Respiratory Diseases In Pediatric Patients Flashcards
(35 cards)
WBCs that take part in asthma
Mast cells
Neutrophils
Eosinophils
T-lymphocytes
Macrophages
Epithelial cells
Status asthmaticus
Acute severe asthma that occurs in the refractory state of a failed SABA/LABA treatment
- can also be treatment from subcutaneous epinephrine
What is the most common lower airway disease in children under 18?
Asthma
Asthma physiology
Chronic inflammatory condition that result in the lung airways being episodically obstructed
The chronic inflammation heightens the sensitivity of airways leadings to hyper responsiveness of airways (bronchospasms)
In children, up to 50% of the total airway resistance can increase
Etiology of wheezing in children’s
1) infections
2) transient wheezers w/ asthma
- wheezing with asthma up to 6yrs (then goes away spontaneously)
3) persistent wheezers w/ asthma
- same as #2 but goes further past age 6
4) late onset wheezer w/ asthma
- same as #3 except starts at 3 yrs rather than when born
Anatomic causes of wheezing
1) central airway wheezing
- laryngomalacia and tracheomalacia
2) extrinsic airway anomalies
- infections
- tumors
- foreign bodies in esophagus
3) intrinsic airway anomalies
- hemangiomas
- tumors
- cystic malformations
Common triggers related to asthma
Allergies
Tobacco smoke
Air pollution and strong orders
exercise induced broncoconstriction
Medications (NSAIDs and BBs)
Emotional anxiety/stress
Weather
Asthma management in children
Always aimed at reducing airway inflammation
1) minimize proinfllatory environment exposures
2) use anti inflammatory medications (pending on what the degree of asthma is)
- corticosteroids
- LABAs
- leukotriene modifers
3) use quick relief medications (SABAs)
When nebulizer vs normal inhaler?
Young child or person cant take in deep breaths for whatever reasons
What does respiratory distress in asthma for children look like?
Retractions
Supraclavicular Indrawing when breathing
Prolonged Expiratory phase of breathing
Standard treatment for asthma exacerbation
Albuterol nebulizer treatments for 15 min
If not better, after albuterol monotherapy, give 3 back-to-back treatments of prednisilone or dexamethasone (corticosteroids) and try again
- If not better at this point send to ER
Send home with albuterol and inhaled steroid for recurrent wheezing
- start inhaled steroid immediately once coughing begins
Laryngomalacia
Exaggerated collapse of the glottis structures during inspiration
- diagnosis is confirmed based on symptoms and flexible laryngoscopy
Requires xrays if in respiratory distress to rule out worse diagnosis
Symptoms:
- noisy breathing and stridor on inhalation (worsens with agitation/crying/feeding/sleeping on back)
- poor weight gain
- apnea
- cyanosis
- GERD
- aspiration
Treatment of laryngomalacia
Usually outgrows it and just requires monitoring during severe episodes
If reflux is present, must be managed differently
If respiratory distress/cyanosis or serious weight loss occurs: requires supraglattoplasty surgery
Tracheomalacia
Chondromalacia of a central airway that leads to insufficient cartilage to maintain airway conductance and latency
Causes persistent wheezing in infancy
Males get this more than females and can be primary or secondary
Symptoms: - low pitched monophonic wheezing on expiration - is persistently congested - wheezing is loudest over trachea -
Primary vs secondary tracheomalacia
Primary:
- congenital absence of tracheal supporting cartilage (may also be oddly shaped as well)
Secondary:
- caused by blockage or obstruction of the airway secondary to an underlying disease
Treatment of tracheomalacia
Usually outgrows it and just requires pall Atari very care during episodes
- Postural drainage helps a lot also
Can use nebulized ipratropium bromide (rare to need)
Surgical approach is required in life-threatening apnea and cyanosis
DONT use SABA/LABA unless patient also has asthma
Sudden Infant Death Syndrome (SIDS)
Unexpected death of an infant younger than 1 year of age in which the cause remains unexplained after autopsy
Risk factors:
- premature births
- African/Native Americans
- low income mother who smokes
- drug abuse mothers
- higher in winter born babies
- genetic based (if sibling dies of SIDS, 3-5x more likely for next births)
SIDS theories
1) cellular brainstem abnormalities and maturational delay related to neural/ cardiorespiratory control
2) may be due to prolonged QT intervals
3) abnormal CNS control of respiration
4) CO2 breathing from sleeping face down
Croup (layngotracheobronchitis)
Most common infection of the middle respiratory tract
- most common in winter
- most common in children 3 months - 5 years
- more common in males
Viral infection of the glottis and subglottic regions that induces Laryngotracheal inflammation w/ mucosal edema
- increases airway resistance and the work of breathing.
- Spreads by secretions
Is caused by any of the following
- parainfluenza viruses 1-4
- influenza
- enteroviruses
- RSV
- adenovirus
Symptoms of croup
Barry/seal coughing
Hoarseness
Low-high grade fever
Occasional respiratory distress
Can present with stridor on inspiration
Rinorrhea
Pharyngitis
- symptoms are worse at night and recur for several days*
- 3rd night is worst
Complete resolution within 1 week
Croup treatment
At home remedies (since more croup is self-limiting)
1) Warm humidity air
- closed bathroom with hot shower running
2) Cold air
- open refrigerator/freezer and breath for a bit
Hospital treatments (if serious) 1) dexamethasone phosphate (1st line since it requires 1 dose)
2) prednisilone (alternate since it requires multiple doses)
* if significant airway compromise is noted, use race ic epinephrine*
Bronchiolitis
Disease of small bronchioles w/ increased mucus production
- leads sometimes to bronchospasms and serious airway obstruction
Most severe in young infants since it can kill young children
More common in early spring/late winter
Spread by secretions and hand carriage is most frequent method of transmission
Causes:
- RSV (#1 by far)
- parainfluenza
- influenza
- rhinoviruses
- coronaviruses
Bronchiolitis symptoms/signs
Early on (1-2 days) - similar symptoms to the common cold
Late phase (3-7 days)
- same symptoms as early on
- also noisy/raspy breathing
- also audible wheezing
- low grade fever
- increased work of breathing
- rare apnea
- prolonged Expiratory phase
- intercostal retractions
- air trapping w/ hyper expansion of lungs
Severe RSV infection
1-2/100 infants (<6 months) gets this with an RSV infection
Requires oxygen and sometimes intubation/ ventilation
Lasts 2-5 days and low mortality if caught
- cough can linger for up to a month
