Transcript
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
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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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…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!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
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…Bronchiolitis
&iagnosis
tiological diagnosis
icrobiologic e;amination
Clinical diagnosis
+igns and symptoms7ge
/esource o inection epidemic o /+0
<aboratory nding /adiological e;amination
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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) <aboratory nding /espiratory rate : 7rterial saturation
pC1#
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…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
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Differential Diagnosis
7sthma
!neumonia 7cute Bronchitis
Congestive Eeart Failure
!ulmonary dema 1bstruction in the lower respiratory
tract
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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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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
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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 ↓
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Corticosteroid
Clinical score : heezing
+at1#
7ccessory muscle use //
Conclusion :
Benets depend on severity andinitiation o treatment
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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 :#DJ
/espiratory ailure : # J <ung collaps (rare)
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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)
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…Bronchiolitis
Correlation with 7sthma 8D J = D J becomes asthmatic patients
+imilarity in : = pathogenicmechanisms
= pathologic disorders
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