K - 4 Bronchiolitis (Ilmu Kesehatan Anak).ppt

8/10/2019 K - 4 Bronchiolitis (Ilmu Kesehatan Anak).ppt

1/24

BRONCHIOLITIS

Helmi M. Lubis, dr, SpA(K)

Ridwan M. Daulay, dr, SpA(K)Wisman Dalimunthe, dr, SpA

Rini Savitri Daulay, dr, M.Ked(Ped), SpA

1


2/24

Definition: 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

2


3/24

Pathology

Necrosis of the respiratory tract epithelium

Destruction of ciliated epithelial cells

Peribronchial infiltration with lymphocites &neutrophils

Sub mucosal edematous

No destruction of collagen, muscle, or elastic

tissue

3


4/24

Pathophysiology

4

Edema + accumulation of mucous & cellular debrisnarrow of peripheral airway partially / totallyoccludedover distention / atelectasis


5/24

5


6/24

Etiology

Predominantly RSV (Respiratory Syncytial Virus)95%

Other viruses :Human metapneumovirus

Rhinovirus

Adenovirus

Influenza virus

Parainfluenza virus

Entero virus

6


7/24

Increase severity in:

Prematurity

Underlying medical condition

Group A RSV strainAge < 3 mo

7


8/24

Diagnosis

Etiological diagnosis

Microbiologic examination (viral culture)

Clinical diagnosis

Signs and symptoms

Age

Resource of infectionepidemic of RSV

Laboratory finding

Radiological examination

8


9/24

Clinical Manifestation

Mild rhinorrhea

Cough

Low-grade fever

1-2 days later: Fast breathing

Cyanosis

Grunting

Chest retraction

Wheezing

Irritable

Vomitus

Poor intake

9


10/24

Physical Examinations

Tachypnea

Tachycardia

Retraction

Prolonged expiration Wheezing

Fever

Mild conjunctivitis Pharyngitis

10


11/24

Radiologic examination

Diffuse hyperinflationPatchy infiltrates

Flat diaphragm

Intercostal space >Retrosternal space > (lateral view)

Peribronchial infiltrates / thickening

Atelectasissegmental collapse

11


12/24

12


13/24


14/24

Respiratory rate : Arterial saturation

pCO2

14


15/24

Differential Diagnosis

Asthma

Pneumonia Acute Bronchitis

Congestive Heart Failure

Pulmonary Edema

Obstruction in the lower respiratory tract

15


16/24

Management

Mildtreated at home

Moderate / severe disease :

Hospitalization

Support :

Oxygen

Intra venous fluid drip (antibiotics)

Detect & treat possible complication

Prevent the spread of infection

16


17/24

Controversial :

Bronchodilator

Corticosteroid

Antiviral

Antibiotic

17


18/24

2Agonist

Flores and Horwitz, 1997

Meta-analysis of RCT inhaled 2Agonist

Sample : 3 inpatient & 5 outpatient studies Treatment : nebulized albuterol

Outcome : clinical score, satO2, LOS

Result : unavailable evidence of 2

Agonist efficacy

18


19/24

Corticosteroid

Treatment : Prednison equivalent 1 mg/kgBW

Outcome : LOS, duration of symptoms (DOS),

clinical scores Result :

LOS and DOS

Clinical score

19


20/24

Corticosteroid

Clinical score :

Wheezing

SaO2

Accessory muscle use RR

Conclusion :

Benefits depend on severity and initiation oftreatment

20


21/24

Natural history & complications Regeneration of bronchiolar epithelium after 3 or 4 d

Cilia after 9 d

Improved clinical findings : in 3-4 days Improved radiological features: in 9 days

Persistent respiratory obstruction : 20%

Respiratory failure : 25 %

Lung collaps

21


22/24

Prognosis

23% infantasthma at 3 years,

Control1% asthma

OR : 28; 90% CI 4-1235

(Garrison et al. 2000 after Sigurs et al. 1995)

22


23/24

Correlation with Asthma

30 % - 50 % becomes asthmatic patients

Similarity in :Pathogenic mechanisms

Pathologic disorders

23


24/24

24

Documents

K - 4 Bronchiolitis (Ilmu Kesehatan Anak).ppt