Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Alterations of Pulmonary Function in Children Chapter 27

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pulmonary Disorders  Disorders of upper airways  Acute upper airway obstructions Infections, foreign body aspiration, angioedema, and trauma Infections, foreign body aspiration, angioedema, and trauma  Chronic upper airway obstructions Congenital malformations, cartilaginous weakness, vocal cord paralysis, and subglottic stenosis Congenital malformations, cartilaginous weakness, vocal cord paralysis, and subglottic stenosis

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pulmonary Disorders  Breathing sounds  A snoring noise is common for nasopharyngeal obstructions  Stridor Harsh, vibratory sound caused by turbulent flow through a partially obstructed airway Harsh, vibratory sound caused by turbulent flow through a partially obstructed airway Inspiratory stridor is common with extrathoracic airway obstructions Inspiratory stridor is common with extrathoracic airway obstructions Expiratory stridor is common with intrathoracic airway obstructions Expiratory stridor is common with intrathoracic airway obstructions

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Breathing Sounds

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pulmonary Disorders  Breathing sounds  A weak or hoarse voice suggests possible laryngeal problems  A cough is an indicator of an irritative symptom

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Upper Airway Infections  Acute laryngotracheobronchitis (croup)  Acute epiglottitis  Aspiration of foreign bodies  Obstructive sleep apnea

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Croup  Acute laryngotracheobronchitis  Common in children from 6 months to 5 years  Commonly caused by a virus (parainfluenza, influenza A or RSV)  Causes subglottic edema

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Croup  Usually occurs after an episode of rhinorrhea, sore throat, and fever  Causes seal-like barking cough  Self-limiting condition  Severe cases are treated with nebulized epinephrine

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Spasmodic Croup  Similar hoarseness, cough, and stridor to croup  Usually in older children  Demonstrates sudden onset, usually at night, and with no previous viral illness  Resolves quickly

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Upper Airway Obstruction with Croup

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Acute Epiglottitis  Severe, rapidly progressive, life- threatening infection of the epiglottis and surrounding area  Usually caused by Haemophilus influenzae type B  Decreased incidence due to HIB vaccination

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Acute Epiglottitis  Manifestations  High fever, sore throat, inspiratory stridor, and severe respiratory distress  Treatment  Emergency airway and antibiotics

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Aspiration of Foreign Bodies  Foreign body aspiration in children occurs frequently between the ages of 1 and 3  Manifestations  Coughing, choking, gagging, and wheezing  Symptoms depend on foreign body size  Aspirated foreign bodies can be removed by bronchoscopy

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Obstructive Sleep Apnea Syndrome (OSAS)  Partial or complete upper airway obstruction during sleep  Obstructive sleep apnea disrupts normal ventilation and sleep patterns  The most common cause for childhood obstructive sleep apnea is adenotonsillar hypertrophy  Treatment tonsillectomy and adenoidectomy, or CPAP

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Respiratory Distress Syndrome (RDS) of the Newborn  Also known as hyaline membrane disease (HMD)  Poor lung structure and lack of adequate surfactant  Primarily a disease of preterm infants  Causes widespread atelectasis, respiratory distress, and pulmonary hypertension

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Respiratory Distress Syndrome (RDS) of the Newborn  Pulmonary hypertension causes continued shunting of blood away from the lungs (ductus arteriosus)  Symptoms  Tachypnea, expiratory grunting, nasal flaring, dusky skin

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Respiratory Distress Syndrome (RDS) of the Newborn  Treatment  Prevention of preterm birth  Mechanical ventilation, surfactant administration, glucocorticoid administration to women in preterm labor

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. RDS in the Newborn

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Bronchopulmonary Dysplasia  Chronic disease; result of acute respiratory disease in the neonatal period  Caused by premature birth, immature lungs, infections, genetics, poor formation of alveoli, etc.

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Bronchopulmonary Dysplasia  Manifestations  Hypoxemia, hypercapnia, elevated work of breathing, bronchospasm, mucus plugging, pulmonary hypertension  Bronchopulmonary dysplasia is not as common because of the availability of exogenous surfactant and antenatal glucocorticoids

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Bronchopulmonary Dysplasia

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Respiratory Infections  Bronchiolitis  Pneumonia  Bacterial pneumonia  Viral pneumonia  Atypical pneumonia  Aspiration pneumonitis

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Respiratory Infections  Bronchiolitis obliterans  Asthma  Acute respiratory distress syndrome (ARDS)

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Asthma

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Cystic Fibrosis  Autosomal recessive multisystem disease  Exocrine or mucus-producing glands secrete abnormally thick mucus because of defective epithelial ion transport  In the lungs, thick secretions obstruct the bronchioles and predispose the lungs to chronic infections

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Cystic Fibrosis  Chronic inflammation leads to hyperplasia of goblet cells, bronchiectasis, pneumonia, hypoxia, fibrosis, etc.

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Cystic Fibrosis

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Sudden Infant Death Syndrome (SIDS)  Disease of unknown cause  Incidence  Lower during first month of life, increases in the second month, and peaks at 3 to 4 months  More common in male infants

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Sudden Infant Death Syndrome (SIDS)  Seasonal variation  Possible relationship to respiratory infections  Wide range of risk factors