18 - LRTI Flashcards
Risk factors for LRTI
loss or suppression of cough reflex / swallow
ciliary defects mucus disorders pulm. oedema immunodeficiency macrophage function inhibition
Acute bronchitis - what is it
inflammation & oedema of trachea and bronchi
Acute bronchitis - clinical presentation
cough (dry), dyspnoea, tachypnoea
Acute bronchitis - who?
winter
children
Acute bronchitis - causative agents
usually viral - rhinovirus, coronavirus, adenovirus, influenza
bacterial - h.influenzae, m.pneumoniae, b.pertussis
Acute bronchitis - diagnosis
tests not indicated in mild presentations
if needed culture may be helpful
Acute bronchitis - treatment
supportive treatment for healthy patients
those with severe may require oxygen therapy or resp. support
antibiotics only if bacterial
Chronic bronchitis - definition
cough productive of sputum on most days during at least 3 months of 2 successive years
Chronic bronchitis - who?
10-25% adult population
most common in men and >40yrs
Smoking, pollution, allergens
Bronchiolitis - who?
children
Bronchiolitis - what is it?
inflammation and oedema of bronchioles
Bronchiolitis - clinical presentation
wheeze, cough, nasal discharge, resp. distress (grunting, retractions, nasal flaring)
Bronchiolitis - when?
peaks in winter and early spring in infants 2-10 months
Bronchiolitis - most common cause
RSV (75% of cases)
others: parainfluenza, adenovirus, influenza
Bronchiolitis - diagnosis
CXR
FBC
Microbiological diagnosis
Bronchiolitis - treatment
supportive: O2, feeding assistance
No clear evidence to support steroids, bronchodilators, ribavirin
Antibiotics only if complicated by bacterial infection
Pneumonia - what is it
infection affecting distal airways and alveoli forming inflammatory exudate
Pneumonia - anatomical patterns
bronchopneumonia - patchy distribution centred on inflamed bronchioles and bronchi which spread to alveoli
lobar - affects a large part or whole lobe (90% due to S. pneumoniae)
Pneumonia - types
community acquired (CAP) hospital acquired (HAP) Ventilator acquired (VAP) Aspiration pneumonia
Aspiration pneumonia
resulting from abnormal entry of fluids e.g. food, drinks, stomach contents into the lower resp. tract
CAP - epidemiology
1 per 100 people per year
20-40% require hospital admission
50-70 yo
Midwinter
CAP - clinical presentation - bacterial
rapid fever/chills productive cough mucopurulent sputum pleuritic chest pain general malaise - fatigue, anorexia
signs: tachypnoea, tachycardia, hypotension.
examination: dull to percuss, reduced air entry w/ bronchial breathing
CAP - clinical presentation - viral
influenza
uncomplicated: fever, headache, myalgia, dry cough, sore throat
CAP - investigations
BP, pulse, oximetry
Bloods: FBC/U&E/CRP/LFTs
CXR
Sputum gram stain & culture; bloods; pneumococcal urinary antigen; legionella urinary antigen; PCR or serology
Assessement of disease severity
CURB65
CURB stands for
confusion
urea >7mmol/l
resp rate >30
blood pressure 65
LRTI prevention
pneumococcal vaccinations - patients with chronic heart, lung, kidney disease/splenectomy
influenza - over 65s, chronic, multiple co-morbidities
