Bronchiolitis / Wheezing – 3-24 Months: Difference between revisions

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Wheezing is a common complaint on radio traffic. In infants, wheezing is most likely due to bronchiolitis or asthma. Listen carefully for a history of recurrent wheezing in the past as a clue toward asthma. For infants presenting for the first time or with associated stridor, think foreign body. Wheezing in older children should not be diagnosed as “bronchitis” as this is not a disease seen in children. Older wheezing children have asthma, a viral process or pneumonia. Be tuned in to a reported past history that points to undiagnosed bronchiectasis (productive cough greater than 3 months). These children should be seen in Pediatric Clinic for an evaluation.
Wheezing is a common complaint on radio traffic. In infants, wheezing is most likely due to bronchiolitis or asthma. Listen carefully for a history of recurrent wheezing in the past as a clue toward asthma. For infants presenting for the first time or with associated stridor, think foreign body. Wheezing in older children should not be diagnosed as “bronchitis” as this is not a disease seen in children. Older wheezing children have asthma, a viral process or pneumonia. Be tuned in to a reported past history that points to undiagnosed bronchiectasis (productive cough greater than 3 months). These children should be seen in Pediatric Clinic for an evaluation.


<br/>'''Pathophysiology:'''
<br/>'''Diagnosis:''' based on history and clinical presentation
<br/>'''Inheritance:'''
<br/>'''Demographics:''' hospitalization rate for Alaska Native children 3x general population in some studies
<br/>'''Demographics:'''
<br/>'''Signs/Symptoms:''' cough, rhinorrhea, wheezing, respiratory distress, poor feeding
<br/>'''Signs/Symptoms:'''
<br/>'''Risk Factors for Severe Disease:'''
<br/>'''Diagnosis:'''
*less than 12 weeks old
<br/>'''Management:'''
*prematurity <34 weeks
<br/>'''Critical Times for Affected Patients:'''
*history of cardiopulmonary disease
*anatomic airway defects
*neuromuscular disease
*immunodeficiency
*tobacco smoke exposure
'''Risk for Apnea:'''
*postconception age <48 weeks
*low birth weight
*tachypnea or respiratory depression
*low room air oxygen saturations
'''Management:''' see [[media:Bronchiolitis_wheezing.pdf|Bronchiolitis/Wheezing YKHC Clinical Guideline]]
<br/>'''Prevention:'''
*Good Hand Hygiene
*Encourage breastfeeding for at least 6 months
*discuss Tobacco Cessation when appropriate
*Synagis for infants who qualify
===Resources/References===
===Resources/References===
* [[media:Bronchiolitis_wheezing.pdf|Bronchiolitis/Wheezing YKHC Clinical Guideline]]
*Lewis, T. et al. [https://journal.chestnet.org/article/S0012-3692(15)32159-0/abstract Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children]. CHEST. 125(5):1665-1673, May 2004. doi.org/10.1378/chest.125.5.1665
*Lewis, T. et al. [https://journal.chestnet.org/article/S0012-3692(15)32159-0/abstract Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children]. CHEST. 125(5):1665-1673, May 2004. doi.org/10.1378/chest.125.5.1665
* Singleton, Rosalyn J. MD; Bruden, Dana MS; Bulkow, Lisa R. MS [https://journals.lww.com/pidj/Fulltext/2007/11001/Respiratory_Syncytial_Virus_Season_and.5.aspx Respiratory Syncytial Virus Season and Hospitalizations in the Alaskan Yukon-Kuskokwim Delta], ''The Pediatric Infectious Disease Journal'': November 2007 - Volume 26 - Issue 11 - p S46-S50 doi: 10.1097/INF.0b013e318157da9b
* [[media:Pediatric Respiratory Hospitalizations.pdf|Respiratory Hospitalizations in the Delta]] (Powerpoint Presentation by Rosalyn Singleton, MD)
* [[media:Pediatric Respiratory Hospitalizations.pdf|Respiratory Hospitalizations in the Delta]] (Powerpoint Presentation by Rosalyn Singleton, MD)
* [[media:Bronchiolitis_wheezing.pdf|Bronchiolitis/Wheezing YKHC Clinical Guideline]]
* Martinez, P; Weiss, B. [https://www.tandfonline.com/doi/abs/10.3402/ijch.v65i4.18119 Unchanged asthma prevalence during 1990–1999 in rural Alaska Native]. International Journal of Circumpolar Health, 65:4, 341-346, DOI: 10.3402/ijch.v65i4.18119
* Martinez, P; Weiss, B. [https://www.tandfonline.com/doi/abs/10.3402/ijch.v65i4.18119 Unchanged asthma prevalence during 1990–1999 in rural Alaska Native]. International Journal of Circumpolar Health, 65:4, 341-346, DOI: 10.3402/ijch.v65i4.18119
* Ware, D.N. et al. (2014) [https://www.tandfonline.com/doi/abs/10.3402/ijch.v73.24324 Household reporting of childhood respiratory health and air pollution in rural Alaska Native communities]. International Journal of Circumpolar Health 73:1.
* Ware, D.N. et al. (2014) [https://www.tandfonline.com/doi/abs/10.3402/ijch.v73.24324 Household reporting of childhood respiratory health and air pollution in rural Alaska Native communities]. International Journal of Circumpolar Health 73:1.
* [http://epibulletins.dhss.alaska.gov/Document/Display?DocumentId=388 Trends in asthma prevalence, hospitalization risk, and inhaled corticosteroid use among Alaska Native and non-Native Medicaid recipients less than 20 years of age]. State of Alaska Epidemiology Bulletin, 2004.
