ACUTE  BRONCHIOLITIS

by

Dr. Kulwant Singh (Principal: S H M College Jamshedpur)

                                               

DEFINITION: Acute bronchiolitis is a common disease of the lower respiratory tract of infants resulting from inflammatory obstruction of the small airways.

INCIDENCE: It occurs during the first 2 years of life with a peak incidence at about 6 months of age. More common in male infants.

AETIOLOGY:

It is predominantly a viral disease.
Causative Organism: 1. Respiratory syncytial virus: more than 50%
  2. Parainfluenza 3 virus
  3. Mycoplasme
  4. Some adenoviruses

PATHOLOGY:

Acute bronchiolitis is characterized by bronchiolar obstruction due to oedema and accumulation of mucus and cellular debris in smaller bronchial tree. There is air trapping and over inflation of lung due to ball valve respiratory obstruction. Atelectosis may occur when the obstruction becomes complete and trapped air is absorbed. The pathogenic process impairs the normal exchange of gases in the lungs, which may lead to hypoxaemia.

 

CLINICAL FEATURES:  

HISTORY

H/O exposure to older children or adults with minor respiratory diseases within the week preceding the onset of illness.

EARLY STAGE

Mild upper respiratory  tract infection with serous nasal discharge and sneezing for several days. Demented appetite. Fever: 101 to 102 degree F.

LATER STAGE

Gradual development of respiratory distress, characterized by paroxysmal wheezy cough, dyspnoea and irritability. Breast or bottle feeding may be difficult, because the rapid respiratory rate may not permit time for sucking and swallowing.

 
ON EXAMINATON
G/E Air hunger, cyanosis, temp: usually normal
Chest: Inspection: Intercostals and sub costal retraction due to the use of accessory muscles of respiration
Auscultation: Tachypnoea: respiration rate: 60-80 per min.
P/A: Liver and spleen may be palpable below the costal margin due to the downward pressure of over inflated lungs.

 
INVESTIGATIONS

X RAY CHEST: May reveal scattered area of consolidation and increased antero-posterior diameter on lateral view. WBC count: normal

 
DIFF/DIAGNOSIS

Bronchial Asthma, Foreign Body in trachea, Bacterial Bronchopneumonia, Congestive Heart Failure, Pertusis.

 
PROGNOSSIS

In mild cases symptoms disappear in 1-3 days.

In severe cases after the critical phase, recovery is fast and complete.

 
COMPLICATIONS

In some percentage of cases hyper-reactive disease is a late complication.

 
TREATMENT

1. Hospitalization and supportive treatment is required for severe case.
 

2. The patient is commonly placed in an atmosphere of cool, humidified oxygen to relieve hypoxaemia and reduce insensible water loss from tachypnoea.

 

 

 

HOMOEOPATHIC TREATMENT
ACONITE

  • Complaints caused by exposure to dry cold air

  • Fever: skin dry, hot, face red or pale, burning thirst for large quantity of cold water

  • Intense restlessness, tossing about in agony

  • Dry cough, hoarse, suffocating on expiration
ANTIM TART

  • From exposure to damp basement, bad effect of vaccination

  • Cough with great rattling of mucus, nothing comes out

  • Fan like motion of alae nasi

  • Feels better by expectoration and sitting upright

  • Prolonged wheezing and expiration
BRYONIA ALBA

  • After taking cold or getting hot in summer, days hot and nights cold
 

  • Fever with dry cough
 

  • Great thirst for large quantities of cold water at long intervals
 

  • Aggravation by rest, amelioration by motion
HEPAR SULPH

  • Cough when exposed to cold air, from eating anything cold.

  • Rattling cough with suffocating attacks.

  • Hoarseness with loss of voice.

  • Sneezing with thick offensive discharge from nose.
ARSENIC ALB

  • Sneezing with watery excoriating discharge

  • Air passage constricted, unable to lie down, fear suffocation

  • Wheezing respiration, aggravation mid day and mid night

  • Cough worse after midnight, worse lying on back
PHOSPHOURS

  • Cough with congestion of lungs

  • Respiration quickened , oppressed

  • Hoarseness, worse evening

  • Fan like motion of alae nasi

  • Whole body trembles while coughing

  • Sputa rusty, blood colored or purulent