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THE WHEEZY INFANT

THE WHEEZY INFANT. ADIL WARIS. ACUTE BRONCHIOLITIS. Usually one off episode Recurrence is rare Mx hypertonic saline .. Mechanism of action?. CHRONIC BRONCHIOLITIS. Bronchiolitis obliterans History of a severe insult important Measles and adenovirus Persistent air trapping

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THE WHEEZY INFANT

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  1. THE WHEEZY INFANT ADIL WARIS

  2. ACUTE BRONCHIOLITIS • Usually one off episode • Recurrence is rare • Mx hypertonic saline .. Mechanism of action?

  3. CHRONIC BRONCHIOLITIS • Bronchiolitis obliterans • History of a severe insult important • Measles and adenovirus • Persistent air trapping • Mx don’t do antihistamines

  4. COW MILK ALLERGY • Clear history on formula milk use • Even via breast milk • Examine the skin • Trial of DAIRY AVOIDANCE indicated

  5. GERD • Classic symptoms may be absent • Weight associated GERD • Investigation tools not accurate, not readily available, expertise needed, expensive • Trial of therapy acceptable

  6. CARDIAC • History and CVS exam • ECHO

  7. Broncho - pulm dysplasia • “chronic lung disease of infancy” • h/o IPPV and oxygen use • increased airway reactivity • Exacerbation of wheezing may occur in viral infection, physical exertion, GER, or fluid overload

  8. BRONCHITIS • Protracted bacterial bronchitis(PBB) • Chronic cough • Relatively well • May wheeze but rare • Not air trapped on percussion • 10 – 14 day antibiotic course

  9. TUBERCULOSIS • Enlarged hilar nodes • Lateral CXR • Failure to thrive • Monophonic wheeze

  10. Congenital airway anomalies • Tracheal stenosis / web • Tracheoesophageal fistula • Bronchogenic cysts • Vascular rings and slings – usually pulm artery slings give wheeze, at rest a stridor • Ct scan indicated

  11. SWALLOWING INCOORDINATION • Neurologically impaired child • Wet bibs • Oropharyngeal pooling • History of cough with fluid diet • Modified swallow studies • Trial of water and solid diet • Trial of NG feeds

  12. FOREIGN BODY • Rare in infancy • Clear history.. hopefully • Monophonic wheeze • or unequal breath sounds • Flexible bronchoscopy • Remember esophageal FB

  13. CYSTIC FIBROSIS • Mainly caucasians • Failure to thrive • Loose stool… fecal elastase/ Fecal steatocrit • Air trapped • Sweat test not available • Sweat iontophoresis • Delta F 508

  14. OTHERS • Primary ciliary dyskinesia • Bacterial tracheitis • Intestitial lung disease

  15. ASTHMA • Takes time to aerosensitise • History of first episode important • Two patients in ten years and symptoms began in 11th month • Everybody has a family atopic history

  16. Conclusion • Very common • Easy to mismanage • Choose your investigational tool well • Trial of therapy where appropriate eg ten day dairy free then PPI trial • Cow milk allergy and GERD common • Asthma rare

  17. QUESTIONS

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