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Suggest treatment for bronchiolitis

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Posted on Thu, 9 Nov 2017
Question: Hi Doctor,

My son has had 2 bouts of bronchiolitis which resulted in hospitalisation, one at 4 months and one at 8 months. Ever since the first hospitalisation he has never been without chest congestion. I am very concerned about cystic fibrosis. His main symptoms are constant chest congestion and bulky stools and recurrent diarhhea. He was routinely screened as a newborn which was negative, but I understand that this is not 100% accurate. could you please answer the following,
1.How common is it for cf to be missed during routine new born screening?
2. My son has no problems gaining weight, if his symptoms were cf related then is it highly unusual that he is not have growth issues as well?
3. I have heard salty skin is a common indicator, I have tasted my son and he is does not have excessive salty skin and/or sweat. How reassuring is this or do some cf patients not have this feature?
doctor
Answered by Dr. Pradeep Kumar (1 hour later)
Brief Answer:
Cystic fibrosis has varied presentation

Detailed Answer:
Hi

Thanks for asking on this platform

I have gone through the query and do understand your concern.
Cystic fibrosis is getting more and more detected now a days just because of increased suspicion rate.
Cystic fibrosis may has various presentation at different age. In literature even it has remained undetected till 45 years of age.
Now a days the sweat chloride test is a very easily done and highly sensitive test, so if you have any suspicion it should be ruled out.
New born screening is done by ITR test and has sensitivity of 85-90%. That is it can detect not all but 85-90% cases of cystic fibrosis.
Again failure to thrive in although a very striking feature but it may not be there in early age. It depends on severity of involvement and more common where intestine or pancreas has involved.
Salty test gives a clue to the diagnosis but it may not be there all the time.
Although the viral infection or bronchiolitis is much common cause of respiratory symptoms in this age with possibility of some underlying allergic component which may lead to persistence of symptoms, cystic fibrosis should also be ruled out.
Sweat chloride test is the usual first test and based on that further investigations can be done.
I request you to discuss this with your doctor and get it ruled out.

I hope this helps.
Please let me know if you have any more questions.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Pradeep Kumar

Pediatrician, Cardiology

Practicing since :2006

Answered : 2002 Questions

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Suggest treatment for bronchiolitis

Brief Answer: Cystic fibrosis has varied presentation Detailed Answer: Hi Thanks for asking on this platform I have gone through the query and do understand your concern. Cystic fibrosis is getting more and more detected now a days just because of increased suspicion rate. Cystic fibrosis may has various presentation at different age. In literature even it has remained undetected till 45 years of age. Now a days the sweat chloride test is a very easily done and highly sensitive test, so if you have any suspicion it should be ruled out. New born screening is done by ITR test and has sensitivity of 85-90%. That is it can detect not all but 85-90% cases of cystic fibrosis. Again failure to thrive in although a very striking feature but it may not be there in early age. It depends on severity of involvement and more common where intestine or pancreas has involved. Salty test gives a clue to the diagnosis but it may not be there all the time. Although the viral infection or bronchiolitis is much common cause of respiratory symptoms in this age with possibility of some underlying allergic component which may lead to persistence of symptoms, cystic fibrosis should also be ruled out. Sweat chloride test is the usual first test and based on that further investigations can be done. I request you to discuss this with your doctor and get it ruled out. I hope this helps. Please let me know if you have any more questions. Regards