Diseases of the respiratory tract Dr Gyrgy Fekete

Diseases of the respiratory tract Dr. György Fekete www. gyer 2. sote. hu

Pediatric pulmonary diseases Ø 50% of deaths under age of 1 yr Ø 20% of all hospitalisations under age of 15 yrs Ø 7% of children: chronic disorder of the lower respiratory system

Most common diseases Ø Viral upper respiratory infections Ø Otitis media Ø Pneumonia Ø Asthma Ø Cystic fibrosis

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

Diagnostic measures Ø Ø Ø Ø Ø History (parents, child) Children often know things their parents do not („last week I choked on a peanut”) Inspection (flaring of alae nasi) Auscultation (take a deep breath: blow out a candle) Respiratory rate (younger than 1 year: 25 -35/min, sleeping !) Stridor: harsh sound Imaging techniques Arterial blood gas analysis Pulse oximetry, capnography Pulmonary function testing, spirometry Laryngoscopy, bronchoscopy

Congenital disorders Ø Laryngomalacia: first 6 weeks, inspiratory stridor, underdevelopment of supraglottic cartilage Ø Benign Ø Symptoms disappear by 18 -24 months of age

Ø Subglottic hemangiomas stridor Skin hemangiomas in 50%

Vascular rings Ø Compress the trachea /esophagus: double aortic arch, pulmonary sling Ø In infants: chronic airway obstruction, stridor, wheezing, croupy cough, apnea Ø Dg: barium swallow: esophageal compression Ø Th: surgical correction

Allergic rhinitis

Allergic rhinitis Ø Most prevalent chronic condition: 5 -40% in children Ø Recurrent sneezing, nasal congestion, nasal discharge Ø Rubbing the nose with the palm of the hand („allergic salute”)

Allergic rhinitis

Croup syndrome Ø Upper airway obstruction Ø Viral croup: parainfluenza, RSV, adenovirus Ø Mycoplasma pneumoniae Ø Barking cough, stridor, suprasternal, intercostal, subcostal retractions, cyanosis Ø Th: hospitalization, oral hydration, nebulized racemic epinephrine (2. 25% sol. ), oral dexamethasone (0. 15 mg/kg), inhaled budenoside

Epiglottitis Emergency! 2 -7 yrs Ø Haemophilus influenzae type B (vaccination) Ø Sudden onset of high fever Ø Dysphagia, muffled voice, cyanosis, stridor, inspir. retractions Ø Progression to total airway obstruction Ø Th: endotracheal intubation, ceftriaxone iv. Ø Manipulate as little as possible! Ø

Foreign body aspiration, upper respiratory tract Ø 6 mo. – 4 yrs (small toys, peanuts) Ø Acute onset of cyanosis, choking, stridor (partial obstruction), inability to caugh or vocalize / aphonia / (complete obstruction) Ø Loss of consciousness, seizures, cardiopulmonary arrest Ø Th: emergency intubation, tracheostomy

Foreign body aspiration, lower respiratory tract Sudden onset of caugh, wheezing, later chronic cough, recurrent pneumonia Ø Bronchiectasis, lung abscess Ø Physical finding: asymmetric breath sounds, localized wheezing Ø Dg. : inspiratory and forced expiratory chest Xray : mediastinal shift away from the affected side (Holzknecht sign) Ø Complete obstruction: atelectasis Ø Th: bronchoscopy Ø

Bronchitis Ø Acute: nonproductive caugh, low fever Ø Physical symptom: diffuse rhonchi Ø Viral infection Ø Chronic: non-infectious causes: asthma, sinusitis, cystic fibrosis, respiratory tract anomalies, foreign bodies, recurrent aspiration

Asthma Ø Risk factors: atopic dermatitis, smoking in the family Ø Shedding of airway epithelium, edema, mucus plug formation, mast cell activation Ø 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 - 100 X

Asthma Ø Wheezing, caugh, dyspnea, exercise intolerance, recurrent bronchitis and pneumonia, prolongation of the expiratory phase Ø Flaring of nostrils, intercostal- suprasternal retractions Ø Hypoxia: cyanosis of the lips, nail beds, tachycardia, agitation

Asthma Ø X-ray: hyperinflation , atelectasis Ø Serum Ig. E elevated, RIA for specific allergens Ø Skin tests Ø Pulmonary function tests (FEV 1, PEFR)

Asthma treatment Stepwise approach, assessment of clinical symptoms Ø Inhaled corticosteroids Ø Long-acting inhaled beta-2 agonists Ø Rescue: systemic corticosteroids Ø Bronchodilators Ø Leukotriene receptor antagonists and modifiers (Montelukast, zileuton) Ø Anti-inflammatory drugs Ø

Ø 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.

Bronchopulmonary dysplasia (BPD) Ø Acute respiratory distress, first week of life Ø 30% of infants with birth-weight of less than 1000 grams Ø Chronic lung disease, inflammatory mediators, infection, lung development, barotrauma Ø 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. Ø Fever, cough, dyspnea, meningismus, abdominal pain, otitis media, Ø Laboratory findings: elevated WBC, CRP Ø Chest X-ray Ø Age-specific bacteria Ø Complications: empyema, sepsis, abscesses Ø

Mediastinal masses Ø Cough, wheezing, symptoms of infection, hemoptysis, dysphagia, pressure on the recurrent laryngeal nerve: hoarseness, vena cava superior syndrome Ø Cystic hygromas, vascular or neurogenic tumors, thymic masses, lymphomas, teratomas, esophageal lesions, mediastinal abscess