Lower Respiratory Tract Infections in children

Question 1

What is acute bronchitis?

Answer 1

Self limiting infection leading to inflammation of trachea and major bronchi (and is therefore associated with oedematous large airways and production of sputum)

Question 2

How long does bronchitis tend to take to resolve?

Answer 2

3 weeks (cough may go on for longer through)

Question 3

What is the leading cause of acute bronchitis?

Answer 3

Viruses

Question 4

When does acute bronchitis tend to happen?

Answer 4

Most cases in Autumn or winter

Question 5

How does acute bronchitis tend to present?

Answer 5

Cough - productive/non-productive (tends to be loose and rattly)
sore throat 
Rhinorrhoea
Wheeze 
Usually normal chest examination

Question 6

How can you differentiate acute bronchitis from pneumonia?

Answer 6

History - sputum, wheeze and SoB may b absent in acute bronchitis, but tends to be present in pneumonia

Examination - no focal chest signs (e.g. dullness to percussion, creps, bronchial breating) in acute bronchitis
Systemic features, e.g. malaise, myalgia, fever usually absent in bronchitis and present in pneumonia

Question 7

How is acute bronchitis diagnosed?

Answer 7

Clinically - does not require investigations

Question 8

What tends to cause acute bronchitis in kids?

Answer 8

H. influenzae/pneumococcus

Question 9

What is considered persistent bacterial bronchitis?

Answer 9

Wet cough persisting for over 1 month

Treat with antibiotics

Question 10

How is acute bronchitis managed normall?

Answer 10

Analgesia
Good fluid intake
Antibiotics (amoxicillin) may be considered if systemically unwell, if they have pre-existing co-morbs, CRP >100

Question 11

What is bronchiolitis?

Answer 11

Condition characterised by bronchiolar inflammation

Question 12

What pathogen causes bronchiolitis in 75-80% of cases?

Answer 12

RSV

Question 13

When is the incidence of bronchiolitis highest?

Answer 13

Winter

Question 14

What is the most common cause of serious LRTI in <1 year olds?

Answer 14

Bronchiolitis

Question 15

What can provide infants with protection against bronchiolitis?

Answer 15

Maternal IgG

Question 16

What are less common causes of bronchiolitis?

Answer 16

Mycoplasma
Adenoviruses

May be secondary bacterial infection

Question 17

In which infants is bronchiolitis infection more serious?

Answer 17

If they have bronchopulmonary dysplasia (e.g. premature), congenital heart disease or CF

Question 18

What are features of bronchiolitis?

Answer 18

Corzyal symptoms (incl. mild fever) precede:
Dry cough
Increasing SoB
Wheezing, fine inspiratory crackles
Feeding difficulties with increased SoB

Question 19

When should infants be taken into hospital by ambulance with bronchiolitis?

Answer 19

Apnoea (reported/observed)
Child looks seriously unwell to a healthcare professional
Severe resp distress, e.g. grunting, marked chest recession, RR>70/min
Central cyanosis
Persistent O2 sats <92% on air

Question 20

For what infants with bronchiolitis should referral to hospital be considered?

Answer 20

If any of the following apply:
RR >60/min
Difficulty breastfeeding/inadequate oral intake (50-75% usual)
Clinical dehydration

Question 21

How is bronchiolitis managed?

Answer 21

Supportive - humidifed O2 if sats <92%
NG feeding if child unable to take enough fluid/feed by mouth
Suction for excessive upper airway secretions

Question 22

At what age do people tend to get bronchiolitis?

Answer 22

<1 year

Question 23

At what age do people tend to get VIW?

Answer 23

6m-4y

Question 24

At what age do people tend to get asthma?

Answer 24

> 2 years

Question 25

What are features of LRTIs in kids?

Answer 25

48h hx of fever (>38.5C), SoB, cough, grunting

Reduced/bronchial breath sounds

Question 26

What are common pathogens causing LRTIs in kids?

Answer 26

Viruses <35%
Pneumococcus
Mycoplasma
Chlamydia
Mixed infection

Question 27

How do you tell if its a LRTI or a pneumonia?

Answer 27

Focal signs, creps and high fever = pneumonia, otherwise = LRTI

Question 28

How should CAP be managed in children?

Answer 28

NB CXR and inflammatory markers not routine
Nothing if mild - review
1st line - amoxicillin, oral macrolide second line
Only IV if vomiting