Respiratory Diseases In Pediatric Patients Flashcards
WBCs that take part in asthma
Mast cells
Neutrophils
Eosinophils
T-lymphocytes
Macrophages
Epithelial cells
Status asthmaticus
Acute severe asthma that occurs in the refractory state of a failed SABA/LABA treatment
- can also be treatment from subcutaneous epinephrine
What is the most common lower airway disease in children under 18?
Asthma
Asthma physiology
Chronic inflammatory condition that result in the lung airways being episodically obstructed
The chronic inflammation heightens the sensitivity of airways leadings to hyper responsiveness of airways (bronchospasms)
In children, up to 50% of the total airway resistance can increase
Etiology of wheezing in children’s
1) infections
2) transient wheezers w/ asthma
- wheezing with asthma up to 6yrs (then goes away spontaneously)
3) persistent wheezers w/ asthma
- same as #2 but goes further past age 6
4) late onset wheezer w/ asthma
- same as #3 except starts at 3 yrs rather than when born
Anatomic causes of wheezing
1) central airway wheezing
- laryngomalacia and tracheomalacia
2) extrinsic airway anomalies
- infections
- tumors
- foreign bodies in esophagus
3) intrinsic airway anomalies
- hemangiomas
- tumors
- cystic malformations
Common triggers related to asthma
Allergies
Tobacco smoke
Air pollution and strong orders
exercise induced broncoconstriction
Medications (NSAIDs and BBs)
Emotional anxiety/stress
Weather
Asthma management in children
Always aimed at reducing airway inflammation
1) minimize proinfllatory environment exposures
2) use anti inflammatory medications (pending on what the degree of asthma is)
- corticosteroids
- LABAs
- leukotriene modifers
3) use quick relief medications (SABAs)
When nebulizer vs normal inhaler?
Young child or person cant take in deep breaths for whatever reasons
What does respiratory distress in asthma for children look like?
Retractions
Supraclavicular Indrawing when breathing
Prolonged Expiratory phase of breathing
Standard treatment for asthma exacerbation
Albuterol nebulizer treatments for 15 min
If not better, after albuterol monotherapy, give 3 back-to-back treatments of prednisilone or dexamethasone (corticosteroids) and try again
- If not better at this point send to ER
Send home with albuterol and inhaled steroid for recurrent wheezing
- start inhaled steroid immediately once coughing begins
Laryngomalacia
Exaggerated collapse of the glottis structures during inspiration
- diagnosis is confirmed based on symptoms and flexible laryngoscopy
Requires xrays if in respiratory distress to rule out worse diagnosis
Symptoms:
- noisy breathing and stridor on inhalation (worsens with agitation/crying/feeding/sleeping on back)
- poor weight gain
- apnea
- cyanosis
- GERD
- aspiration
Treatment of laryngomalacia
Usually outgrows it and just requires monitoring during severe episodes
If reflux is present, must be managed differently
If respiratory distress/cyanosis or serious weight loss occurs: requires supraglattoplasty surgery
Tracheomalacia
Chondromalacia of a central airway that leads to insufficient cartilage to maintain airway conductance and latency
Causes persistent wheezing in infancy
Males get this more than females and can be primary or secondary
Symptoms: - low pitched monophonic wheezing on expiration - is persistently congested - wheezing is loudest over trachea -
Primary vs secondary tracheomalacia
Primary:
- congenital absence of tracheal supporting cartilage (may also be oddly shaped as well)
Secondary:
- caused by blockage or obstruction of the airway secondary to an underlying disease