on a random query amongst various pediatrician friends following
misconceptions about bronchiolitis were found:
1. Bronchiolitis is common at 6 month to 6 year age group.
============== the correct answer is 2-4 months, but from 1 month to
2 years.
2. A brochiolitis child with respiratory distress is a concern for
likelyhood of bacterial infection, so should be given antibiotics if
he is running high fever.
============== secondary bacterial infection in bronchiolitis is
unusual, except in cases of congenital hearts, CLDs and other
compromised states, and only in these cases use of antibiotics can
be justified on concern grounds, or wait till you get any evidence
of bacterial infection.
3. crepitations is a predominant feature of bronchiolitis.
============== no ! its the audible wheeze! so much so that if no
wheeze no bronchiolitis.
4. all bronchiolitis patients get converted into asthma.
============= not all but a significant number of patients do get
repeated wheeze.
5. bronchiolitis cant recurr. if it recurs, it is asthma.
============ it can recur n number times because RSV doesnot have
any lasting immunity.
6. Fever is must in bronchiolitis, no fever suggests asthma.
============ no! viruses like parainfluenza can cause bronchiolitis
with no or mild and short fever.
7. All bronchiolitis are viral.
============= no! even mycoplasma can cause bronchiolitis.
8. bronchiolitis can rarely be serious and most cases settle in 5
days.
============ Adenovirus bronchiolitis always has serious potential ,
lasts longer, affects infants and can cause bronchiolitis obliterans.
9.Mycoplasma bronchiolitis cant be differentiated from viral
bronchiolitis.
========== true ! but can be suspected if age is 2 or more and cough
is a predominant feature with distress and minimal wheeze.
10. palivizumab and ribavarin are must,
=========== they are must only in compromised cases and can be given
as prophylaxis.
11. steroids and bronchodilators have no role.
========== they have a controversial role. and surely helps when
used judiciously like in refractory cases in which desaturation upto
90 has been demonstrated.
12. all bronchiolitis cases should be Nil by mouth.
========== no ! most fo them can be maaged on OPD basis and feeding
can be permitted as long as child accepts it significantly.
13. it cant be differentiated fromn bronchopneumonia or pneumonia,
so chest x ray is must.
========== chest xray wont serve any purpose as treatment wont
change, for bronchiolitis is a clinical diagnosis and easily
differentiated from pneumonia due to presence of wheeze and absence
of local signs and crepts and from bronchopneumonia due to wheeze
being predominant than crepts.


thanks