RESPIRATORY SYSTEM CONDITIONS

Mrs. J. Leshan C.O pediatrician

Defination • Is an inflammatory condition of the lung • Is characterized by inflammation of the parenchyma of the lung ( alveoli) & abnormal alveolar filling with fluid (consolidation & exudation) Causes / types

1) Infectious pneumonia Bacterial, viral, fungal, parasitic, atypical, community acquired, hospital acquired 2) Non- infectious Chemical pneumonia 3)Pneumonia caused by infectious & non- infectious agents , lipid pneumonia,

Causes • Gram positive- strept pneumoniae,-most common Staph aureus Strept agalactiae- in newborn babies • Gram negative; H. influenzae, klebsiella, E. coli, pseudomonas aeroginosa Classification

• Very severe pneumonia • Severe pneumonia • Pneumonia Very severe pneumonia

Cough or DIB plus at least one of the following; • Central cyanosis • Inability to B/feed or drink or vomiting everything • Convulsion, lethargy or unconsciousness • Severe respiratory distress Cnt….

In addition, some or all of the other signs of pneumonia may be present; • Tachypnoea • Nasal flaring • Grunting ( in young infants) • Lower chest in drawing • Chest auscultation- decreased B/sound bronchial B/sound, crackles • Abnormal vocal resonance Severe pneumonia

Cough or DIB plus at least one of the following signs; • Lower chest wall in drawing- main sign • Nasal flaring • Grunting ( in young infants) • In addition, some or all the other signs of pneumonia Pneumonia

• Child has cough, DIB & tachypnoea • In addition other signs of pneumonia in auscultation may be present NB: check that the child has NONE of the severe or very severe pneumonia Management

1) Very severe pneumonia supportive mnx • Admit the child to hospital • Oxygen- continue until sign of hypoxia( severe lower chest in drawing) is no longer present • Remove by gentle suction any thick secretions in the throat which the child cannot clear • Encourage breast feeding • If the child cant drink, insert NG tube & give maintenance fluid in frequent small amounts • Monitor vital signs every 3 hours Specific mnx

• I.V x-pen 50,000IU/kg every 6 hours plus gentamycin 7.5 mg/kg OD for 5 days • If child improves continue with oral amoxyl 25mg/kg 2) Severe pneumonia mnx

• Admit • Supportive Rx- as very severe pneumonia • X-pen for atlist 3 days then switch to oral amoxyl when child improves 3) Pneumonia

• Treat the child as out patient • Cotrimoxazole BD or amoxycillin

Definition • Is an acute viral infection with maximum effect at the bronchiolar level. • Is rare in children above 2 years of age • Peak age 3-6 months Causes

• Respiratory syncytial virus ( RSV)-most common cause • Others; adenovirus, , parainfluenza Pathophysiology

• There's swelling of bronchiole mucosa and Lumina are filled with mucus and exudates. • The walls of the bronchi and bronchioles are infiltrated with inflammatory cells. • Varying degrees of obstruction produced in the small air passages lead to hyperinflation, obstructive emphysema resulting from partial obstruction & patchy areas of . • Dilation of bronchial passages on inspiration allows sufficient space for intake of air but narrowing of the passages on expiration prevents air from leaving the lungs. Clinical presentation

Initial • Rhinorrhoea • • Cough/ sneezing • Wheezing • +/- otitis media & conjunctivitis • Intermittent Gradual

• Increased coughing and wheezing • Air hunger • Tachypnoea and chest in drawing • cyanosis Severe

• Apneic spells • Hypercapnia (rise in arterial carbon dioxide tension) leading to respiratory acidosis and hypoxemia Management

• Admit –those in gradual or severe illness • Adequate fluid intake • Humidified Oxygen • Bed rest • Bronchodilators and

• Is inflammation of the large airways( & bronchi) • Is not very common in children • Can be acute or chronic Aetiology

• Is associated with URI • 90% are viral i.e. adenovirus, influenzae, parainflenza Other causes; • Bacterial infection e.g. S.pneumoniae, H. influenza • Air pollutants (expose infants to smoking) • Cold dump environment • Chronic aspiration or gastroesophageal reflux • Fungal infection • Congenital heart disease Features

• persistent dry hacking, non productive cough that worsens at night and becomes productive in 2-3 days. Management

• Bed rest • Adequate hydration • Oral corticosteroids- due to persistent cough • Bronchodilator • Avoidance of smoke Complications

• • • Acute ACUTE

• Is a serious obstructive inflammatory process that occurs predominantly in children 2-5 years of age. • The obstruction is supraglottic unlike subglottic obstruction of . • Cause; bacterial-haemophilus influenzae Features

• Onset is rapidly progressive • Sore throat and pain in swallowing • Drooling of saliva • Fever • Toxic appearance ( child appears sicker) • Child insist on sitting upright & leaning forward with chin thrust, mouth open & tongue protruding (tripod position) • Sridor aggravated when supine • Rapid pulse & respiration Management

• Analgesic • Antibiotics • antipyretics LARYNGOTRACHEOBRONCHITI S -LTB() • Is a respiratory condition that is usually triggered by acute viral infection of upper airway. Causes

