Lecture 7 - Pulmonary Flashcards
Bronchiolitis
Viral etiology: RSV, influenza, parainfluenza, metapneumovirus
Presentation: apnea (especially <4 months of age) copious rhionrrhea cough/wheeze \+/- fever
Dx: does NOT require Xray
specific cause can be confirmed by antigen detection testing or PCR
RSV is MC
Tx: supportive care
- nasal suctioning, hydration, sup O2
- trial of B2 agonist or recemic epi
- nebulized 3% hypertonic saline
Why screen for RSV? avoid unnecessary ABX use
What are the pathogens causing bronchiolitis?
Viral etiology: RSV, influenza, parainfluenza, metapneumovirus
RSV MC cause
What is the clinical presentation of bronchiolitis?
apnea (especially <4 months of age)
copious rhionrrhea
cough/wheeze
+/- fever
How do you dx bronchiolitis?
does NOT require Xray
specific cause can be confirmed by antigen detection testing or PCR
RSV is MC
What is the treatment of bronchiolitis?
supportive care
- nasal suctioning, hydration, sup O2
- trial of B2 agonist or recemic epi
- nebulized 3% hypertonic saline
Why screen for RSV? avoid unnecessary ABX use
Sequelae of bronchiolitis?
obstruction of upper.lower airways can lead to respiratory failure in infants
higher risk in premature and younger infants
can be mitigated with monthly palivizumab (Synagis)
When do pts with bronchiolitis need to be hospitalized?
presents with apnea
unable to maintain oral intake
hypoxemia (<90%)
concern for impending respiratory failure
What is the RSV prophylaxis?
palivizumab (synagis)
IgG monoclonal antibody
administered monthly during RSV season
Recommended:
infants born <29 weeks gestation, younger than 12 months at onset of RSV season
Who gets Palvizumab?
Synagis
RSV prophylaxis
Recommended:
infants born <29 weeks gestation, younger than 12 months at onset of RSV season
Impending Respiratory Failure in Infants can be caused by?
upper or lower airway obstruction
sepsis
hypotonia
How do pts with impending respiratory failure in infants present?
increased accessory muscle use
inability to coordinate feeding
decreased arousability
hypoxemia/hypercarbia
Pertussis clinical presentation
incubation period 7-10 days
stages:
- catarrhal: cough and rhinorrhea (1-2 weeks)
- paroxysmal: paraoxysms, inspiratory whoop, post-tussive emesis (2-8 weeks)
- convalescent: gradual waning of sxs (weeks to months)
fever generally absent
What are the stages of pertussis?
- catarrhal: cough and rhinorrhea (1-2 weeks)
- paroxysmal: paraoxysms, inspiratory whoop, post-tussive emesis (2-8 weeks)
- convalescent: gradual waning of sxs (weeks to months)
How do you dx pertussis?
PCR
Culture
DFA - direct fluorescent antibody)
Serology
Clinically:
-paroxysmal cough, post tussive emesis, whoop
What is the treatment for pertussis?
Macrolides
-azithromycin (5 days)
Alternative: erythromycin (14 days), clarithromycin (7days), TMP-SMX (14 days)
During which phase of pertussis, if treated with a macrolide, will ameliorate the cough?
catarrhal
What are some potential complications of pertussis?
hospitalization apnea PNA seizure death
What/who is the most common source of infection of pertussis?
sibling
followed by mother
What is the first sign of PNA in infants?
apnea
How do neonates with PNA present?
fever or hypoxia only
How do children with PNA present?
fever chills tachypnea cough malaise retractions apprehension
How does viral PNA differ in presentation from bacterial PNA?
viral - cough, wheezing, URI sx
Bacteria - high fever, chills, cough, dyspnea, focal lung findings
Atypical - tachypnea, cough, crackles on auscultation
What is the MC PNA causing pathogen in neonates?
GBS
What is the MC PNA causing pathogen in 1-3 months old?
febrile - RSV
afebrile - chlamydia, mycoplasma, bordetella pertussis
Asthma
a chronic inflammatory disorder of the airways that causes variable and reversible recurrent episodes of airway obstruction
What is the theory behind asthma?
early life (even in utero) exposures greatly determine future risk
nutrition allergen exposure endotoxin pollutants microbiome psychosocial factors
How do you dx asthma?
episodic sxs of airflow obstruction or airway hyper-responsiveness are present
prove that it’s reversible by:
increased FEV1 of >200mL and 12% from baseline after inhalation of a short acting B2 agonist
When do you do spirometry testing for children with suspected asthma?
at the initial assessment
after treatment is initiated and sxs have stabilized
during periods of progressive or prolonged loss of asthma control
at least every 1-2 years; more frequently depending on response to therapy
Decreased FVC
restrictive process
Decreased FEV1
airflow limitation/obstruction
Exercise Induced Bronchospasm
doesn’t occur in everyone with asthma
1st line treatment:
-pre-treatment - 2 puffs albuterol with spacer at least 15 minutes before exercise
if sxs still occur you don NOT need to wait 4 hours before using albuterol again
Classifications of asthma
look at the chart in the slides
What is the first step in asthma management in children 0-4 years old?
SABA PRN
Step 2:
Low Dose ICS
Step 3:
medium dose ICU
Steph 4:
MEdium dose ICS and LABA
What do you use to determine initiation and adjustment of medications?
severity determines how you initiate medications
control determines how you adjust medications
What is the preferred agent for initiating controller therapy?
ICS
inhaled corticosteroids
Green, Yellow, Red Zones
Look back at the slides for this one
What are the highest risks of severe asthmas exacerbations?
poor asthma control
higher disease severity
prior hospitalizations
non-adherence to therapy
Status asthmaticus
no response to repetitive or continuous administration of short acting inhaled B2 agonist
