Paediatric Respiratory Conditions PDF

Childhood Respiratory Disorders  Contents Bronchial Asthma Pneumonias Tuberculosis Bronchiectasis  Asthma Definition: Hyper responsiveness of tracheo-bronchial smooth muscles to various stimuli which leads to narrowing of tracheo-bronchial tr...

Childhood Respiratory Disorders  Contents Bronchial Asthma Pneumonias Tuberculosis Bronchiectasis  Asthma Definition: Hyper responsiveness of tracheo-bronchial smooth muscles to various stimuli which leads to narrowing of tracheo-bronchial tree. Often accompanied by increased tracheo-bronchial secretions and edema Presents with dyspnea and wheeze.  There are 2 main types of childhood asthma: 1) Recurrent wheezing in early childhood, primarily triggered by common viral infections of the respiratory tract. 2) Chronic asthma associated with allergy that persists into later childhood and often adulthood. Risk Factors for Persistent Asthma Family history of Asthma Allergy Atopic dermatitis Allergic rhinitis Food allergy Severe lower respiratory tract infection Pneumonia Environmental tobacco smoke exposure  Asthma Triggers Common: Viral infections of the respiratory tract , Aeroallergens in sensitized asthmatics. Animal dander, Dust mites, Cockroaches Pollens (trees, grasses, weeds) Air pollutants Environmental tobacco smoke Sulfur dioxide Particulate matter, dust Wood- or coal-burning smoke  Asthma Triggers…. Exercise, Crying, laughter, hyperventilation Co-morbid conditions Rhinitis Sinusitis Gastroesophageal reflux  Clinical features Intermittent dry coughing and/or expiratory wheezing. Older children and adults: shortness of breath and chest tightness. Younger children: intermittent, chest “pain.” Respiratory symptoms can be worse at night/early morning. Daytime symptoms, often linked with physical activities or play  Diagnosis Peak expiratory flow monitoring devices to measure airflow. Chest radiographs: Often appear to be normal, aside from subtle and nonspecific findings of hyperinflation (flattening of the diaphragms) and peribronchial thickening.  Four Components of Optimal Asthma Management 1. REGULAR ASSESSMENT AND MONITORING Asthma checkups Every 2–4 wk until good control is achieved 2–4 per yr to maintain good control Lung function monitoring 2. CONTROL OF FACTORS CONTRIBUTING TO ASTHMA SEVERITIY Eliminate or reduce problematic environmental exposures Treat co-morbid conditions: rhinitis, sinusitis, gastroesophageal reflux  Four Components of Optimal Asthma Management 3. ASTHMA PHARMACOTHERAPY Long-term-control vs quick-relief medications Beta agonists, Ipratropium, Inhaled Corticosteroids Step-up, step-down approach Asthma exacerbation management 4. PATIENT EDUCATION Provide a two-part care plan Daily management Action plan for asthma exacerbations ELIMINATE OR REDUCE PROBLEMATIC ENVIRONMENTAL EXPOSURES Environmental tobacco smoke elimination or reduction Elimination of Pets (cats, dogs, rodents, birds) Dust mites, dust TREAT CO-MORBID CONDITIONS Rhinitis Sinusitis Gastroesophageal reflux ANNUAL INFLUENZA VACCINATION  Classification of Asthma Severity CLASSIFICATION STEP DAYS NIGHTS (FEV1 or WITH WITH PEF[*] % SYMPTOM SYMPTOM Predicted S S Normal) Severe 4 Continu Frequent ≤60 persistent al Moderate 3 Daily >1/wk >60– persistent 2/wk, >2/mo ≥80 persistent but