Shortness of breath & the child with wheeze

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Presentation transcript:

Shortness of breath & the child with wheeze The child with acute respiratory distress Dr Matthew Hurley NIHR Academic Clinical Lecturer (Assistant Professor) Honorary ST8 Paediatric Respiratory Medicine Nottingham University Hospitals NHS Trust

Learning outcomes Be aware of the 2 different pathways for shortness of breath Know the normal RR for different ages and the signs of respiratory distress Be able to identify the difference between viral induced wheeze and asthma and know the treatment for both Appreciate when to refer, treatment and appropriate homecare advice for patients with bronchiolitis and asthma

What is common How to treat them When to be worried What not to miss Learning outcomes II What is common How to treat them When to be worried What not to miss

Causes of breathlessness Bronchiolitis Virus-induced wheeze (episodic wheeze) Upper airway infection Inhaled foreign body Asthma LRTI Cardiac failure Metabolic (DKA) Anaemia

Normal values

Pathophysiology Bronchiolitis vs Virus-induced wheeze Asthma

Bronchiolitis persistent cough and either tachypnoea or chest recession (or both) and either wheeze or crackles on chest auscultation (or both). apnoea (small babies)

When to refer apnoea (observed or reported) child looks seriously unwell to a healthcare professional severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute central cyanosis persistent oxygen saturation of less than 92% when breathing air.

When to consider referring a respiratory rate of over 60 breaths/minute difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume, taking account of risk factors and using clinical judgement) clinical dehydration.

Risk factors chronic lung disease (including bronchopulmonary dysplasia) haemodynamically significant congenital heart disease age - young infants (under 3 months) premature birth, particularly under 32 weeks neuromuscular disorders immunodeficiency

Treatment

Do… No medication Advice on natural history Safety-netting

Bronchial responsiveness…. Episodic wheeze Multi-trigger wheeze Asthma

Severity

Treatment

Prednisolone…..

Prednisolone…

Beware!

Beware!

Beware!

Summary Bronchiolitis, episodic wheeze and asthma are (probably) different entities and need to be treated differently Education is the treatment for bronchiolitis Steroids for the few for wheeze

Discussion…