BRONŞİOLİTBRONŞİOLİT

BROCHIOLITISBROCHIOLITIS

BROCHIOLITIS MEANS INFLAMATION OF THE BRONCHIOLES

• IT OCCURS DURING THE FIRST YEAR OF LIFE PEAK INCIDENCE AT 6 mo OF AGE

• THE INCIDENCE IS HIGHEST DURING THE WINTER AND EARLY SPRING

BROCHIOLITISBROCHIOLITIS

• IT OCCURS SPORADICALLY OR EPIDEMICALLY

• IT OCCURS IN MALE INFANTS WHO HAVE NOT BEEN BREAST-FED AND WHO LIVE IN CROWDED CONDITIONS

ETIOLOGY:ETIOLOGY:

ACUTE BRONCHIOLITIS IS PREDOMINANTLY

• A VIRAL ILLNESS• RSV IN 50% OF CASES• PARAINFLUENZA 3• MYCOPLASMA• ADENOVIRUSES

THE SOURCE OF ILLNESS IS USUALLY A FAMILY MEMBER WITH MINOR RESPIRATORY ILLNESS

PATHOPHYSIOLOGYPATHOPHYSIOLOGY

BY DROPLET↓

INVASION OF THE SMALLER BRONCHIALRADICLES BY VIRUS

↓EDEMA, ACCUMULATION OF MUCUS,

CELLULAR DEBRIS↓

BRONCHIOLAR OBSTRUCTION↓

EVEN MINOR THICKENING OF THE BRONCHIOLAR WALL IN INFANTS PROFOUNDLY AFFECT AIRFLOW

↓RESISTANCE IN THE SMALL AIR PASSAGES IS INCREASED

DURING THE INSPIRATORY AND EXPIRATORY PHASES↓

THE BALL VALVE RESPIRATORY OBSTRUCTION LEADS TO EARLY AIR TRAPPING AND OVER INFLATION

↓ATELECTASIS MAY OCCUR

PATHOLOGIC PROCESS↓

IMPAIRS THE NORMAL EXCHANGE OF GOSES IN THE LUNG↓

VENTILATION PERFUSSION MISMATCH↓

HYPOXEMIA↓

HYPERCAPNIA (CO2 RETENTION)

CLINICAL MANIFESTATIONCLINICAL MANIFESTATION

THE HISTORY OF A FAMILY MEMBERS WITH MINOR RESPIRATORY VIRAL ILLNESS

SEROUS NASAL DISCHARGESNEEZINGDIMINISHED APPETITEFEVER 38,5-39 C

PAROXYSMAL WHEEZY COUGHDYSPNEAIRRITABILITYVOMITING

A MILD URTI

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

• TACHYPNE 60-80/min

• R.DISTRESS

• ALAE NASI FLARE

• USE OF THE ACCESSORY MUSCLES

• INTERCOSTAL AND SUBCOSTAL DISTENTION

• HEPATO-SPLENOMEGALY (BY OVERINFLATED LUNGS)

• WIDESPREAD FINE CRACKLES

• EXPIRATORY WHEEZING (USUALLY AUDIBLE)

LABORATORYLABORATORY

- WBC: NORMAL LIMITS

- LYMPOHOCYT

- VIRUS MAY BE DEMONSTRATED IN NASOPHARYNGEAL SECRETION BY ANTIGEN DETECTION OR BY CULTURE

DIFFERENTIONAL DIAGNOSISDIFFERENTIONAL DIAGNOSIS

ASTHMAFOREIGN BODYCONGESTIVE HEART FAILUREPERTUSISORGANOPHOSPHATE POISONINGCYSTIC FIBROSISBACTERIAL BRONCHOPNEUMONIA

COURSE AND PROGNOSISCOURSE AND PROGNOSIS

• FIRST 48-72 HOUR IS MOST CRITICAL PHASE

• AFTER THE CRITICAL PERIOD IMPROVEMENT OCCURS RAPIDLY

• RECOVERY IS COMPLETE IN A FEW DAYS

• FATALITY RATE BELOW 1%

• DEATH MAY RESULT FROM PROLONGED APNEIC SPELLS, SEVERE UNCOMPENSATED RESPIRATORY ACIDOSIS OR DEHYDRATION

COURSE AND PROGNOSISCOURSE AND PROGNOSIS

• INFANTS WITH CONGENITAL HEART DISEASE, BRONCHOPULMONARY DYSPLASIA, IMMUNODEFICIENCY, OR CYSTIC FIBROSIS HAVE A GREATER MORBIDITY

