1. Diseases of the respiratory tract
Dr. György Fekete

2. 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

3. Most common diseases Viral upper respiratory infections Otitis media
Pneumonia
Asthma
Cystic fibrosis

4. Symptoms Dyspnea, tachypnea, hyperpnea Cough Chest pain
Rales(crackles), rhonchi
Wheezing
Retractions
Fever

5. Diagnostic measures
History (parents, child) Children often know things their parents do not („last week I choked on a peanut”)
Inspection (flaring of alae nasi)
Auscultation (take a deep breath: blow out a candle)
Respiratory rate (younger than 1 year: 25-35/min, sleeping !)
Stridor: harsh sound
Imaging techniques
Arterial blood gas analysis
Pulse oximetry, capnography
Pulmonary function testing,
spirometry
Laryngoscopy, bronchoscopy

6. Congenital disorders
Laryngomalacia: first 6 weeks, inspiratory stridor, underdevelopment of supraglottic cartilage
Benign
Symptoms disappear by months of age

7. Subglottic hemangiomas
stridor
Skin hemangiomas in 50%

8. 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

11. Allergic rhinitis

12. Allergic rhinitis Most prevalent chronic condition: 5-40% in children
Recurrent sneezing, nasal congestion, nasal discharge
Rubbing the nose with the palm of the hand („allergic salute”)

13. Allergic rhinitis

14. Croup syndrome Upper airway obstruction
Viral croup: parainfluenza, RSV, adenovirus
Mycoplasma pneumoniae
Barking cough, stridor, suprasternal, intercostal, subcostal retractions, cyanosis
Th: hospitalization, oral hydration, nebulized racemic epinephrine (2.25% sol.), oral dexamethasone (0.15 mg/kg), inhaled budenoside

15. Epiglottitis Emergency! 2-7 yrs
Haemophilus influenzae type B (vaccination)
Sudden onset of high fever
Dysphagia, muffled voice, cyanosis, stridor, inspir. retractions
Progression to total airway obstruction
Th: endotracheal intubation, ceftriaxone iv.
Manipulate as little as possible!

18. 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

19. 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

20. 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

21. Asthma Risk factors: atopic dermatitis, smoking in the family
Shedding of airway epithelium, edema, mucus plug formation, mast cell activation
Sensitisation to inhalant allergens: perennial aeroallergens, dust mites, cockroaches, animals

22. 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
                                                                                                                                                                                    

28. 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

30. Asthma X-ray: hyperinflation , atelectasis
Serum IgE elevated, RIA for specific allergens
Skin tests
Pulmonary function tests (FEV1, PEFR)

32. 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

35. Nebulizer use - part one
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Nebulizer use - part one
                                                            
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.
Review Date: 9/11/ :00:00 AM Reviewed By:A.D.A.M Medical Illustration Team
                           
   
          
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation

37. 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

38. 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

41. 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