Diseases of the respiratory tract

1. Diseases of the respiratory tract Dr. György Fekete www.gyer2.sote.hu

2. 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

3. Most common diseases • Viral upper respiratory infections • Otitis media • Pneumonia • Asthma • Cystic fibrosis

4. Symptoms • Dyspnea, tachypnea, hyperpnea • Cough • Chest pain • Rales(crackles), rhonchi • Wheezing • Retractions • Fever

5. Diagnostic measures • History (parents, child) Childrenoftenknowthingstheirparentsdonot („lastweek I chokedon a peanut”) • Inspection (flaring of alaenasi) • Auscultation (take a deepbreath: blow out a candle) • Respiratoryrate (youngerthan 1 year: 25-35/min, sleeping !) • Stridor: harshsound • Imagingtechniques • Arterialbloodgasanalysis • Pulseoximetry, capnography • Pulmonaryfunction testing, spirometry • Laryngoscopy, bronchoscopy

6. Congenital disorders • Laryngomalacia:first 6 weeks, inspiratorystridor, underdevelopment of supraglotticcartilage • Benign • Symptomsdisappearby 18-24 months of age

7. Subglottichemangiomas stridor Skinhemangiomasin 50%

8. 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

11. Allergic rhinitis

12. Allergicrhinitis • Most prevalentchroniccondition: 5-40% inchildren • Recurrentsneezing, nasalcongestion, nasaldischarge • Rubbingthenosewiththepalm of thehand („allergicsalute”)

13. Allergic rhinitis

14. Croup syndrome • Upperairwayobstruction • Viralcroup:parainfluenza, RSV, adenovirus • Mycoplasmapneumoniae • Barkingcough, stridor, suprasternal, intercostal, subcostalretractions, cyanosis • Th: hospitalization, oralhydration, nebulizedracemicepinephrine (2.25% sol.), oraldexamethasone (0.15 mg/kg), inhaledbudenoside

15. Epiglottitis • Emergency! 2-7 yrs • Haemophilusinfluenzaetype B (vaccination) • Suddenonset of highfever • Dysphagia, muffledvoice, cyanosis, stridor, inspir. retractions • Progressiontototalairwayobstruction • Th:endotrachealintubation, ceftriaxoneiv. • Manipulateaslittleaspossible!

18. 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

19. 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

20. 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

21. 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

22. 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

28. 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

30. Asthma • X-ray: hyperinflation , atelectasis • Serum IgE elevated, RIA for specific allergens • Skin tests • Pulmonary function tests (FEV1, PEFR)

32. 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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37. 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

38. 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

41. 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