Common respiratory disorders in children Flashcards
Laryngomalacia
- Most common
- The laryngeal structure is malformed and floppy causing the tissue to fall over the airway and partially block it
The symptoms of laryngomalacia
Stridor, difficulty breathing
Usually resolve by 2 years
Tracheo oesophageal fistula
- It is an abnormal connection between these two tubes
- So swallowed liquid or food can be aspirated into the child’s lungs
- Feeding into the stomach directly can also lead to reflux and aspiration of stomach acid and food
- Observe child’s respiratory effort and chest movement
What are the common respiratory infections?
- Upper Respiratory Tract Infections
2. Lower Respiratory Tract Infections
Upper Respiratory Tract infections
- Child < 5 years will experience about 3-8 episode/ year and over 90% are cause by a virus which antibiotic is no necessary
- Common cold ( acute infective rhinitis )
- Pharyngitis / Tonsilitis
- Sinusitis
Lower respiratory tract infections
- Acute Laryngotracheobronchitis ( Coup )
- Bronchiolitis . Bronchitis
- Pneumonia
What is the difference between upper respiratory tract infections and lower respiratory infections?
While lower respiratory tract infections involve the airways below the larynx, upper respiratory tract infections occur in the structures in the larynx or above. People who have lower respiratory tract infections will experience coughing as the primary symptom.
Acute Laryngotracheobronchitis ( Coup ) Lower Respiratory Tract infection
- It is caused by parainfluenza viruses or other causative agents : Respiratory Syncytial Virus ( RSV ) , Adenovirus
- Susceptible to 6 months - 5 years and peaks between 6 months to 2 years
- Westley Croup Score is used to determine severity
What are the symptoms of Acute Laryngotracheobronchitis ( Coup )
Fever, breathing problem at night, a few days of UTRI followed by stridor and a harsh barking cough
What is the treatment of Acute Laryngotracheobronchitis ( Coup )?
- Humidified oxygen ; Inhaled epinephrine
- Corticosteroids ; PO/IV Dexamethasone
What is the complication of Acute Laryngotracheobronchitis ( Coup )?
- Airway obstruction , respiratory failure, dehydration
- Pneumonia, hypoxia, hypercapnia
The prevention of Acute Laryngotracheobronchitis ( Coup )
Vaccination
What is bronchiolitis ?
Bronchiolitis is a viral infection that causes the airways (bronchioles) in the lungs to become narrow,
What is Croup, or acute laryngotracheobronchitis?
Croup, or acute laryngotracheobronchitis, is an acute infectious respiratory disease of infants and children caused by infection of the larynx or the trachea - alone or together. It can cause partial or severe obstruction of the airway, which results in breathing difficulties and coughing
Bronchiolitis
It can occur in any child < 2 years old
Causative agent : Respiratory Syncytial Virus ( RSV ), Rhinovirus and Influenza virus
What are the symptoms of bronchiolitis?
- It starts with UTRI, symptoms worsen 3-5 days
- Peak 5-7 days, resolve by 2-3 weeks
What are the risk factors of bronchiolitis?
- Prematurity
- Congenital diseases
What is the treatment of bronchiolitis?
- Oxygenation aim SaO2 > 95%
- Hydration & nutrition
- relieve nasal congestion
- bronchodilator
The prevention of bronchiolitis
Vaccination
What is pneumonia?
- It is the acute infection of lung parenchyma that impairs gas exchange
- May be cause by various microorganisms,
Streptococcus pneumonia (most common)
• Mycoplasma pneumonia (most common in school children),
• Bacteria Pneumonia
• Viral Pneumonia
• Aspiration Pneumonia
What are the symptoms of pneumonia?
- Fever, cough and tachypnoea
What are the investigations?
CXR, FBC, CRP, blood culture
What is the treatment of pneunomia
- Oxygen aim SaO2 > 95%
- Hydration and Nutrition
- Oral antibiotics are sufficient for the majority
- IV antibiotic e.g. ampicillin and gentamycin for neonates and toxic presentation
Bronchial asthma
- Presents at any age, 2/3 before age 18
- Boy > Girl
- Chronic reactive airway disorder involving episodic, reversible airway obstruction resulting from bronchospasm, increased mucus secretions and mucosal oedema
- Characterized by airway inflammation, intermittent airflow obstruction and bronchial hyperresponsiveness
What are the signs and symptoms?
