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Diseases of the respiratory tract. Dr. György Fekete www.gyer2.sote.hu. Pediatric pulmonary diseases. 50% of deaths under age of 1 yr 20% of all hospitalisations under age of 15 yrs 7% of children: chronic disorder of the lower respiratory system. Most common diseases.
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Diseases of the respiratory tract Dr. György Fekete www.gyer2.sote.hu
Pediatric pulmonary diseases • 50% of deaths under age of 1 yr • 20% of all hospitalisations under age of 15 yrs • 7% of children: chronic disorder of the lower respiratory system
Most common diseases • Viral upper respiratory infections • Otitis media • Pneumonia • Asthma • Cystic fibrosis
Symptoms • Dyspnea, tachypnea, hyperpnea • Cough • Chest pain • Rales(crackles), rhonchi • Wheezing • Retractions • Fever
Diagnostic measures • History (parents, child) • Inspection (flaring of alae nasi) • Auscultation (take a deep breath: blow out a candle) • Respiratory rate (younger than 1 year: 25-35/min, sleeping) • Imaging techniques • Arterial blood gas analysis • Pulse oximetry, capnography • Pulmonary function testing • Laryngoscopy, bronchoscopy
Congenital disorders • Laryngomalacia: first 6 weeks, inspiratory stridor, underdevelopment of supraglottic cartilage
Subglottic hemangiomas stridor
Vascular rings • Compress the trachea /esophagus: double aortic arch, pulmonary sling • In infants: chronic airway obstruction, stridor, wheezing, croupy cough, apnea • Dg: barium swallow: esophageal compression • Th: surgical correction
Croup syndrome • Viral croup: parainfluenza, RSV, adenovirus • Mycoplasma pneumoniae • Barking cough, stridor, retractions, cyanosis • Th: oral hydration, nebulized racemic epinephrine (2.25% sol.), oral dexamethasone (0.15 mg/kg), inhaled budenoside
Epiglottitis • Emergency! 2-7 yrs • Haemophilus influenzae type B (vaccination) • Sudden onset of fever • Dysphagia, muffled voice, cyanosis, stridor, inspir. retractions • Progression to total airway obstruction • Th: endotracheal intubation, ceftriaxone iv. • Manipulate as little as possible!
Foreign body aspiration, upper respiratory tract • 6 mo. – 4 yrs (small toys, peanuts) • Acute onset of cyanosis, choking, stridor (partial obstruction), inability to caugh or vocalize / aphonia / (complete obstruction) • Loss of consciousness, seizures, cardiopulmonary arrest • Th: emergency intubation, tracheostomy
Foreign body aspiration, lower respiratory tract • Sudden onset of caugh, wheezing,later chronic cough, recurrent pneumonia • Bronchiectasis, lung abscess • Physical finding: asymmetric breath sounds, localized wheezing • Dg.: inspiratory and forced expiratory chest X-ray : mediastinal shift away from the affected side (Holzknecht sign) • Complete obstruction: atelectasis • Th: bronchoscopy
Bronchitis • Acute: nonproductive caugh, low fever • Physical symptom: diffuse rhonchi • Viral infection • Chronic: non-infectious causes: asthma, sinusitis, cystic fibrosis, respiratory tract anomalies, foreign bodies, recurrent aspiration
Asthma • Risk factors: atopic dermatitis, smoking in the family • Shedding of airway epithelium, edema, mucus plug formation, mast cell activation • Sensitisation to inhalant allergens: perennial aeroallergens, dust mites, cockroaches, animals
Mast cell, Normal marrow One 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
Asthma • Wheezing, caugh, dyspnea, exercise intolerance, recurrent bronchitis and pneumonia, prolongation of the expiratory phase • Flaring of nostrils, intercostal- suprasternal retractions • Hypoxia: cyanosis of the lips, nail beds, tachycardia, agitation
Asthma • X-ray: hyperinflation , atelectasis • Serum IgE elevated, RIA for specific allergens • Skin tests • Pulmonary function tests (FEV1, PEFR)
Asthma treatment • Stepwise approach, assessment of clinical symptoms • Inhaled corticosteroids • Long-acting inhaled beta-2 agonists • Rescue: systemic corticosteroids • Bronchodilators • Leukotriene receptor antagonists and modifiers (Montelukast, zileuton) • Anti-inflammatory drugs
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Bronchopulmonary dysplasia (BPD) • Acute respiratory distress, first week of life • 30% of infants with birth-weight of less than 1000 grams • Chronic lung disease, inflammatory mediators, infection, lung development, barotrauma • Oxygen requirement for more than 28 days, positive pressure ventilation, CPAP, gestational age
Bacterial pneumonia • Risks: aspiration, immunodeficiency, tracheoesophageal fistula, cleft palate, CF, congestive heart failure, splenectomia,etc. • Fever, cough, dyspnea, meningismus, abdominal pain, otitis media, • Laboratory findings: elevated WBC, CRP • Chest X-ray • Age-specific bacteria • Complications: empyema, sepsis, abscesses
Mediastinal masses • Cough, wheezing, symptoms of infection, hemoptysis, dysphagia, pressure on the recurrent laryngeal nerve: hoarseness, vena cava superior syndrome • Cystic hygromas, vascular or neurogenic tumors, thymic masses, lymphomas, teratomas, esophageal lesions, mediastinal abscess