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

From Guide to YKHC Medical Practices

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* [[media:Bronchiolitis_wheezing.pdf|Bronchiolitis/Wheezing YKHC Clinical Guideline]]
* [[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
* 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)
* 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

Revision as of 07:08, 18 February 2021

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