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Diseases of the respiratory tract

Learn about common pediatric respiratory illnesses, symptoms, diagnostic measures like imaging techniques, and treatment options. Understand congenital disorders, croup syndrome, and foreign body aspirations. Gain insights into asthma, bronchopulmonary dysplasia, allergic rhinitis, and more.

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Diseases of the respiratory tract

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  1. Diseases of the respiratory tract Dr. György Fekete www.gyer2.sote.hu

  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) Childrenoftenknowthingstheirparentsdonot („lastweek I chokedon a peanut”) • Inspection (flaring of alaenasi) • Auscultation (take a deepbreath: blow out a candle) • Respiratoryrate (youngerthan 1 year: 25-35/min, sleeping !) • Stridor: harshsound • Imagingtechniques • Arterialbloodgasanalysis • Pulseoximetry, capnography • Pulmonaryfunction testing, spirometry • Laryngoscopy, bronchoscopy

  6. Congenital disorders • Laryngomalacia:first 6 weeks, inspiratorystridor, underdevelopment of supraglotticcartilage • Benign • Symptomsdisappearby 18-24 months of age

  7. Subglottichemangiomas stridor Skinhemangiomasin 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

  9. Allergic rhinitis

  10. Allergicrhinitis • Most prevalentchroniccondition: 5-40% inchildren • Recurrentsneezing, nasalcongestion, nasaldischarge • Rubbingthenosewiththepalm of thehand („allergicsalute”)

  11. Allergic rhinitis

  12. Croup syndrome • Upperairwayobstruction • Viralcroup:parainfluenza, RSV, adenovirus • Mycoplasmapneumoniae • Barkingcough, stridor, suprasternal, intercostal, subcostalretractions, cyanosis • Th: hospitalization, oralhydration, nebulizedracemicepinephrine (2.25% sol.), oraldexamethasone (0.15 mg/kg), inhaledbudenoside

  13. Epiglottitis • Emergency! 2-7 yrs • Haemophilusinfluenzaetype B (vaccination) • Suddenonset of highfever • Dysphagia, muffledvoice, cyanosis, stridor, inspir. retractions • Progressiontototalairwayobstruction • Th:endotrachealintubation, ceftriaxoneiv. • Manipulateaslittleaspossible!

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

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

  21. 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

  22. Home > Medical Reference > Encyclopedia (English)Toggle English / Spanish

  23. 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

  24. 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

  25. 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

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