Wisman Dr, Sp.

Bronchiolitis
Bronchioles inflammation
Clinical syndromes:

fast breathing, breathing difficulties,

retractions, wheezing, poor feeding, ,
cough, irritability, (very young) apnoe.
Predominantly < 2 years of age
(2 6 months)
Difficult to differentiate with pneumonia

Holgate ST, et al. JACI 2003; 111(2):215

Defense mechanisms of
respiratory tract
Non immune defenses

Aerodynamic filtering
Airways reflexes
Mucus
Secreted substances
Cilia
Respiratory epithelium

Immune defenses
Cellular
Humoral

Mucociliary system

Braga,

 Pathology

Bronchiolitis

Necrosis of the resp. epithelium

Destruction of ciliated epithelial cells
Peribronchial infiltration with lymphocites &

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

 Diagnosis

Bronchiolitis

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,

cough, cold, low-grade fever

1-2 d fast breathing, chest
retraction, wheezing, irritable, vomitus,
poor intake
Physical Examinations

tachypnea, tachycardia, retraction,

prolonged expiration, wheezing,
fever,pharyngitis, conjunctivitis, otitis
media, dehydration

Bronchiolitis

Radiologic examination
diffuse hyperinflation
flat diaphragm,
Intercostal space >
retrosternal space >

peribronchial infiltrates / thickening

patchy atelectasis segmental collapse
pleural effusion (rare)
Laboratory finding
Respiratory rate : Arterial saturation

pCO2

Bronchiolitis

Laboratory finding
Microbiologic examination
WBC : 5000 24.000 cells/mm3,

predominantly PMN & bands

Blood Gas Analysis

Arterial saturation
pCO2
Mild respiratory alkalosis
Metabolic acidosis
Acute respiratory acidosis

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

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

Persistent respiratory obstruction : 20%

Respiratory failure : 25 %
Lung collaps (rare)

Bronchiolitis

Correlation with Asthma

30 % - 50 % becomes asthmatic patients
Similarity in :
- pathogenic

mechanisms
- pathologic
disorders