What is Bronchiolitis?

So I just started a job at a children's hospital (about 2.5 months ago) and during the orientation process they made sure to give me a very brief overview of bronchiolitis.  Then they made sure to inform me that in the coming months I will learn all there is to know about bronchiolitis as it is coming into "season."  This made me rather nervous; while I am excited to learn something new, one thing I have already learned is the age range for which it affects and the severity it can affect a young child.  The reason this made me somewhat nervous is because I have a young child (almost 5 months) and she is in that bronchiolitis age range.  So this made me want to go out and research it, and share what I learned with all of you.  And if you see fit, I ask that you share this information with anyone you know that may benefit from it (i.e. parents of young children).

What is bronchiolitis?

Bronchiolitis is an infection in the bronchioles.  The bronchioles are small airways in the lungs.  These airways become inflamed and filled with mucous making it rather difficult to breathe.

Bronchiolitis is primarily a winter disease occurring during the winter months.  Though the peak for the disease is January through March.

Who is at Risk for Bronchiolitis?

Any child under the age of two.  Though the peak age range is from 3-6 months of age.  Male infants are at higher risk than female infants.  Also infants that were born premature (less than 37 weeks gestation) are at much greater risk for bronchiolitis.

Other risk factors to be aware of include the following:
     Never been breast fed (breast fed babies receive immunities from their mother)
     Exposure to tobacco smoke
     Underlying heart or lung condition
     Contact with multiple children (such as a child care setting)
     Depressed immune system
     Crowded living environment
     Having siblings that attend school or child care and brings the infection home with them

What is the Cause of Bronchiolitis?

The primary cause of bronchiolitis is a virus called Respiratory Syncytial Virus (RSV).  Though there are other viruses that can cause the disease as well, such as: Rhinovirus, Influenza (flu), Parainfluenza and Adenovirus.

What are the Symptoms of Bronchiolitis?

Early symptoms are similar to those of the common cold.  These symptoms include stuffiness, runny nose, cough and mild fever.  These symptoms may last for several days.

Then the symptoms may worsen and you will start to notice:
     nasal flaring (widening of the nostrils when the infant breathes)
     tachypnea (rapid breathing)
     retractions (drawing in of the neck, chest or upper abdomen with breathing)
     wheezing (high pitched sound when breathing out) or crackling in the breath sounds
     rapid heart beat
     irritability

The child may also have difficulty eating because they can't breathe and eat at the same time.  When this occurs you need to watch and be aware of dehydration.  Symptoms of dehydration include a dry mouth, crying without tears and urinating less than normal.  If you notice any of these, contact your physician.

Severe bronchiolitis can include all of the above symptoms, but is most notable by extreme difficulty breathing and a bluish discoloring of the skin and mucous membranes.  This is a sign of inadequate oxygenation and requires emergency medical treatment.

The symptoms of bronchiolitis can last for around two weeks, though severe cases can last longer.

What is the treatment for Bronchiolitis?

There really is no treatment other than supportive therapy.  Since it is caused by a virus, antibiotics are of no use.

Ensure that the child is receiving adequate fluids through breast feeding, formula or electrolyte balanced drinks such as Pedialyte.  In a hospital setting they may start in IV and give fluids through that as well.

Humidified air can also help.  However, if you use a humidifier remember to thoroughly clean it daily to prevent mold.  The humidified air can help to thin the secretions and make them easier for your child to cough up.

Suctioning can also help make it easier for your child to breathe.  You can use a bulb syringe with a saline to suction at home.  Just put a couple of drops of the saline into each nostril and then suction it out with the bulb syringe.  You can also use a nasal aspirator that you may be able to purchase from a pharmacy.  In the hospital setting they may suction the child more aggressively with a suction catheter.  They may nasopharyngeal or nasotracheal suction your child.  You may not like to watch it, but it needs to be done to assist your child in clearing the mucous from their airway.  They will breathe much easier afterwords.

In severe cases the child may need to be placed on humidified oxygen or even need assistance breathing such as with a ventilator.