It ranges from mild wheezing and dyspnea to life-threatening respiratory failure
Some causes of asthma
- Reactive airway disease & Bronchial edema
- Bronchial hypersecretion
- Aspiration
- Congenital abnormalities of the airway
- Congenital heart disease
- Reactive airway disease & Bronchial edema
Infections:
Viral Bronchiolitis, post-viral wheeze
Mycoplasma Infections
Anaphylaxis
- Bronchial hypersecretion
Inhalation of irritants
Cholinergic Drugs
- Aspiration
- Gastroesophageal reflux
* Foreign Body
- Congenital abnormalities of the airway
- Bronchomalacia
* Bronchial stenosis
What is the assessment of bronchial asthma?
- Biochemcial
- Genetic
- Infections
- Environmental
- Psychological factors
What is the history of bronchial asthma?
- Personal or family history of atopy : Eczema, allergic conjunctivitis
- Triggers : Viral infection, house dust mites, animal dander, pollens, physical, stress, environmental
How do we classify bronchial asthma?
- Frequency, severity and duration of symptom
- Degree of airflow obstruction ( spirometry measure ) or peak expiratory flow
- Frequency of night-time symptoms and degree to which asthma interferes with daily activities
Mild persistent asthma
- Daytime symptoms 3 to 6 days a week
- Night time symptoms 3 to 4 times a month
- Lung function testing is >80% of predicted value
Moderate persistent asthma
- Daily daytime symptoms
- At least weekly night time symptoms
- Lung function testing is 60-80% of predicted value
Severe persistent asthma
- Continual daytime symptom
- Frequent night time symptom
- Lung function testing is < 60% of predicted value
What is the score for Asthma Control Test Score?
If score > 20, asthma may be well controlled
Investigation for asthma
- The strongest predictor for wheezing that develops into asthma is atopy ( 70 - 90% )
Atopy refers to the genetic tendency to develop allergic diseases
- Chest x-ray : Evidence of hyper inflation
- Peak Expiratory Flow
- Spirometry
What is the management of asthma?
Physical assessment
- air entry
- wheezing and bronchodilator response
- signs of respiratory distress
Acute exacerbation of asthma
- Pharmacotherapy
Relievers : Salbutamol / Ipratropium
Preventers : Corticosteroids
Oxygen
Management of underlying asthma severity
( Depending on cause )
- Adherence to action plan
- Environmental modification
What are the complications of asthma?
- Status asthma
- pneumonia
- death
What is the acute exacerbation of asthma?
- shortness of breath
- cough
- wheezing
- chest tightness
What are the management goals?
- Rapid reversal of airflow obstruction
- Correct significant hypoxemia
- Reduce recurrence of severe airflow obstruction
- Salbutamol / Ipratroprium bromide
- Nasal prong or face mask to maintain SaO2 > 95%
Mild exacerbation
- Salbutamol MDI / Nebulizer
Moderate exacerbation
- Oxygen to maintain SaO2 >95% via nasal prong / mask
- Salbutamol MDI / Nebulizer
- Oral Prednisolone
- Excerbation > 48 hours
- Past history of severe exacerbation
- Persistent asthma not responding to increased dose of inhaled steroids
What is the patient and family teaching for asthma?
- asthma nurse referral
- explain the disorder, diagnosis and treatment
- proper medication dosages, administration and potential adverse reactions
- need to notify the practitioner for fever, chest pain, SOB without coughing or exercising or uncontrollable coughing
- avoiding known allergens and irritants
- metered-dose inhaler and spaced use as indicated
- Use of short acting bronchodilator before inhaled corticosteroid if both prescribed
- Pursed-lip and diaphragmatic breathing
- Use of peak flow meter to measure the degree of airway obstruction and the importance of maintaining a diary of levels and symptoms
- Effective coughing techniques
- Maintaining adequate hydration and helping to loosen secretions
