BRONCHIOLITIS

Ridwan M. Daulay, dr, SpA(K)

Wisman Dalimunthe, dr, M.Ked(Ped), SpA(K)
Rini Savitri Daulay, dr, M.Ked(Ped), SpA
Fathia Meirina, dr, M.Ked(Ped), SpA
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 Bronchioles inflammation
 Clinical syndromes:
fast breathing, breathing difficulties, retractions,
wheezing, poor feeding, cough, irritability, (very
young) apnoe.
 Predominantly < 2 years of age
(2 – 8 months)
 Difficult to differentiate with pneumonia
 Pathology
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 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
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Edema + accumulation of mucous & cellular debris

 narrow of peripheral airway  partially / totally
occluded  over distention / atelectasis
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 Etiology
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 Predominantly RSV (Respiratory Syncytial Virus)

 95%

 Other viruses :
 Rhinovirus
 Adenovirus
 Influenza virus
 Parainfluenza virus
 Entero virus
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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
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 Etiological diagnosis
 Microbiologic examination

 Clinical diagnosis
 Signs and symptoms
 Age
 Resource of infection  epidemic of RSV

 Laboratory finding

 Radiological examination
 Clinical Manifestation
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Mild rhinorrhea  1-2 days later:
Cough  Fast breathing
Low-grade fever  Cyanosis
 Grunting
 Chest retraction
 Wheezing
 Irritable
 Vomitus
 Poor intake
 Physical Examinations
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Tachypnea
Tachycardia
Retraction
Prolonged expiration
Wheezing
Fever
Mild conjunctivitis
Pharyngitis
 Radiologic examination
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 Diffuse hyperinflation
 Patchy infiltrates
 Flat diaphragm
 Intercostal space >
 Retrosternal space >
 Peribronchial infiltrates / thickening
 Atelectasis  segmental collapse
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 Laboratory Finding
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 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
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 Respiratory rate  : Arterial saturation 

pCO2 
 HCO3-

15 PaCO2
40

24 mEq/l

7.4 pH
 Differential Diagnosis
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Asthma
Pneumonia
Acute Bronchitis
Congestive Heart Failure
Pulmonary Edema
Obstruction in the lower respiratory tract
 Management
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 Mild  treated at home

 Moderate / severe disease :
 Hospitalization
 Support :
 Oxygen

 Intra venous fluid drip (antibiotics)

 Detect & treat possible complication

 Prevent the spread of infection
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 Controversial :
 Bronchodilator
 Corticosteroid
 Antiviral
 Antibiotic
 2 – Agonist
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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

Flores and Horwitz, 1997

 Corticosteroid
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Treatment : Prednison equivalent 0,6-6,3 mg/kg.

Total : 3,0 – 18,9 mg/kg
Outcome : LOS, duration of symptoms (DOS), clinical
scores
Result :
 LOS and DOS 
 Clinical score 

Garrison et al, 2000, Databases (Medline, Embase, Cochrane)

 Corticosteroid
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Clinical score :
Wheezing
SaO2
Accessory muscle use
RR

Conclusion :
Benefits depend on severity and initiation of
treatment
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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)
 Prognosis
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23% infant  asthma at 3 years,

Control  1% asthma
OR : 28; 90% CI 4-1235
(Garrison et al. 2000 after Sigurs et al. 1995)
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Correlation with Asthma

 30 % - 50 % becomes asthmatic patients
 Similarity in :
 Pathogenic mechanisms
 Pathologic disorders
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