Diseases of the Diseases of the respiratory tractrespiratory tract

Dr. György Fekete Dr. György Fekete

www.gyer2.sote.huwww.gyer2.sote.hu

Pediatric pulmonary diseasesPediatric pulmonary diseases

50% of deaths under age of 1 yr50% of deaths under age of 1 yr 20% of all hospitalisations under age 20% of all hospitalisations under age

of 15 yrsof 15 yrs 7% of children: chronic disorder of the 7% of children: chronic disorder of the

lower respiratory systemlower respiratory system

Most common diseasesMost common diseases

Viral upper respiratory infectionsViral upper respiratory infections Otitis mediaOtitis media PneumoniaPneumonia AsthmaAsthma Cystic fibrosisCystic fibrosis

SymptomsSymptoms

Dyspnea, tachypnea, hyperpneaDyspnea, tachypnea, hyperpnea CoughCough Chest painChest pain Rales(crackles), rhonchiRales(crackles), rhonchi WheezingWheezing RetractionsRetractions FeverFever

Diagnostic measuresDiagnostic measures

History (parents, child)History (parents, child) Inspection (flaring of alae nasi)Inspection (flaring of alae nasi) Auscultation (take a deep breath: blow out a candle)Auscultation (take a deep breath: blow out a candle) Respiratory rate (younger than 1 year: 25-35/min, Respiratory rate (younger than 1 year: 25-35/min,

sleeping)sleeping) Imaging techniquesImaging techniques Arterial blood gas analysisArterial blood gas analysis Pulse oximetry, capnographyPulse oximetry, capnography Pulmonary function testingPulmonary function testing Laryngoscopy, bronchoscopyLaryngoscopy, bronchoscopy

Congenital disordersCongenital disorders

Laryngomalacia:Laryngomalacia: first 6 weeks, first 6 weeks, inspiratory stridor, underdevelopment inspiratory stridor, underdevelopment of supraglottic cartilageof supraglottic cartilage

Subglottic hemangiomasSubglottic hemangiomas

stridorstridor

Vascular ringsVascular rings

Compress the trachea /esophagus: double Compress the trachea /esophagus: double aortic arch, pulmonary slingaortic arch, pulmonary sling

In infants: chronic airway obstruction, In infants: chronic airway obstruction, stridor, wheezing, croupy cough, apnea stridor, wheezing, croupy cough, apnea

Dg:Dg: barium swallow: esophageal barium swallow: esophageal compressioncompression

Th:Th: surgical correction surgical correction

Allergic rhinitisAllergic rhinitis

Allergic rhinitisAllergic rhinitis

Allergic rhinitisAllergic rhinitis

Croup syndromeCroup syndrome

Viral croup:Viral croup: parainfluenza, RSV, parainfluenza, RSV, adenovirusadenovirus

Mycoplasma pneumoniaeMycoplasma pneumoniae Barking cough, stridor, retractions, Barking cough, stridor, retractions,

cyanosiscyanosis Th:Th: oral hydration, nebulized racemic oral hydration, nebulized racemic

epinephrine (2.25% sol.), oral epinephrine (2.25% sol.), oral dexamethasone (0.15 mg/kg), inhaled dexamethasone (0.15 mg/kg), inhaled budenosidebudenoside

EpiglottitisEpiglottitis

Emergency! 2-7 yrsEmergency! 2-7 yrs Haemophilus influenzae type B (vaccination)Haemophilus influenzae type B (vaccination) Sudden onset of feverSudden onset of fever Dysphagia, muffled voice, cyanosis, stridor, Dysphagia, muffled voice, cyanosis, stridor,

inspir. retractionsinspir. retractions Progression to total airway obstructionProgression to total airway obstruction Th:Th: endotracheal intubation, ceftriaxone iv. endotracheal intubation, ceftriaxone iv. Manipulate as little as possible!Manipulate as little as possible!

Foreign body aspiration, upper Foreign body aspiration, upper respiratory tractrespiratory tract

6 mo. – 4 yrs (small toys, peanuts)6 mo. – 4 yrs (small toys, peanuts) Acute onset of cyanosis, choking, stridor Acute onset of cyanosis, choking, stridor

(partial obstruction), inability to caugh or (partial obstruction), inability to caugh or vocalize / aphonia / (complete obstruction)vocalize / aphonia / (complete obstruction)

Loss of consciousness, seizures, Loss of consciousness, seizures, cardiopulmonary arrestcardiopulmonary arrest

Th:Th: emergency intubation, tracheostomy emergency intubation, tracheostomy

Foreign body aspiration, lower Foreign body aspiration, lower respiratory tractrespiratory tract

Sudden onset of caugh, wheezing,later chronic Sudden onset of caugh, wheezing,later chronic cough, recurrent pneumoniacough, recurrent pneumonia

Bronchiectasis, lung abscessBronchiectasis, lung abscess Physical finding: asymmetric breath sounds, Physical finding: asymmetric breath sounds,

localized wheezinglocalized wheezing Dg.:Dg.: inspiratory and forced expiratory chest X- inspiratory and forced expiratory chest X-

ray : mediastinal shift away from the affected ray : mediastinal shift away from the affected side (Holzknecht sign)side (Holzknecht sign)