• Viral- parainfluenza, influenza, measles, adenovirus, RSV. • Bacterial-staph aureus, strept pneumonae, H. influenza Pathophysiology

• The Infection leads to swelling of the , trachea, & large bronchi due to infiltration of WBCs. • The swelling produces leading to increased work of breathing & the characteristic turbulent, noisy air flow known as stridor Features stage I • Hoarseness • Barking cough • Inspiratory sridor when disturbed Stage II

• Continuous respiratory sridor ( even at rest) • Lower rib retraction • Retraction of soft tissue of • Use of accessory muscles of respiration • Labored respiration Stage III

• Signs of anoxia & carbon dioxide retention • Restlessness • Anxiety • Pallor • Sweating • Rapid respiration Stage IV

• Intermittent /permanent cyanosis • Cessation of breathing Management

• Keep the child calm • Admit-from stage II • Oxygen • Rehydration • Corticosteroids- inhalation or parenteral • Nebulised epinephrine • Stage I is self limiting therefore managed at home but explain to the parent to return if disease progresses. Complications

• Respiratory failure • Bacterial • Pneumonia • Pulmonary oedema • Cardiac arrest

• Is a chronic inflammatory disease of the airways in which many cells (mast cells, eosinophils &T lymphocytes) play a role. • The chronic airway inflammation is associated with airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness & coughing particularly at night or early morning. • These episodes are associated with airway obstruction within the lung that is reversible either spontaneously or with treatment. Etiology

• Atopy ( the genetic predisposition for the development of an IgE- mediated response to common aeroallergens) is the strongest predictor for developing asthma. • It tends to run in families • Early in life is more common in boys than girls especially among first born boys. • Allergy influences both the persistence & severity of asthma. Trigger factors for ashmatic attacks/ exacerbations • Allergens e.g. pollens, dust • Irritants –smoke,odors,sprays • Emotional reactions-fear, anger, laughing, crying • Exercise • Cold air • Changes in weather or temperature • Environmental change i.e. moving to new home, school • Infections • Animals –cats, dogs, rodent, horses • Medications i.e. NSAIDS, beta blockers • Exposure to occupational chemical • Foods-dairy products, nuts • Conditions i.e. GERD,TEF • Endocrine factors-menses, pregnancy, thyroid disease Clinical presentation

• Cough-hacking, paroxysmal, irritative& nonproductive then becomes rattling& productive of frothy, clear gelatinous sputum • • Prolonged expiratory phase • Wheeze • Restlessness /anxiety • Cyanosis • May have malar rash and red eyes • Speak with short, panting, broken phrases • Use of accessory muscles of respiration • Hyper resonance on percussion Management

Quick relief/ rescue medications: • Nebulized bronchodilators • Metered dose inhalers with a spacer i.e. corticosteroids, bronchodilators • S.C adrenaline 0.01 mg/kg Long-term control/ preventor medications: • Salbutamol inhaled or P.O • Corticosteroids- predinisolone • Avoid allergens • Counsel/ educate the parents about the disease, management and prevention • Follow up Ddx

• Recurrent viral infections • Chronic rhino- • GERD • TB • CHD • Foreign body aspiration • • Bronchopulmonary dysplasia • primary cilliary dyskinesia syndrome • Immune deficiency TUBERCULOSIS

• Is caused by mycobacterium tuberculosis • Is spread through aerosol droplets when a person with active TB sneezes, cough, speak, spit, sing or laugh. • Children with HIV infection have increased incidence of TB • Most infections are asymptomatic and latent but one in ten latent infections progresses to active TB Classification

1) Pulmonary TB- 90% 2) Extra pulmonary TB-10% • Pleural • Miliary TB • TB meningitis • TB adenitis • Urogenital TB • Bones & joints (potts disease of spine) Features

• Cough for more than 2 weeks despite use of antibiotics • Night sweat • Weight loss • Enlarged lymphnodes • Persistent fever ( >3 weeks) • Chest pain • Inadequate growth (low weight for age or FTT) • History of contact with an adult with chronic cough or on Rx for TB TB scoring chart

Feature/ 0 1 3 score

Duration of < 2 weeks 2-4 weeks > 4 weeks illness

Nutritional > 80% 60-80% < 60% status (weight for age) Family None Reported Confirmed history of TB smear +ve Score chart 2

Positive tuberculin test 3 Enlarged painless lymph nodes, sinus present 3 Night sweats, unexplained fever 2 Malnutrition not improving after treatment 3 Angle deformity of spine 4 Firm, non-fluid, non-traumatic swelling of joint 3 Unexplained abdominal swelling or ascites 3 Change of temperament, fits or coma 3 Abdominal X-ray 2 Cnt….

• When total score for chart 1 &2 together is 7 or more, then treat for TB Management

• 2RHZ/ 4RH • Adequate nutrition • Follow up ASSIGNMENT

1. a) Define status ashmaticus b) How do you manage status asthmaticus 2. List types of poisons in pediatrics and their management 3. Briefly describe abdominal wall defects 4. Concerning chicken pox, write short notes on definition, causes, presentation & management