Breathing treatments have not been found to be helpful in the treatment of bronchiolitis.  Though your hospital may give your child a breathing treatment just to try it.

Is There a way to Prevent Bronchiolitis?

The best way to prevent bronchiolitis is through hand washing.  I know it sounds rather cliche but it is true.  Encourage anyone that comes in contact with your young child to wash their hands first.  Do not allow anyone to smoke around your child.  Also practice and encourage others to practice good respiratory etiquette (i.e. cover coughs and sneezes) as the viruses that cause bronchiolitis are transferred through moisture droplets that are put into the air through coughs and sneezes.  And again, FREQUENT hand washing is key.


I hope that you have found this information helpful.  When in doubt or if your child is showing signs of distress contact your physician or take them to the emergency department immediately.  You can never be to careful, especially when it comes to your child's health.

On a side note, there has been a relationship discovered between bronchiolitis and asthma.  The nature and extent of this relationship is still being researched.  So it will be interesting to get the results of that.

Sources:

Pub Med

Kids Health

Mayo Clinic

Healthy Children

Other useful article:

American Association of Pediatrics

My solution for healthcare

The time has come around for another presidential election.  With it comes another debate over healthcare.  Like everyone else out there, I have my own way to attempt to fix the problem.  My solution, however is would not get anywhere, because it deals with and eliminates the entitlement programs of Medicare and Medicaid.  I actually wrote a paper about it for one of the classes that I recently took (I am currently working on obtaining my Bachelor's degree).  So in light of the current climate and renewed healthcare debate, I thought I would share it here:

I would like to bring your attention to the current state of healthcare in our country.  We have a problem with rising health care costs.  Even those with insurance are getting huge bills from hospitals and physicians.  These costs are starting to cause people not to want to go to the doctor or hospital for fear of it causing them to go into bankruptcy.  In 2010 health care costs neared approximately 2.6 trillion dollars ("U.s. health care," 2012).  Total expenditure of health care accounts for about 18% of the total domestic product.  51% of these costs come from hospital and physician costs.  Another factor adding to these increased costs is that since 2001 insurance premiums have increased 113%.  There have been a few different reforms proposed to combat these rising costs and even to help those that are uninsured.  These include socialized medicine, free-market health care and tort reform. 

                One solution that is popular is reforming our health care is to go to a socialized or nationalized form of health care delivery.  The advantage of this system is universal coverage (Messerli, n.d.).  Currently there is an estimated 45 million individuals without insurance, including illegals, and socialized medicine will cover all of them.  This system of reform will also reduce paper work as there will be one set that will need to be done for one form of insurance.  There will also be just one entity paying for the health care, that would be the government, so there will be no cost to the individual.

                There are also several downsides to nationalized health care.  The first is the fact that free is not really free (Messerli, n.d.).  The American people will still be paying for it through increased taxes which in the long run will really hurt the economy causing more loss of jobs.  Also, there really is no government agency that runs efficiently and do we really want the same types of people that write the tax code and run the post office or DMV running our health care?  Another issue is that government run health care can lead to an increased loss of personal freedoms with the government passing more restrictions on what we can and cannot due/eat/drink in an effort to lower health care costs.

                Socialized medicine is something that many other nations have tried in an attempt to lower health care costs.  One such nations is England with the National Health Service.  This system is full of careless staff and long waits.  There are frequent stories coming from England about people that have had to wait in ambulances for hours.  However a story that stands out is that of a young man that actually called police from his hospital bed because he was thirsty (Ellicott, 2012).  He ended up dying just a few hours later of dehydration.  There is also another story where doctors actually have to prescribe drinking water to try and prevent deaths due to dehydration (Smith, 2011).  According to the Patients Association in England, there are thousands that have suffered from sub-standard care resulting in approximately 1200 deaths in just one hospital alone (Smith, 2009).  Total around the nation is over 1 million complaints of cruelty from nurses and other staff.  This is definitely something to consider when looking at this style of healthcare here in our country.

