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

Allergic rhinitis

Allergic rhinitis

Allergic rhinitis

Croup syndrome



Viral croup:

adenovirus parainfluenza, RSV,  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:

the family atopic dermatitis, smoking in  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



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)

 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