* [http://epibulletins.dhss.alaska.gov/Document/Display?DocumentId=388 Trends in asthma prevalence, hospitalization risk, and inhaled corticosteroid use among Alaska Native and non-Native Medicaid recipients less than 20 years of age]. State of Alaska Epidemiology Bulletin, 2004.
* Singleton, R. et al. [https://www.sciencedirect.com/science/article/pii/S0012369215373360?via%3Dihub Asthma Hospitalizations Among American Indian and Alaska Native People and for the General US Population]. Chest. 2006, Nov. 130(5):1554-1562. doi.org/10.1378/chest.130.5.1554
* Singleton, R. et al. [https://www.sciencedirect.com/science/article/pii/S0012369215373360?via%3Dihub Asthma Hospitalizations Among American Indian and Alaska Native People and for the General US Population]. ''Chest''. 2006, Nov. 130(5):1554-1562. doi.org/10.1378/chest.130.5.1554
*Bruden, D. et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931377/pdf/nihms-1063087.pdf Eighteen Years of Respiratory Syncytial Virus Surveillance: Changes in Seasonality and Hospitalization Rates in Southwestern Alaska Native Children]. Pediatr Infect Dis J. 2015;34(9):945-950. doi:10.1097/INF.0000000000000772
*Bruden, D. et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931377/pdf/nihms-1063087.pdf Eighteen Years of Respiratory Syncytial Virus Surveillance: Changes in Seasonality and Hospitalization Rates in Southwestern Alaska Native Children]. ''Pediatr Infect Dis J''. 2015;34(9):945-950. doi:10.1097/INF.0000000000000772
*Ralston, et al.  [https://pediatrics.aappublications.org/content/134/5/e1474 Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis].  ''Pediatrics'' November 2014, 134 (5) e1474-e1502; DOI: https://doi.org/10.1542/peds.2014-2742
*[https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/bronchiolitis.html Clinical Practice Guideline: Bronchiolitis].  AAFP.  2019.
*Kirolos, et al.  [https://academic.oup.com/jid/article/222/Supplement_7/S672/5549996 A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis].  ''The Journal of Infectious Diseases'', Volume 222, Issue Supplement_7, 1 November 2020, Pages S672–S679, doi.org/10.1093/infdis/jiz240
*Kou, et al.  [https://www.sciencedirect.com/science/article/pii/S0733862717301414?via%3Dihub Bronchiolitis: From Practice Guideline to Clinical Practice]. ''Emerg. Med. Clin. North. Am.'', 36 (2018), pp. 275-286, 10.1016/j.emc.2017.12.006
*Roqué i Figuls, Marta et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458017/ Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.] ''The Cochrane database of systematic reviews'' vol. 2,2 CD004873. 1 Feb. 2016, doi:10.1002/14651858.CD004873.pub5
*Condella, Anna et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5942012/ Multicenter Study of Albuterol Use Among Infants Hospitalized with Bronchiolitis.] ''The western journal of emergency medicine'' vol. 19,3 (2018): 475-483. doi:10.5811/westjem.2018.3.35837
*Zhang, Linjie et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485976/ Nebulised hypertonic saline solution for acute bronchiolitis in infants.] ''The Cochrane database of systematic reviews'' vol. 12,12 CD006458. 21 Dec. 2017, doi:10.1002/14651858.CD006458.pub4
*Hsieh, Chia-Wen et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489028/ Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials.] ''BMC pediatrics'' vol. 20,1 434. 14 Sep. 2020, doi:10.1186/s12887-020-02314-3
*Hendaus, Mohamed A et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608625/ Pulse oximetry in bronchiolitis: is it needed?.] ''Therapeutics and clinical risk management'' vol. 11 1573-8. 12 Oct. 2015, doi:10.2147/TCRM.S93176
*Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924476/pdf/nihms-1642529.pdf 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group.] J Allergy Clin Immunol. 2020 Dec;146(6):1217-1270. doi: 10.1016/j.jaci.2020.10.003. Erratum in: J Allergy Clin Immunol. 2021 Apr;147(4):1528-1530. PMID: 33280709; PMCID: PMC7924476.
*[https://www.cdc.gov/rsv/research/aip.html RSV in Alaskan Native Infants] from the CDC.
*[https://www.cdc.gov/rsv/research/aip.html RSV in Alaskan Native Infants] from the CDC.
*[https://www.cdc.gov/ncezid/dpei/pdf/16_270091_FS_ArcticInvestigations_508-2.pdf Improving Health for Alaska and Arctic Residents: Arctic Investigations Program] through the CDC
*[https://www.cdc.gov/ncezid/dpei/pdf/16_270091_FS_ArcticInvestigations_508-2.pdf Improving Health for Alaska and Arctic Residents: Arctic Investigations Program] through the CDC
* [[media:Pediatric Asthma - 7-9-2019.pdf|Pediatric Asthma 2019]] (PowerPoint Presentation)
* [[media:Controversies in Asthma Care for Children.pdf|Pediatric Asthma Part 2 2019]] (PowerPoint Presentation)
* [[media:RSV-adult.pdf|RSV Infections in adults]] (PowerPoint Presentation)
* [https://www.seattlechildrens.org/pdf/bronchiolitis-pathway.pdf Seattle Children's Hospital Bronchiolitis Pathway]


