Paeds - Respiratory Flashcards
How do URT disorders present?
Coryza, sore throat, earache, sinusitis, stridor
How do LRT disorders present?
Cough, wheeze, resp distress
What % children after affected by asthma?
1/10
What is asthma?
Chronic airway inflammation + bronchial hyperactivity, reversible airway obstruction
What are the 2 patterns of wheezing in asthma?
Viral induced wheezing
Multiple trigger wheeze
What are the risk factors for viral induced wheezing?
Maternal smoking
What is not a risk factor fr viral induced wheezing?
FHx of asthma
At what age does viral induced wheezing resolve by?
Aged 5
What conditions is multiple trigger wheeze associated with?
Eczema
Rhinosinusitis
What is the pathological triad in asthma?
B inflamm
Hyper-response
Airway narrow
What is the clinical triad in asthma?
Cough
Wheeze
SOB
O/E - Asthma (5)
Normal between attacks Hyperinflation of chest Barrel-shaped chest Polyphonic expiratory wheeze Harrison sulci
Ix in asthma
Allergies - skin prick/IgE
CXR - rule out pathology
Spirometry - PEFR
E.g. of SABA?
Salbutamol
Is Salbutamol a reliever or preventer?
Preventer
How long does salbutamol work for?
2-4hrs
SE salbutamol?
Tremor
E.g. of LABA
Salmeterol
Is salmeterol a reliever or preventer?
Reliever
How long does salmeterol work for?
12hrs
In what conjunction must salmeterol be used?
W/ an ICS
What specific type of asthma is salmeterol useful in?
Exercise induced asthma
When is Ipratropium used?
In infants
When others = found to be effective
or
Severe acute asthma
E.g.s of ICS
Beclomethasone
Is Beclomethasone a preventer or reliever?
Preventer
How must you take beclomethasone for it to work?
Take daily
SE beclomethasone
Oral candidiasis
High doses - impaired growth, adrenal suppression, altered bone pets
Add on therapies in asthma
LTRA - Montelukast
Theophylline
PO steriods
Omaluzinab
Step by step approach - Asthma, <5 y/o
1) SABA as required
2) + LTRA or ICS (200-400mcg)
3) If on LTRA + ICS, if on ICS + LTRA
4) Rx to consultant
Step by step approach -Asthma >5y/o
1) SABA
2) + ICS (200-400Mcg)
3) + LABA
4) incr dose ICS to 800mcg
5) + PO steroid @ lowest dose + Rx to consultant
What age is a pressurised meter dose inhaler for?
All ages
<2 need face mask + spacer
>2 - spacer alone
What age is a breath inhaler for?
6+
What age is a dry powder inhaler for?
4+
Features of a severe acute asthma attack(6)
Tachypnoea O2 sats <92% PEFR 33-50 Can't talk in full sentences TachyC Signs of resp distress
Features of a life threatening acute asthma attack (5)
Silent chest Decr RR PEFR <33 Decr consciousness/agitation Cyanosis - O2 < 85
When should you admit an asthmatic child to hospital? (3)
Won’t respond to high dose bronchodilator
Marked reduction PEFR
O2 in air <92%
Mx moderate asthma attack (2)
SABA + spacer 2-4 puffs every 2 mins
PO Prednisolone 1-2mg/kg
Mx severe asthma attack (4)
High flow O2
SABA - 10 puffs via spacer
PO Pred/IV Hydrocortisone
Consider - Ipratropium/IV SABA/Mg
Mx life threatening asthma attack (5)
15L High flow O2 SABA PO Prednisolone/IV HC Ipratropium IV SABA or Mg
If child is responding to Tx in an acute asthma attack, what should be done?
Continue bronchodilators every 1-4hrs prn
PO pred for 3 days
If child is not responding to Tx in an acute asthma attack, what should be done?
Transfer to HDU/PICU
Wheeze differentials (8)
Transient early wheeze Non-atopy wheeze (post-viral) Cardiac failure Bronchiolitis Pneumonia CF GOR Croup
What is the most common respiratory infection in infancy?
Bronchiolitis
Which season is Bronchiolitis more common in?
Winter
What is the peak age for bronchiolitis?
3-6months
Which organism causes >80% bronchiolitis?
RSV
Other causative pathogens bronchiolitis (3)
Parainfluenza
Rhinovirus
Adenovirus
RF Bronchiolitis (5)
Older siblings
Nursery
Passive smoke
Pre-term or LBW
Sx Bronchiolitis
Coryzal Sx –> Dry cough + Incr SOB
Inspection findings - Bronchiolitis
Recession
TachyC
Pallor
Percussion findings Bronchiolitis
Hyper-inflated chest
Auscultation findings - Bronchiolitis
Fine end insp crackles
Wheeze - Exp > Insp
Ix bronchiolitis (3)
PCR secretions
O2 sats
Blood gas
Mx bronchiolitis (4)
Supportive
Humidified O2
IV Fl
Highly infective - stop spread
Prognosis bronchiolitis
Most recover 2 w
1/2 have recurrent cough/wheeze
What prevention can be given for bronchiolitis?
Palibuzimab
When should someone with bronchiolitis be admitted to hospital?
If feeding <50% usual
Or Increasing dyspnoea
Causes - newborn pneumonia (2)
GBS
Gram -ve bacilli
Causes - infant pneumonia (4)
RSV
Strep P
H influ
Staph A (serious)