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Shortness of Breath 

Shortness of Breath
Shortness of Breath
Acute Care Casebook

Sylvia E. Garcia


This case illustrates the classic presentation of bronchiolitis, which is a clinical diagnosis. The pathophysiology is that of an upper respiratory infection, most commonly respiratory syncytial virus, progressing to involve the lower airways, with subsequent wheezing and respiratory distress. Supportive care is the focus of management in the majority of cases, as interventions including bronchodilators, nebulized racemic epinephrine, nebulized hypertonic saline (for nonhospitalized settings), steroids, and antibiotics all provide inconsistent or no benefit. Although a small subset of patients has shown to benefit from bronchodilator therapy, no study clearly defines this group. In severe cases, noninvasive respiratory support may be needed. Radiographic imaging and respiratory panel testing for infectious causes are not routinely recommended.

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