Respiratory Disease Flashcards
3 other viruses that can cause bronchiolitis and which is the most virulent?
Human metapneumovirus hMPV
Adenovirus - most virulent
Parainfluenza virus
What is the commonest cause of bronchiolitis?
Respiratory syncitial virus RSV
Risk factors for severe bronchiolitis?
Prematurity or low birth weight
Less than 12 weeks of age
Ongoing chronic lung disease
Congenital heart disease
What examination finding is characteristic of bronchiolitis?
Widespread (bi basilar) fine inspiratory crackles +/- high pitched expiratory wheeze
What findings can occur in the abdomen in severe respiratory disease due to lung hyperinflation?
Hepatomegaly and less commonly splenomegaly
What one investigation is most useful in diagnosing bronchiolitis?
NPA for rapid RSV testing
Viral cultures
How long does bronchiolitis normally last and when are kids normally asymptomatic?
Normally 7-10 days, 50% asymptomatic by 2 weeks
What may prompt admission for respiratory disease generally?
Signs of respiratory distress, increased work of breathing, RR>70
Poor feeding or dehydration
Lethargy or systemically unwell, high fever
Cyanosis or saturation <92/94%, apnoea
What 3 factors lower threshold for admission in respiratory disease?
Significant (lung, heart) comorbidities
Prematurity
Less than 3m old
What are the management options for bronchiolitis in hospital?
Typically supportive; O2, fluids if dehydrated
Can offer bronchodilators and antibiotics
If care needing to be escalated or consistently de saturating on 50% O 2, consider PICU humicare (like CPAP)
What can be a long term problem after early or bad bronchiolitis? Short term complications?
Subsequent reactive airways disease - asthma, viral induced wheeze
Secondary bacterial infection, pneumonia etc. Bronchiectasis if particularly bad
What is the RSV vaccine and under what circumstances is it given?
Palivizumab - for very young, premature, congenital heart disease, immunodeficient etc.
What is the gender distribution of incidence of asthma through childhood?
Prepuberty = Boys Adolescent = Even Adult = Women
When does peak flow and spirometry testing become viable for asthma in kids?
Age 6 for peak flow
5 for spirometry
Define reversibility in relation to asthma and bronchodilators?
> 12% increase in lung function 10 minutes after bronchodilator administered
Why are spacers good for bronchodilator inhalation? (3 reasons)
Make inhalers easier to use and more effective
Stop medication from sticking to back of throat and causing thrush, pharyngitis
Better than a nebuliser in an emergency
Signs of life threatening acute asthma attack?
Silent chest Cyanotic or apnoeas Poor respiratory effort/exhaustion Hypotensive or bradycardia Confused, impaired consciousness O2 < 92, PEFR < 33%
What is the most important early treatment of a severe asthma attack presenting in the emergency dept?
Oral prednisolone 20-40mg
Step 1 of chronic asthma management?
PRN SABA - salbutamol blue inhaler w/spacer to use as required
What indicates movement from step 1 to step 2 of chronic asthma ladder?
Using SABA more than twice a week, at night once a week or having had acute exacerbation within last 2 years
Step 2 in chronic asthma management?
PRN SABA + regular preventer (brown inhaler- inhaled corticosteroid)
Step 3 of chronic asthma management?
PRN SABA + regular inhaled corticosteroid + regular LABA (salmeterol)
If not controlling up corticosteroid dose to highest possible
Note: for under 5s use leukotriene antagonist instead of LABA
Step 3/4 alternatives for chronic asthma?
Leukotriene antagonists
Modified release oral theophylline (aminophylline)
Oral B2 agonists if really bad
Summary of step 4 for chronic asthma management?
PRN SABA
Regular highest dose inhaled corticosteroid
Regular LABA if of any benefit
One of regular inhaled leukotriene antagonist, oral theophylline or oral beta 2 agonist
