Acute Respiratory Illness in Paediatrics Flashcards
What is pneumonia?
- Infective process caused by a virus, bateria or mycoplasm that triggers and immune response
- Diagnosed by CXR
What does the immune response to pneumonia result in?
- Release of cytokines,
- Subsequent inflammation & cell destruction
- Alveoli fill with fluid made up of various white blood cells (depending on causative agent) & oxygenation is
impaired as a result
What are the early symptoms of pneumonia?
- Cough
- Pyrexia
- Breathlessness
- Chest pain
- In severe cases it can lead to vomiting, convulsions and loss
of consciousness.
What does the general management of pneumonia involve?
- Antibiotic therapy
- Pain relief
- Fluids
What does the physio management of pneumonia involve?
- In previously healthy children nil indication for manual techniques
- Specific ACTs in children with altered muscle tone, strength or MCC (e.g. CP, neuromuscular disorders, CF)
What is bronchiolitis?
- Most common severe lower respiratory tract disease in infancy
- Viral infection of respiratory tract commonly caused by Respiratory Syncytial Virus (RSV)
What is the pathophysiology of bronchiolitis?
- Acute inflammation, oedema & necrosis of epithelial
cells lining bronchioles - Immune response (lymphocytes, plasma cells &
macrophages) - Bronchospasm
- Obstruction of small airways
What is the clinical presentation of bronchiolitis?
- Initial cold-like symptoms (runny nose, lethargy)
- Progresses to coughing, wheeze/fine inspiratory crackles on ausc
- Increased WOB
- Tachnypnoea
- Subcostal & intercostal recession
- Nasal flaring
- Tracheal tug
- Head bobbing
- Grunting
- Stridor
What does evidence show regarding chest physio for bronchiolitis?
Chest physio using percs & ribs does not reduce LOS, O2 requirements or improve severity
What is pertussis?
- Aka whooping cough, caused by bordatella pertussis
- Dangerous in infants <6 months & in children with respiratory compromise
What is the clinical presentation of pertussis?
- Cold-like symptoms 7-10 days
- Cough becomes paroxysmal: Thick sputum, provoked by crying, feeding etc
- Spasms of coughing may cause hypoxia & apnoea which can lead to seizures, intracranial bleeding & encephalopathy
What does the medical management of pertussis involve?
- Immunisation (2, 4, 6 months)
- Most managed at home
- Hospital if development of pneumonia
- May last 6-8 weeks
- Infants with frequent apnoea episodes or hypoxic convulsions may need to be intubated
What is the most common complication of pertussis?
Bronchopneumonia
- CXR shows hyperinflation, collapse & consolidation in severe cases
What is the role of physio in pertussis?
Nil indication for physio
What is croup?
Inflammation of upper airway triggered by recent infection (usually parainfluenza)
What is the clinical presentation of croup?
- Coryzal, harsh barking cough & hoarse voice
- Stridor: Worse at night
- May develop respiratory failure
- Acute phase of obstruction 1-2 days
- Stridor & cough may continue 7-10 days
What does the medical management of croup involve?
- O2 and minimal handling
- Nebulised adrenaline (short term relief)
- Antibiotics only if additional bacterial infection is suspected
- Glucocorticoids (rapid beneficial effects)
- Some require intubation
What is the role of physio in croup?
Physio is contraindicated in the non intubated child with croup
What is asthma?
- Chronic inflammation process within airway
- Causes recurrent episodes of wheezing, breathlessness & cough
What is the pathophysiology of airway obstruction in asthma?
- Bronchial wall smooth muscle constriction
- Airway wall oedema
- Inflammatory cell infiltration of the submucosa
- Intra-luminal mucus accumulation
- Basement membrane thickening
What is the epidemiology of asthma?
- More likely in children of asthmatics or atopic people (i.e. eczema, food allergy, hay fever, urticaria)
- Triggers: Allergens, exercise, emotion
- Diagnosis not made before 3 years
- Prognosis: Varied, some outgrow asthma, some develop later in life
What does the medical management of asthma involve?
- Education
- Asthma action plans
- Drug therapy
What is the role of physio in asthma?
- No routine indication for chest physio
- May have a role in education, device use etc
What are the potential contributors of lung disease in children with CP?
- Lower motor ability, history of asthma/cough/wheeze, GORD
- Pulmonary aspiration
- Impaired mucociliary clearance
- Recurrent infection leading to bronchiectasis
- Kyphoscoliosis
- Upper airway obstruction
- Lower airway obstruction/asthma
What predicts respiratory dysfunction in children with CP?
Degree of
- Spinal deformity
- Neck rotation deformity
- Severe asymmetrical posture - Severity of motor dysfunction
What does the management of pulmonary aspiration in CP involve?
- Thickened feeds & anti reflux treatment
- Gastrostomy & fundoplication
- Control of saliva
What does the management of impaired MCC in CP involve?
- Inhalations (saline/hypertonic saline, bronchodilators)
- Physical therapy to assist secretion removal
What does the management of infection in CP involve?
Antibiotics & immunisation
What does the management of scoliosis, upper and lower airway obstruction in CP involve?
- Scoliosis: Benefit vs risk of surgery
- Upper airway obstruction: Surgery vs CPAP
- Lower airway obstruction: Asthma treatment trial, CPAP/BIPAP, cough is not effective
When do children with CP require ACT?
When they have difficulty clearing excessive secretions of lower respiratory tract (not saliva)
What ACT is used in lower respiratory tract infection?
- Modified PD only
- Oropharyngeal or nasopharyngeal suction
