Respiratory approach

Approach to chronic cough Definition Hints in history a- nature of cough b- diurnal variation c- associated symptoms d. exacerbating factors and relieving factors e- associated symptoms f- family history

Cough in asthma A- usually dry B- more at night C- respond to bronchodilators D- associated with wheeze E- symptom- free periods

Examination: Signs indicating chronic serious lower respiratory tract disease: A- failure to thrive B- clubbing of fingers C- chest deformity

Other signs to look for A- signs of allergy B- nasal polyps C- signs of immunodeficiency E- lymph nodes F- cardiac murmurs E-organomegaly F- skin rashes

Investigation A- CBC B- LFT E- CXR, Sinus and previous Xrays F- Sweat chloride test E- Immune screen F- PH monitoring G- PFT and bronchoscopy

6 months old with chronic cough, sweat chloride 70, 75 in 2 occasions, lymphocytes counts 400, 450 in 2 occasions: What results u believe in? What's the diagnosis?

2 years old with recurrent admissions due to patchy pneumonias, manifested by cough, wheeze. Good response to nebulizer, negative blood cultures. A- is it recurrent bacterial pneumonia B- indication for further investigation C- is it bronchial asthma

Bronchial asthma suspect in all the followings: A- chronic cough, chronic bronchitis B- recurrent pneumonias without bacteriological proof C- unequivocal response to ventolin nebulizer

Bronchial asthma: A- definition: B- other diagnosis mimicking asthma C- most important history: Diurnal variation and seasonal Exacerbating factors Relieving factors Associated other atopic features

symptom-free periods Parental history of asthma Environmental

Attack of asthma Interventional medication: Systemic steroids Ventolin administration +/- anticholinergic Mg sulphate Adrenaline

Asthma attack Indication for admission: Dehydration O2 sat <92 after treatment Apnea Convulsion Previous Icu admission Respiratory distress interfering with eating and activity

Asthma attack: Discharge: Able to have oral intake No use of accessory muscle O2 sat>92 Discharge on steroid for 3-5 days and Ventolin inhaler and controllers

Asthma:controllers: Steroid inhalers: availables: Beclomathasone(clenil) Budesonide( pulmicort) Fluticasone(flexetide) Combination: Symbicort, Seretide, Theophylline, Antileucotreines

What to follow: Growth parameter Cataract Asthma control: sleep and activity disturbances, use of ventolin, acute care visits

Recurrent pneumonia Definition Most popular causes in children: Cystic fibrosis PCD Immunedeficiency Recurrent aspiration( CP patients)

pneumonias Indications to look for underlying cause: Severe Persistent Unusual organisms Recurrent

Cystic fibrosis Definition Systems involved: respiratory, killing GI Reproductive system

CF Other manifestations: Hypotonic, hypoelectrolytemic dehydration with alkalosis( infants, recurrent) Syndrome of Anemia, edema and Anemia Neonatal cholestasis

CF Diagnosis: Sweat chloride Gene mutation Nasal potential difference

CF Treatment: respiratory: Antibiotics the cornerstone of treating CF GI: enzyme replacement, vitamins, diet Liver disease complications

Airmay obsrtruction Cardinal sign: Stridor Classification Acute( toxic and notoxic) and chronic Congenital or aquired

Clinical manifestation Stridor : ( Inspiratory stridor ) - Harsh sound produced by vibration of upper airway structure - Indicates upper airway obstruction Hoarseness: Indicates involvement of vocal cords Respiratory distress / suprasternal retraction

stridors Toxic : - Acute epiglotitis - Bacterial tracheitis -Retropharyngeal abcess and retrotonsillar abcess(quinze) Nontoxic: Croup Foreign body

CROUP (also termed laryngotracheitis or laryngotracheobronchitis): Is a respiratory condition, that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside larynx and trachea but may also extend to the bronchi produces the classical symptoms of a "barking" cough, stridor, and hoarseness.