[[:category:YKHC Guidelines]]
[[:category:YKHC Guidelines|YKHC Clinical Guidelines]]
<br/>[[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]
<br/>[[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

Latest revision as of 05:47, 10 February 2022

Wheezing is a common complaint on radio traffic. In infants, wheezing is most likely due to bronchiolitis or asthma. Listen carefully for a history of recurrent wheezing in the past as a clue toward asthma. For infants presenting for the first time or with associated stridor, think foreign body. Wheezing in older children should not be diagnosed as “bronchitis” as this is not a disease seen in children. Older wheezing children have asthma, a viral process or pneumonia. Be tuned in to a reported past history that points to undiagnosed bronchiectasis (productive cough greater than 3 months). These children should be seen in Pediatric Clinic for an evaluation.


Diagnosis: based on history and clinical presentation
Demographics: hospitalization rate for Alaska Native children 3x general population in some studies
Signs/Symptoms: cough, rhinorrhea, wheezing, respiratory distress, poor feeding
Risk Factors for Severe Disease:

  • less than 12 weeks old
  • prematurity <34 weeks
  • history of cardiopulmonary disease
  • anatomic airway defects
  • neuromuscular disease
  • immunodeficiency
  • tobacco smoke exposure

Risk for Apnea:

  • postconception age <48 weeks
  • low birth weight
  • tachypnea or respiratory depression
  • low room air oxygen saturations

Management: see Bronchiolitis/Wheezing YKHC Clinical Guideline
Prevention:

  • Good Hand Hygiene
  • Encourage breastfeeding for at least 6 months
  • discuss Tobacco Cessation when appropriate
  • Synagis for infants who qualify

Resources/References


YKHC Clinical Guidelines
Common/Unique Medical Diagnoses

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