bronchiolitis

(brong″kē-ō-līt′ĭs)

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[bronchiole + -itis]
Inflammation of the bronchioles, particularly as an acute disease in children during the first 2 years of life, with peak incidence around 6 months. Most cases occur during the winter and early spring months.

INCIDENCE
In some studies of children under the age of two, bronchiolitis is identified in as many as 135 of every 1000 children. It is the primary cause of emergency room visits and hospitalization in infancy.

CAUSES
The respiratory syncytial virus (RSV) accounts for 50% of cases. Other viruses (parainfluenza, adenoviruses) and Mycoplasma species make up the remaining cases. There is no evidence that bacteria cause the illness or that antibiotics cure it.

SYMPTOMS AND SIGNS
Upper respiratory infection (URI) symptoms (runny nose, sneezing) appear first, quickly replaced by the hallmarks of the disease, respiratory distress, nasal flaring, retractions, tachypnea, cyanosis, and wheezing. Some infants, esp. those only a few months old, develop severe respiratory distress with hypoxia and gasping respiration, requiring hospitalization, oxygen, and assisted ventilation. Chest x-ray films show hyperinflation of the lungs with scattered areas of pneumonia and/or atelectasis.

TREATMENT
Infants with moderate or worse respiratory distress should be admitted to the hospital for observation, respiratory therapy, and oxygen. Whether bronchodilators such as nebulized albuterol have any value in the treatment is still debated, but they are often used. Ribavirin, a nebulized antiviral agent, is used in severe cases of bronchiolitis due to proven RSV infection in children under age 2.

IMPACT ON HEALTH
The case fatality rate is less than 1%, but a significant proportion of affected infants develop reactive airway disease, i.e., asthma, in later childhood.

PREVENTION
Preventive drugs have been developed for infants with bronchopulmonary dysplasia and other congenital cardiac or pulmonary diseases. These include palivizumab, a monoclonal antibody, and an RSV immune globulin.

PATIENT CARE
The infant requires close observation regarding the demands imposed by airway obstruction at the bronchiolar level. He or she is observed for gradually increasing respiratory distress, paroxysmal cough, dyspnea and irritability, for tachypnea with flaring nostrils and intercostal and subcostal retractions, and for shallow respiratory excursion.

The infant should be percussed for hyperresonance and scattered consolidation and auscultated for fine crackles, prolonged expiratory phase, and diminished breath sounds by the nurse, respiratory therapist, and physician. Audible or auscultatory wheezing may be present, as well as hyperinflation leading to increased anteroposterior diameter and depressed diaphragm.

The parents are educated regarding the need for hospitalization, and treatments that will be employed are explained. The use of a mist tent and oxygen are discussed as well as assisted ventilation if this becomes necessary, and the parents are taught how to maintain contact with their infant. The parents also need to understand that tachypnea, weakness, and fatigue limit the infant's ability to obtain fluids in sufficient amounts to provide adequate hydration, thus intravenous fluids are used until symptoms abate. Since parents expect medications to be prescribed for their infant, the nurse explains why various drugs (antibiotics, bronchodilators, corticosteroids, cough suppressants, and expectorants) are not employed and helps them to understand why sedatives are contraindicated although rest is an important part of therapy. Hospitalization of an infant is traumatic to parents and to the child depending on his or her age and severity of illness, so emotional support is provided throughout this crisis. The parents are helped to provide love, and to touch and care for their infant, are instructed on how they can contact the nurse if they must be absent from the crib, and are helped to understand and deal with behavioral regression that may occur.
SYN: SEE: wheezy bronchitis

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