                Another possible solution to the current health care situation in our country is one that I feel we should really look at.  That is a free-market approach to health care.  The current problem with health care is caused because of government intervention (Richmond, 1992).  Through regulations and masking the true costs of health care it has just kind of gotten in the way and taken the control of health care away from the consumers of the health care.  A free market solution will get the government out of the way and put the consumer in charge of their own health care.  They would also be in charge of paying for their own health care. 

                Americans currently only pay for approximately 12% of their health care, the rest is paid for by the government and insurance companies (Palumbo, 2011).  If individuals actually had to pay for all of their health care the prices would plummet and they would also be more likely to take better care of themselves with their lifestyles and preventative medicine to lower the costs on themselves even further.  Another reason for the lower costs would be the competition for patients between hospitals, clinics and physicians; it would force them to lower costs and increase quality of care for the patients. 

                One possible problem with the free-market solution is access for the poor and the elderly to good quality health care.  My solution for this is letting the physicians and the hospitals keep their non-profit status if they wish to.   In order to keep this status they still have to provide services pro-bono for those that qualify, i.e. the poor and the elderly.  They can also use these services in public relations and marketing to gain for consumers of their services.  Americans are more willing to give their business to companies that are involved in charity than those that are not.  Another solution is along the same lines, but there will also be a development of health care charities to find a way to provide health care to those that cannot otherwise afford it.  There are also many faith based hospitals that have it in their mission to provide quality health care to those that would otherwise not be able to afford it.

                The most important way to lower costs, however, is through tort reform.  Every year frivolous law suits with no basis in science or fact add over 100 billion dollars to the cost of health care (Becker, 2012).  This leads to an increase in malpractice insurance that physicians and hospitals end up having to pay.  Approximately 50% of a physician’s private practice income goes to pay for medical malpractice just to protect their livelihoods.  This is something that does need to be addressed to lower these costs.  If the cost of medical malpractice can be lowered, which it can through tort reform, then the cost of health care will also drop.

                These are three possible solutions.  The only ones that make complete sense to go with and will lower costs for everyone and also reduce the national debt is the free-market approach the health care and also tort reform.

References

Becker, T. (2012, March 12). Without tort reform, health care costs will keep rising. Retrieved from                http://www.swarthmorephoenix.com/2012/03/01/opinions/without-tort-reform-health-care-costs-will-keep-rising

Ellicott, C. (2012, July 3). Patient dying of thirst rang 999: Inquest hears of mother's fury at nurses who   neglected son. Retrieved from http://www.dailymail.co.uk/news/article-2167643/Patient-dying-thirst-rang-999-Inquest-hears-mothers-fury-nurses-neglected-son.html?printingPage=true

Messerli, J. (n.d.). Should the government provide free universal health care for all americans?. Retrieved           from http://www.balancedpolitics.org/universal_health_care.htm

Palumbo, M. (2011, December 17). How the free market can cure health care read more:                http://www.americanthinker.com/2011/12/how_the_free_market_can_cure_health_care.html

Richmond, S. (1992, June). A free market for health care. Retrieved from              http://www.fff.org/freedom/0692c.asp

Smith, R. (2009, August 27). 'cruel and neglectful' care of one million nhs patients exposed. Retrieved      from http://www.telegraph.co.uk/health/healthnews/6092658/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed.html

Smith, W. (2011, May 29). Nhs meltdown: Doctors prescribe drinking water to prevent elderly deaths.     Retrieved from http://www.firstthings.com/blogs/secondhandsmoke/2011/05/29/nhs-              meltdown-doctors-prescribe-drinking-water-to-prevent-elderly-deaths/

U.s. health care costs. (2012). Retrieved from http://www.kaiseredu.org/issue-modules/us-health-care-costs/background-brief.aspx

 

What is a Respiratory Care Professional?

We in the Respiratory Care profession have an identity crises.  Nobody outside of the hospital seems to know who we are or what we do!  This is partly our own fault, we don't advocate, we don't have any big campaigns and we don't latch on to any awareness programs, such as COPD, Asthma or lung cancer.  Though we are also a relatively new profession when compared to alot of other professions out there, like nursing or radiology; but you would think that with 30+ years in the industry people would start to recognize us a little more. 

