k4 ika bronchiolitis (ika)

7/23/2019 K4 IKA Bronchiolitis (IKA)

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Helmi M Lubis, Dr, Sp.A(K)

Ridwan M Daulay, Dr, SpA(K)

Wisman Dr, Sp.A



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



…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



…Bronchiolitis

tiology !redominantly /+0 (/espiratory +yncytial!redominantly /+0 (/espiratory +yncytial

0irus)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



…Bronchiolitis

&iagnosis

tiological diagnosis

icrobiologic e;amination

Clinical diagnosis

+igns and symptoms7ge

/esource o inection epidemic o /+0

<aboratory nding /adiological e;amination



…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



…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) <aboratory nding /espiratory rate : 7rterial saturation

pC1#



…Bronchiolitis

<aboratory nding icrobiologic e;amination

BC : DDD $ #4DDD cells.mm8,predominantly ! * bands

Blood 6as 7nalysis 7rterial saturation

pC1#

ild respiratory al>alosis

etabolic acidosis

7cute respiratory acidosis



Differential Diagnosis

7sthma

!neumonia 7cute Bronchitis

Congestive Eeart Failure

!ulmonary dema 1bstruction in the lower respiratory

tract



…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



β2 – Agonist

Flores and Eorwitz, 299G

eta=analysis o /CH inhaled β# $ 7gonist

+ample : 8 inpatient * outpatientstudies

Hreatment : nebulized albuterol

1utcome : clinical score, sat1#, <1+

/esult : unavailable evidence o β# $

7gonist ecacy



Corticosteroid

6arrison et al, #DDD&atabases (edline, mbase,Cochrane)

Hreatment : !rednison eIuivalent D,%=%,8 mg.>g Hotal : 8,D $ 23,9 mg.>g

1utcome : <1+, duration o

symptoms (&1+), clinical scores

/esult : <1+ and &1+ ↓

clinical score ↓



Corticosteroid

Clinical score : heezing

+at1#

7ccessory muscle use //

Conclusion :

Benets depend on severity andinitiation o treatment



…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 :#DJ

/espiratory ailure : # J <ung collaps (rare)



Prognosis

#8J inant asthma at 8 years,

Control 2J asthma

1/ : #3K 9DJ C@ 4=2#8(6arrison et al #DDD ater +igurs etal 299)



…Bronchiolitis

Correlation with 7sthma 8D J = D J becomes asthmatic patients

+imilarity in : = pathogenicmechanisms

= pathologic disorders

k4 ika bronchiolitis (ika)

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