Paediatric Respiratory Flashcards
What is asthma?
A chronic condition characterised by reversible and paroxysmal constriction of the airways and airway occlusion from inflammatory exudate.
What is the most common chronic condition in children?
Asthma
Although poorly understood what is the general pathophysiology of atopic asthma?
Allergens are presented to TH2 cells from dendritic cells, these release cytokines.
This increases humoral immune system response causing a proliferation of mast cells and eosinophils
Cytokines contribute to underlying airway inflammation, bronchoconstriction and exudate production
What are some risk factors for developing asthma?
FHx of asthma/atopy
Low birth weight, prematurity, parental smoking
Viral bronchiolitis in early life
What are precipitating factors in regards to asthma?
Stimuli which initate an exacerbation of asthma
What are some example of precipitating factors of asthma?
Cold air, exercise, pollution, NSAIDs, beta blockers, exposure to allergens
What s laryngomalacia?
A condition affecting infants, where the supraglottic larynx is structured in a way that causes partial airway obstruction leading to stridor on inhalation
What is stridor?
A harsh whistling sound caused by air being forced through an obstruction of the upper airway
What is the usual structural change seen in laryngomalacia?
The arytenoid folds are shortened, which pulls on the epiglottis and changes its shape to a characteristic omega shape
How would a child with laryngomalacia present?
Peak at 6 months, inspiratory stridor which is usually intermittent and more prominent with feeding, distress, lying on their back or with URTIs. Do not usually have respiratory distress or complete airway obstruction
What us the management for laryngomalacia?
Usually improves as the larynx matures with age
Surgery can be performed to alter tissue in the larynx, rarely tracheostomy is needed
What is whooping cough?
URTI caused by bordetella pertussis. Child will have severe coughing fits where they cant inhale and subsequently make a loud whooping sound as they forcefully inhale after
Who are vaccinated against pertussis?
Children and pregnant women
How does whooping cough usually present?
Starts with mild coryzal symptoms, low grade fever and mild dry cough. After around 1 week the more severe coughing fits start.
Infants with pertussis may present with apnoeas rather than a cough
What can you use to confirm the diagnosis of whooping cough?
Nasal swab with PCR testing or culture
Is whooping cough a notifiable disease?
Yes pertussis is a notifiable disease
What features may make you admit someone with pertussis?
Acutely unwell, under 6 months, apnoeas, cyanosis, severe coughing fits
What is the management of pertussis?
Supportive care, infection control measures to reduce spread
Macrolide antibiotics
What is a complication of whooping cough?
Bronchiectasis
How long does a cough from pertussis usually last?
Typically resolves in 8 weeks however can last several months
What is bronchopulmonary dysplasia also known as?
Chronic lung disease of prematurity (CLDP)
How is CLDP dignosed?
Through CXR and if infant requires oxygen after 36 weeks gestational age
How can we prevent bronchopulmonary dysplasia?
Giving mothers showing signs of premature labour corticosteroids (betamethasone)
Once neonate born:
- use CPAP rather than intubation+ventilation
- caffeine to simulate respiratory effort
- not over oxygenating
What is the management of CLDP?
Infant may require low dose home oxygen and weaned off over 1st year of life
Protection against RSV with monoclonal antibody injection monthly
What are common LRTIs in children?
Pneumonia, bronchiolitis, whooping cough
What are common URTIs in children?
Croup, common cold, pharyngitis/tonsillitis
(Not common but epiglottitis important differential)
What are symptoms of obstructive sleep apnoea in children?
Excessive daytime sleepiness or hyperactivity, learning and behaviour problems, faltering growth, in sever cases pulmonary hypertension
What is the most common cause of obstructive sleep apnoea in children?
Adenotonsillar hypertrophy leading to upper airway obstruction
How can obstructive sleep apnoea be diagnosed?
Overnight pulse oximetry and polysomnography in more complex cases
How do we treat OBA secondary to adenotonsillar hypertrophy?
Adenotonsillectomy
Topical steroid nasal sprays and antihistamines in milder cases
For children with OBA and persistent obstruction following medical and surgical treatment, what management would we start?
CPAP or BiPAP may be required at night
What makes up kartagners triad?
Paranasal sinusitis, bronchiectasis, situs invertus
What is bronchiectasis?
Abnormal dilation of the airways with associated destruction of bronchial tissue
What are some different aetiologies for bronchiectasis?
Post infectious, cystic fibrosis, immunodeficiency, primary ciliary dyskinesia, post-obstructive (foreign body aspiration), youngs syndrome, yellow-nail syndrome
What features may suggest the cause for pneumonia is more likely bacterial rather than viral?
Fever >38.5
age >2
Absence of rhinorrhoea or wheeze
Localised pain
What are features of severe CAP in infants?
RR >70, CRT >2secs, Nasal flaring, intermittent apnoea, grunting, unable to feed
What are some features of severe CAP in older children?
RR >50, CRT >2secs, unable to complete sentence, severe recessions, nasal flaring, signs of dehydration
What features in a history would suggest that the patient is at risk of severe asthma?
Previous near fatal asthma, previous admissions for asthma in last year, requiring three or more classes of asthma meds, heavy SABA use, brittle asthma
