1. July 29, 2010

5. Most common pathogen causing lower airway disease in infants and toddlers 90,000 hospitalizations/year $700 million/year for children <1y

6. Human to Human December to March No long-term immunity Universal infection by 2y 40% lower airway disease

7. Rhinitis Tachypnea Wheezing Cough Crackles Accessory muscle use Nasal flaring

8. Acute inflammation Edema and necrosis of epithelial cells lining small airways Increased mucus production Bronchospasm

9. CXR Peribronchial thickening or interstital PNA 50-80% Subsegmental consolidation 10-25%

10. 33-50% Recurrent wheezing months to years M>F Prolonged airway hyperresponsiveness and asthma

11. Rely on History and PE Pulse oximetry No routine studies recommended X rays Diagnostic testing

12. Risk Factors <12 weeks Prematurity CHD Immunodeficiency

13. Bronchodilators Not routine Trial Α or β adrenergics Continue only if response is noted

14. Corticosteroids Not recommended routinely Ribavirin should not be used routinely

15. Antibacterials Only for specific indications SBI PNA AOM Use as if bronchiolitis was not present

16. Hydration and PO ability 60-70 RR CPT Not recommended No evidence supports improvement

17. Oxygen <90% Do not measure sats as course improves Measure closely in children with significant heart or lung disease

18. Palivizumab Decreased rates of hospitalization

19. Hand Decontamination Most important for prevention Before and after, inanimate objects and after removing gloves Alcohol based rub preferred Educate the families

20. Passive Smoking Increases risk of infection Breastfeeding Protective immune factors Decreases risk of hospitalization No recommendation at this time