 5000 24.000 cells/mm3,
Differential Diagnosis
Asthma
Pneumonia
Acute Bronchitis
Congestive Heart Failure
Pulmonary Edema
Obstruction in the lower respiratory
tract
Bronchiolitis
Management
Mild treated at home
Moderate / severe disease hospitalization
support :
oxygen
intra venous fluid drip
(antibiotics)
detect & treat possible complication
prevent the spread of inf.
Controversial :
bronchodilator
corticosteroid
antiviral
antibiotic
2 Agonist
Flores and Horwitz, 1997
Meta-analysis of RCT inhaled 2 Agonist
Sample : 3 inpatient & 5 outpatient
studies
Treatment : nebulized albuterol
Outcome : clinical score, satO2, LOS
Result : unavailable evidence of 2
Agonist efficacy
Corticosteroid
Garrison et al, 2000
Corticosteroid
Clinical score :
Wheezing
SatO2
Accessory muscle use
RR
Conclusion :
Benefits depend on severity and
initiation of treatment
Bronchiolitis
Natural history & complications
Regeneration of bronchiolar epithelium
after 3 or 4 d
Cilia after 3 or 4 d
Improved clinical findings : in 3-4 days
Improved radiological features: in 9 days
20%
Respiratory failure : 25 %
Lung collaps (rare)
Prognosis
23% infant asthma at 3 years,
Control 1% asthma
OR : 28; 90% CI 4-1235
(Garrison et al. 2000 after Sigurs et
al. 1995)
Bronchiolitis
mechanisms
- pathologic disorders