Complete obstruction: atelectasisComplete obstruction: atelectasis Th:Th: bronchoscopy bronchoscopy

BronchitisBronchitis

Acute:Acute: nonproductive caugh, low fever nonproductive caugh, low fever Physical symptom: diffuse rhonchiPhysical symptom: diffuse rhonchi Viral infectionViral infection Chronic:Chronic: non-infectious causes: asthma, non-infectious causes: asthma,

sinusitis, cystic fibrosis, respiratory tract sinusitis, cystic fibrosis, respiratory tract anomalies, foreign bodies, recurrent anomalies, foreign bodies, recurrent aspirationaspiration

AsthmaAsthma

Risk factors:Risk factors: atopic dermatitis, smoking in atopic dermatitis, smoking in the familythe family

Shedding of airway epithelium, edema, Shedding of airway epithelium, edema, mucus plug formation, mast cell activationmucus plug formation, mast cell activation

Sensitisation to inhalant allergens: Sensitisation to inhalant allergens: perennial aeroallergens, dust mites, perennial aeroallergens, dust mites, cockroaches, animalscockroaches, animals

Mast cell, Normal marrowOne mast cell partially degranulated (vacuolated areas), 1 plasma cell, 1 blast (top right center) 4 neutrophilic myelocytes, 2 band neutrophils, 1 smudge cell. Normal marrow - 100X

                                                                                                                                                                                    

                                             

                                                     

       

AsthmaAsthma

Wheezing, caugh, dyspnea, exercise Wheezing, caugh, dyspnea, exercise intolerance, recurrent bronchitis and intolerance, recurrent bronchitis and pneumonia, prolongation of the expiratory pneumonia, prolongation of the expiratory phasephase

Flaring of nostrils, intercostal- suprasternal Flaring of nostrils, intercostal- suprasternal retractionsretractions

Hypoxia: cyanosis of the lips, nail beds, Hypoxia: cyanosis of the lips, nail beds, tachycardia, agitation tachycardia, agitation

AsthmaAsthma

X-ray: hyperinflation , atelectasisX-ray: hyperinflation , atelectasis Serum IgE elevated, RIA for specific Serum IgE elevated, RIA for specific

allergensallergens Skin testsSkin tests Pulmonary function tests (FEV1, PEFR)Pulmonary function tests (FEV1, PEFR)

Asthma treatmentAsthma treatment

Stepwise approach, assessment of clinical Stepwise approach, assessment of clinical symptomssymptoms

Inhaled corticosteroidsInhaled corticosteroids Long-acting inhaled beta-2 agonistsLong-acting inhaled beta-2 agonists Rescue: systemic corticosteroidsRescue: systemic corticosteroids BronchodilatorsBronchodilators Leukotriene receptor antagonists and modifiers Leukotriene receptor antagonists and modifiers

(Montelukast, zileuton)(Montelukast, zileuton) Anti-inflammatory drugsAnti-inflammatory drugs

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Nebulizer use - part one

                                                            

Nebulizers are used to treat asthma, Chronic Obstructive Pulmonary Disease (COPD), and other conditions where inhaled medicines are indicated. Nebulizers deliver a stream of medicated air to the lungs over a period of time.

Review Date: 9/11/2002 12:00:00 AMReviewed By:A.D.A.M Medical Illustration Team

                               

Bronchopulmonary dysplasia Bronchopulmonary dysplasia (BPD)(BPD)

Acute respiratory distress, first week of lifeAcute respiratory distress, first week of life 30% of infants with birth-weight of less 30% of infants with birth-weight of less

than 1000 gramsthan 1000 grams Chronic lung disease, inflammatory Chronic lung disease, inflammatory

mediators, infection, lung development, mediators, infection, lung development, barotraumabarotrauma

Oxygen requirement for more than 28 Oxygen requirement for more than 28 days, positive pressure ventilation, CPAP, days, positive pressure ventilation, CPAP, gestational agegestational age

Bacterial pneumoniaBacterial pneumonia

Risks:Risks: aspiration, immunodeficiency, aspiration, immunodeficiency, tracheoesophageal fistula, cleft palate, CF, tracheoesophageal fistula, cleft palate, CF, congestive heart failure, splenectomia,etc.congestive heart failure, splenectomia,etc.

Fever, cough, dyspnea, meningismus, Fever, cough, dyspnea, meningismus, abdominal pain, otitis media, abdominal pain, otitis media,

Laboratory findings:Laboratory findings: elevated WBC, CRP elevated WBC, CRP Chest X-rayChest X-ray Age-specific bacteriaAge-specific bacteria Complications:Complications: empyema, sepsis, abscesses empyema, sepsis, abscesses

Mediastinal massesMediastinal masses

Cough, wheezing, symptoms of infection, Cough, wheezing, symptoms of infection, hemoptysis, dysphagia, pressure on the hemoptysis, dysphagia, pressure on the recurrent laryngeal nerve: hoarseness, recurrent laryngeal nerve: hoarseness, vena cava superior syndromevena cava superior syndrome

Cystic hygromas, vascular or neurogenic Cystic hygromas, vascular or neurogenic tumors, thymic masses, lymphomas, tumors, thymic masses, lymphomas, teratomas, esophageal lesions, teratomas, esophageal lesions, mediastinal abscessmediastinal abscess