So here is my meager attempt to inform you who and what Respiratory Care Professionals are:

Respiratory Care Professionals, better known as Respiratory Therapists or Cardiopulmonary Therapists, are health care specialists.  Some people simplify it to that we are kind of like a specialized nurse.  If you want to make it really simple I guess you could say that; but we are so much more than that.  We spend two to four years, sometimes even longer, studying two systems in the body; the heart and the lungs and how they affect the rest of the body and how the rest of the body affects them.  They learn all the diseases associated with these two organ systems, how to diagnose and treat them.  Or in the case of chronic illness, such as COPD, how to manage them.  We are in the hospital 24/7 365 days a year.  We are ready to go at a moments notice to any part of the hospital where a patient may be in distress to assist them.  We are there and work with any age group from premature neonates to the elderly patient.

We are artificial life support specialists.  They manage ventilators, can assist with management of balloon pumps (for critical heart patients), and ECMO (extracorporeal membrane oxygenation: basically bypassing the lungs to oxygenate the blood).  We are also trained hemodynamic (heart and blood pressures) monitoring and the ability to insert lines to watch these pressures and obtain blood samples.  Essentially we are critical care specialists.  Often times we have to take at least three national board exams before we can even start working.

We are trained in emergency care as well.  We can insert breathing tubes and perform CPR.  We are apart of every hospital Code Blue team and Rapid Response team.  A lot of ambulance, medical flight and patient transport services even hire us to be a part of their teams.

You will see us on general hospital floors as well.  We will be there to give you medicine to breathe in for your lungs or to teach you about a new diagnosis that you may have just received.  We will be there to help make sure you or your loved one is comfortable if you are in the process of passing on.

You will also see us working in the Neonatal Intensive Care Unit with babies that can't quite breathe on their own yet and are there for high risk deliveries.

We are also in the testing part as well.  We perform pulmonary function tests to diagnose lung problems.  We do EKG's and stress tests to diagnose heart problems as well.  We also do sleep studies to find out if you have problems while you sleep and help fit you with a device to alleviate that problem.

You may also see us in other outpatient clinics teaching people about their disease processes and how to live with them and manage them to have the best quality of life.  You will see us in COPD clinics, Asthma clinics as well as Pulmonary and Cardiac Rehabilitation.

If you need oxygen or other respiratory equipment at home we will be there to drop it off and teach you how to use it.  We will be around to check on you occasionally and be on call 24/7 in case of an emergency with your home equipment.

As you can tell we are a vital part of the health care team, ready to go at a moments notice.  So why haven't more people heard of us?  I don't know.  We are kind of the unsung heroes of the hospital.  Most of us are okay with being the unsung hero, all we want in return for what we do is just respect and appreciation.

If you want more information you can go to the American Association for Respiratory Care.  You can also watch this amazing video about who and what Respiratory Care Professionals are.

I hope this answers your questions.  If you think you might want to be a Respiratory Care Professional or have questions about it, just contact your local friendly Respiratory Therapist.  If they are like most, they would love to sit down and talk to you about what it is that they do.

David

Welcome

Welcome everyone to my new blog!  I am really excited to start this up and have you be a part of it. 

First a little bit about me; as it says in the about me section to the right, I am a Seventh-day Adventist Christian, husband, father and Respiratory Care Professional.  I live in SW Ohio (not the best area for lung health) and work in a medium sized community hospital.  I work with all age groups and many different disease processes in all areas of the hospital.  I have been a Respiratory Care Professional for a little over four years now and am proud of and love what I do.

Now I don't want to divulge to much information in this first post, we need to save some stuff about myself, my thoughts and what it is I do for later posts.

Topics that we will cover include medical (more specifically topics that pertain to the heart and lungs), humor (medical and otherwise), spiritual and we may also occasionally dive into a little politics (I will try to keep this to a minimum). 

My hope is to grow this blog into a place where we can come together and learn, laugh and grow together.  If you have any questions regarding the topics mentioned above, please feel free to ask!  It will give me a topic to post about!

Thank you, and I look forward to seeing you here in the future!

David