Thread by @mattclark1980

#WILTW number 3

It’s still busy and lots of bronchiolitis. Two weeks ago I discussed using the @NICEComms guidance to manage routine cases as efficiently as possibly. But not every cases of bronchiolitis is ‘routine’

A baby is admitted with their second episode of bronchiolitis, both times RSV negative, this time quite unwell and needing a lot of respiratory support. Just bad luck of suggestive of an underlying respiratory condition?

Quite a bit of debate about this. in the end we agreed the following investigations

👉CXR
👉trial of salbutamol, if effective start ICS
👉sweat test (CF)
👉immunoglobulin subtypes and vaccine response

After this discussion I did some reading because and came across this really interesting article.

frontiersin.org/articles/10.33…

Staying on the topic of wheeze, the next patient we discussed was 30 months with wheeze - better with salbutamol and steroids. So does she have asthma and should she be started on inhaled corticosteroids? Yes and Yes.

We often talk about ‘happy wheezers’ and are reluctant to ‘label’ younger children with a diagnosis of asthma and start them on an ICS and this IS NOT a good thing. This 👉 @hsib_org report explains why.

hsib.org.uk/investigations…

And there is NICE guidance on managing <5s with asthma:

I’ve also found this from @wheezylikesund1 really helpful

We really need a culture shift in how think about wheeze in younger children.

It’s not all 🫁. Next child has a UTI, another common condition with really excellent guidance.

nice.org.uk/guidance/cg54/…

In my experience, people often struggle to distinguish between upper and lower UTI. If temp >38 it’s an upper UTI.

So it’s 7-10 days of antibiotics

That’s all for this week. I’m away next week so handing #WILTW over to @lizvaughan57 & @fionaf_H

@threadreaderapp unroll

And when I get back from leave, I am going to learn how to spell and start proofreading my tweets 🙈