Week 23 - respiratory disease Flashcards
Cold vs flu symptoms
Cold:
-Congestion
-Watery/itchy eyes
-Feeling tired
Both:
-Cough
-Runny / stuffy nose
-Sore throat
-Headache
Flu:
-Fever
-Body aches
-Extreme fatigue
Common cold
Mild, self-limiting, viral (rhinovirus), upper respiratory tract infection
General symptoms:
Nasal stuffiness and discharge, sneezing, sore throat, and cough
->No known treatment improves the time course of infection
Transmitted by either direct contact or aerosol transmission
->People can remain infectious for several weeks
The most common complications are; sinusitis, lower respiratory tract infections (LRTI), and acute otitis media
Onset of symptoms after infection is sudden, reaching a peak at day 2–3, then decreasing in intensity
Common cold - duration
-In adults and older children, symptoms tend to last about a week -> although cough can persist for up to 3 weeks
-In younger children, symptoms typically last 10–14 days
->Smokers tend to have more severe respiratory symptoms (including cough), and the infection is more prolonged
Common cold - common symptoms
Common symptoms or signs in adults and older children
include:
-Sore or irritated throat
-Nasal irritation, congestion, nasal discharge (rhinorrhoea),
and sneezing
-Nasal discharge is often profuse and clear at first but becomes thicker and darker as the infection progresses
-Cough, which typically develops after nasal symptoms clear
-Hoarse voice caused by associated laryngitis
-General malaise
Seasonal influenza
Acute respiratory illness caused by RNA viruses of the family Orthomyxoviridae (influenza viruses)
Most complications of influenza in adults are respiratory in nature and include:
-Acute bronchitis
-Pneumonia
-Exacerbations of asthma and chronic obstructive
pulmonary disease (COPD)
-Otitis media
-Sinusitis
Seasonal influenza - severity
Influenza presents with symptoms appearing around 2 days after exposure;
->Uncomplicated influenza: coryza (inflammation), nasal
discharge, cough, fever, gastrointestinal (GI) symptoms,
headache, malaise, myalgia, arthralgia, ocular symptoms, and sore throat
->Complicated influenza:
require hospital admission,
involve the lower respiratory tract, central nervous system (CNS), or cause significant exacerbation of an underlying medical condition
‘At risk’ group includes (seasonal influenza)
Those with chronic respiratory, heart, kidney, liver, or neurological disease; diabetes mellitus (DM); or those who are obese or immunosuppressed:
-Those > 65 years
-Women who are pregnant (or women up to two weeks post partum)
-Children aged < 6 months
Management (seasonal influenza)
-Drink adequate fluid
-Take paracetamol or ibuprofen to relieve symptoms, rest
-Stay off work or school until the worst symptoms have resolved (usually ~1 week)
Urgent admission to hospital should be considered if… (seasonal influenza)
-A complication such as pneumonia occurs
-The person has a concomitant disease that may be affected by influenza (for example, type 1 diabetes)
-There is suspicion of a serious illness other than influenza (for example, meningitis)
Cough
It is a reflex response to airway irritation -> triggered by stimulation of airway cough receptors, either by irritants
or by conditions that cause airway distortion
->Cough can be acute (lasting < 3 weeks), sub-acute (lasting 3–8 weeks),
->or chronic (lasting > 8 weeks).
Commonly caused by a viral upper respiratory tract infection (URTI)
Other causes include:
-Acute bronchitis
-Pneumonia
-Acute exacerbations of asthma
-Environmental or occupational causes
-Foreign body aspiration
Cough - management
Management of people with cough should be based on treating the underlying cause where it has been identified, or sequential trials of treatment to confirm or refute common causes
->Offer self care (e.g. paracetamol or ibuprofen for pain and inflammation,
if appropriate), and refer to smoking cessation if relevant
Cough - referral
Referral to a respiratory physician should be arranged for people with a cough that does NOT respond to trials of treatment, if the diagnosis is
uncertain, or if systemically unwell
->Emergency referral should be arranged for people with:
-Clinical features of foreign body aspiration
Croup
Croup (laryngotracheobronchitis) is a common childhood disease
->Usually caused by a virus
Symptoms:
sudden onset of a seal-like barking cough usually
accompanied by stridor (predominantly inspiratory), hoarse voice, and respiratory distress due to upper-airway obstruction
Symptoms are usually worse at night -> there may be a fever.
-There is often a preceding 12–48 hour history of a non-specific
cough, rhinorrhoea, and fever
-Croup most commonly affects children between 6 months and
6 years of age -> peak incidence during the second year of life
Mild croup symptoms
Seal-like barking cough
but no stridor or sternal / intercostal recession at rest
Moderate croup symptoms
Seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy
Severe croup symptoms
Seal-like barking cough with stridor and sternal / intercostal
recession associated with agitation or lethargy
->A child should be immediately admitted when presenting with moderate or severe croup, or impending respiratory failure
Croup - management
All children with mild, moderate, or severe croup should receive a single dose of oral dexamethasone (0.15 mg
per kg body weight)
->If the child is too unwell to receive medication -> inhaled
budesonide (2 mg nebulised as a single dose) or intramuscular
(IM) dexamethasome (0.6 mg/kg as a single dose) are possible
alternatives
-Mild croup can usually be managed at home
-Croup is usually self-limiting and symptoms usually resolve
within 48 hours
->If the child is being managed at home, the use of paracetamol or ibuprofen to control fever and pain should be advised, and
parents should be advised to seek urgent medical advice if there is any deterioration
Whooping cough
Also known as pertussis
->Highly infectious disease caused by the bacterium Bordetella pertussis
->It is spread by aerosol droplets released during coughing, and
disproportionately affects infants and young children
-The incubation period is usually about 7 days, and the person is infectious for 3 weeks after the onset of symptoms
Whooping cough has 3 phases of symptoms:
The catarrhal phase -> lasts ~ a week and is characterised by the development of a dry, unproductive cough
The paroxysmal phase -> may last for a month or more and is characterised by coughing fits, whooping, and post-tussive vomiting, the person may be relatively well between paroxysms
The convalescent phase -> may last an additional 2 months or more -> is characterised by gradual improvement in the frequency and severity of symptoms
Whooping cough -> management
Whooping cough is a notifiable disease!!!
->People who are seriously unwell should be admitted to hospital (a low threshold is required for children aged 6 months or less)
->An antibiotic (usually a macrolide, such as erythromycin or clarithromycin) should be prescribed to all people with suspected or confirmed whooping cough with onset of cough within the previous 21 days
->Advice should be given on rest, adequate fluid intake, and the use of paracetamol or ibuprofen for symptomatic relief
->Children and healthcare workers should be advised to stay off nursery, school, or work until 48 hours of appropriate antibiotic treatment has been
completed, or 21 days after onset of symptoms if not treated
->Close contacts may require antibiotic prophylaxis
9 types of cough in children
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