COURSE AND PROGNOSISCOURSE AND PROGNOSIS

• A SIGNIFICANT PROPORTION OF INFANTS WITH BRONCHIOLITIS HAVE HYPER-REACTIVE AIRWAYS DURING LATER CHILDHOOD

• THE INFANTS WITH BRONCHIOLITIS WHO DEVELOPED REACTIVE AIRWAYS ARE MORE LIKELY TO HAVE A FAMILY HISTORY OF ASTHMA AND ALLERGY, A PROLONGED ACUTE EPIZODE OF BRONCHIOLITIS AND EXPOSURE TO CIGARETTE SMOKE

TREATMENTTREATMENT

• INFANTS WITH RESPIRATORY DISTRESS SHOULD BE HOSPITALIZED

• PATIENT MUST BE PLACED IN AN ATMOSPHERE OF COOL HUMUDIFIED OXYGEN TO RELIEVE HYPOXEMIA AND REDUCE INSENSIBLE WATER LOSS FROM TACHYPNEA PO2 90

THIS TREATMENT RELIEVES THE DYSPNEA AND CYNOSIS AND ALLAYS AXIETY AND RESTLESSNESS

• SEDATIVES SHOULD BE AVOIDED BECAUSE OF POTENTIAL DEPRESSION OF RESPIRATION

TREATMENTTREATMENT

• ORAL INTAKE MUST OFTEN BE SUPLEMENTED OR REPLACED BY PARENTERAL FLUIDS

• ELECTROLYTE BALANCE AND pH SHOULD BE ADJUSTED BY SUITABLE INTRAVENOUS SOLUTIONS

• RIBAVIRIN (VIRAZOLE) AN ANTIVIRAL AGENT FOR TREATMENT OF HIGH-RISK RSV PATIENTS. IT SHOWED AN IMPROVEMENT IN OXYGENETION AND DECREASED VIRAL SHEDDING (CONGENITAL HEART DISEASE, BRONCHOPULMONARY DYSPLASIA)

TREATMENTTREATMENT

•ANTIBIOTICS HAVE NO THERAPEUTIC VALVE UNLESS THERE IS SECONDARY BACTERIAL PNEUMONIA

•CORTICOSTEROIDS MAY BE EFFECTIVE IN SEVERE CASES

•BRONCHODILATING AEROLIZED DRUGS (e-g ALBUTEROL) ARE FREQUENTLY USED EMPRICIALLY

TREATMENTTREATMENT

•EPINEPHRINE OR OTHER ADRENERGIC AGENTS HAVE A THEORETICAL BASIS FOR USE AEROLIZED EPINEPHRINE PROVIDED SOME BENEFIT TO INFANTS WITH BRONCHIOLITS

•IF RESPIRATORY FAILERE IS RAPIDLY DEVELOPED TRACHEOSTOMY IS NOT BENEFICAL BUT MECHANICAL VENTILATORY MAY BE EFFECTIVE

BROCHIOLITIS OBLITERANSBROCHIOLITIS OBLITERANS

IN BRONCHIOLITIS OBLITERANS THE BRONCHIOLES AND SMALLER AIRWAYS ARE INJURED AND THE ATTEMPED REPAIR PRODUCES LARGE AMONTS OF GRANULATION TISSUE THAT CAUSES AIRWAY OBSTRUCTION.

AIRWAY LUMENS ARE OBLITARED WITH MODULAR MASSES OF GRANULATION AND FIBROSIS

ETIOLOGY:ETIOLOGY:

MEASLESINFLUENZAEADENOVIRUSMYCOPLASMAPERTUSSIS

INHALATION OF THE OXIDES OF NITROGEN OR OTHER CHEMICAL

CLINICAL MANIFESTATIONCLINICAL MANIFESTATION

COUGH R.DISTRESS CYNOSIS

PROGRESSIVE DISEASE SHOWSINCREASING DYSPNEACOUGHSPUTUM PRODUCTIONWHEEZING

MAY OCCUR OR AFTER PERIOD OF APPARENT IMPROVEMENT

ROENTGENOGRAPHROENTGENOGRAPH

FROM NORMAL TO A PATTERN THAT SUGGESTS MILIARY TUBERCULOSIS.JAMES SWYER SYNDROME UNILATERAL HYPERLUCENCY AND A DECRASE IN ABOUT 10% OF CASES.

PULMONARY FUNCTION TEST:PULMONARY FUNCTION TEST:

RESTRICTIVE OR A COMBINATION OF OBSTUETIVE AND RESTRICTIVE PATTERN

HRLT:HRLT: BRONCHIECTASIS

DIAGNOSIS:DIAGNOSIS: CAN BE CONFIRMED BY LUNG BIOPSY

PROGNOSIS:PROGNOSIS: SOME PATIENTS DETERIORATE RAPIDLY AND DIE WITHIN WEEKS OF THE ONSET OF THE INITIAL SYMPTOMS BUT MOST SURVIVE SOME WITH CHRONIC DISABILITY

TREATMENTTREATMENTTHERE IS NO SPESIFIC TREATMENT CORTICOSTEROID MAY BE EFFECTIVE