Download - Bronchiolitis MEU pleno.ppt
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Wisman Dr, Sp.A
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Bronchiolitis
Bronchioles infammation
Clinical syndromes:ast breathing, breathing diculties,retractions, wheezing, poor eeding, ,cough, irritability, (very young) apnoe
!redominantly " # years o age(# $ % months)
&icult to di'erentiate with pneumonia
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Holgate ST, et al. JACI 2003; 111(2):215
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&eense mechanisms orespiratory tract
– Aerodynamic filtering
– Airways reflexes
– Mucus
– Secreted substances
– Cilia
– Respiratory epithelium
• Non immune defenses
• Immune defenses – Cellular
– umoral
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Mucociliary system
Braga,
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…Bronchiolitis !athology
ecrosis o the resp epithelium &estruction o ciliated epithelial cells
!eribronchial inltration with lymphocites *neutrophils
+ub mucosal edematous o destruction o collagen, muscle, or elastic
tissue
!athophysiologydema - accumulation o mucous * cellulardebris narrow o peripheral airway partially .totally occluded over distention . atelectasis
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…Bronchiolitis
tiology !redominantly /+0 (/espiratory +yncytial
0irus) 1ther viruses : rhinovirus, adenovirus,
infuenza virus, parainfuenza virus, enterovirus, etc
+everity !rematurity 1/ 234
5nderlying medical condition 1/ #34 6roup 7 /+0 strain 1/ 8#% 7ge " 8 mo 1/ 489
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…Bronchiolitis
&iagnosis
tiological diagnosis
icrobiologic e;amination
Clinical diagnosis
+igns and symptoms7ge
/esource o inection epidemic o /+0
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…Bronchiolitis
Clinical aniestations : mild rhinorrhea,cough, cold, low=grade ever
2=# d ast breathing, chestretraction, wheezing, irritable, vomitus,poor inta>e
!hysical ;aminationstachypnea, tachycardia, retraction,
prolonged e;piration, wheezing,ever,pharyngitis, con?unctivitis, otitismedia, dehydration
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…Bronchiolitis
/adiologic e;aminationdi'use hyperinfation fat diaphragm, @ntercostal space A
retrosternal space A
peribronchial inltrates . thic>ening
patchy atelectasis segmental collapse
pleural e'usion (rare)
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…Bronchiolitis
alosis etabolic acidosis
7cute respiratory acidosis
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…Bronchiolitis
anagement ild treated at home
oderate . severe disease hospitalization
support : o;ygen
intra venous fuid drip(antibiotics)
detect * treat possible complication
prevent the spread o in
Controversial : bronchodilator
corticosteroid
antiviral
antibiotic
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…Bronchiolitis
atural history * complications /egeneration o bronchiolar epithelium
ater 8 or 4 d
Cilia ater 8 or 4 d
@mproved clinical ndings : in 8=4 days
@mproved radiological eatures: in 9 days
!ersistent respiratory obstruction : #DE
/espiratory ailure : # E
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…Bronchiolitis
Correlation with 7sthma 8D E = D E becomes asthmatic patients
+imilarity in : = pathogenicmechanisms
= pathologicdisorders
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