Paeds Respiratory Flashcards
what causes wheeze in children?
- Viral induced wheeze
- Multiple trigger wheeze
- Asthma
- Recurrent anaphylaxis (e.g. in food allergy)
- Chronic aspiration
- Cystic fibrosis
- Bronchopulmonary dysplasia
- Bronchiolitis
- Tracheo-bronchomalacia
- Cardiac failure
It is usually during expiration - stridor
Anything that can cause bronchospasm, swelling of mucosal lining, excessive secretions, inhaled FB or extrinsic compression of airway
What is BPD ?
Bronchopulmonary dysplasia (BPD) isa form of chronic lung disease that affects newborns. Most infants who develop BPD have been born prematurely and need oxygen therapy. Most infants recover from BPD, but some may have long-term breathing difficulties.”
What is TBM ?
Tracheobronchomalaciaor TBM is a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse”-
What is Bronchiolitis ?
Viral infection of bronchioles
usaually the peak age is btw 3-6 months & it’s very common & will occur in 1st year of life.
Only 2-3% are hospitalised
80% Respiratory Syncytial Virus (RSV) infection
How do you manage ?
Diagnose Clinically
Self - limiting
The management is supportive
How Bronchiolotis present in the UK ?
Starts as URTI
Evolves to
Respiratory distress
Cough
Wheeze
Bilateral crepitations (often)
what are the features of respiratory distress in infants ?
poor feeding due to breathlessness and cyanosis. hypoxia
What are the RF of Bronchiolitis ?
Older siblings
Nursery
Passive smoking (especially mum)
Overcrowding
Breastfeeding is considered protective
What are the RF that leads to severe condition ?
Prematurity (<37 weeks)
Low birth weight
Mechanical ventilation when a neonate
Age less than 12 weeks
Chronic lung disease (eg, cystic fibrosis, bronchopulmonary dysplasia)
Congenital heart disease
Neurological disease with hypotonia and pharyngeal discoordination
Epilepsy
Insulin-dependent diabetes
Immunocompromise
Congenital defects of the airways
Down’s syndrome
What is the National Health care guideline say about Bronchiolitis ?
advise that bronchiolitis should be considered in children under the age of 2 years who present with a 1- to 3-day history of coryzal symptoms, followed by:
Persistent cough;and
Either tachypnoea or chest recession (or both);and
Either wheeze or crackles on chest auscultation (or both).
Other typical features include fever (usually of less than 39°C) and poor feeding. Consider an alternative diagnosis such as pneumonia if temperature is higher and crackles are focal. Consider viral-induced wheeze if there is wheeze without crackles, episodic symptoms and/or a family history of atopy.
Very young babies may present with apnoea alone, with no other signs
What are the investigation of Bronchiolitis ?
Pulse ox
Viral throat swabs (2° care only)
Nil else needed unless other diagnosis suspected or deterioration
What is the management of bronchiolitis in the primary care ?
If Mild
Manage at home
Parental education
Peak symptoms 3-5 days
Safety net
Supportive
Fluids/nutrition
Temp control
When do you provide anti- pyretics ?
if child is distressed by the temperature.
What is the management of bronchiolitis in the secondary care?
Supportive
O2 and NG feeding (if needed)
HFNC
CPAP
Infection control measures
Should I give antibiotics?
No
What is the prevention and recovery process of Bronchiolitis ?
It usually lasts 3-7 days (cough up to 3 weeks) with full recovery
- sometimes it might go on to have a recurrent wheeze , rarely may have a permanent damage
How would you recover an infant that ahs Bronchiolitis ?
Palivizumab-
* monthly IM injection for high risk infants
* First needs to be given before season starts
What is Palivizumab ?
It is a monocolonal antibody against RSV. Reduces hospitalisation and ICU stays
Who can have Palivizumab ?
- Those who with bronchopulmonary dysplasia (BPD, also known as chronic lung disease) due to prematurity or chronic lung disease.
- Those at high risk due to congenital heart disease.
- Those at high risk due to severe combined immunodeficiency syndrome.”
What is recurrent wheeze phenotypes ?
- Viral induced wheeze – only during viral infections
- Multiple trigger wheeze –multiple triggers, more likely to develop into asthma over time
- Asthma
What is Viral induced Wheeze ?
Small airways
More likely to narrow and obstruct
Aberrant immune response to infection
May have reduced airway diameter from birth
What are the RF of viral induced wheeze ?
- Maternal smoking
- Prematurity
- Male
- FH asthma/allergy not a risk factor
- Usually resolves by age 5 with increased airway size
What makes you think the wheeze is viral based ?
The child is between 12 months and 5 years
* Coryzal symptoms
* Only wheeze with a viral illness
* Have a relatively rapid onset of wheeze
* Have demonstrated response to beta-agonist treatment
* They could aslo present with asthma symptoms such as wheeze, SOB, cough
No investigations needed
Whta is the management of Viral induced wheeze ?
Use clinical judgement
Severity of this and previous episodes
(Effective) treatment with bronchodilators prior to presentation?
What is the management of viral induced wheeze ?
Management is when it’s symptomatic
If Mild, No respiratory distress/tachypnoea
Able to continue normal activities
Manage at home
2-5 puffs salbutamol every 4 hours (including over night)
Until symptoms resolve
Use a spacer with mask
