Lesson 17: INTRODUCTION TO CHILDHOOD RESPIRATORY AND CARDIOVASCULAR DISORDERS

CHILDHOOD RESPIRATORY DISEASES Respiratory tract infections represent the most common infections of childhood and range from trivial to life-threatening illnesses. Ninety percent of these are caused by viruses.Common respiratory problems in children: Upper respiratory tract infections Lower respiratory tract infections Asthma Cystic fibrosisUpper Respiratory Tract Infections The upper respiratory tract comprises the ears, nose, throat, tonsils, pharynx, and sinuses.1. Acute nasopharyngitis (Common cold): This is a viral infection causing a clear or mucopurulent nasal discharge and nasal blockage. Symptomatic treatment is given.2. Pharyngitis and Tonsillitis (Sore throat): These are common viral but also may be caused by streptococci. Children present with a sore throat, fever and constitutional upset. It can be treated with oral penicillin.3. Acute otitis media:This may be viral or bacterial. Children present with fever, vomiting, and distress. Examination reveals a red eardrum with loss of the light reflex. The drum may bulge and perforation may occur with a purulent discharge. Treatment is with amoxycillin and paracetamol. Complication: Persistent middle ear effusion which may lead to conductive deafness. 4.Croup (Laryngotracheobronchitis): This may be caused by Para influenza virus. Symptoms include fever, barking cough and stridor which may become worse at night. Supportive management includeparacetamol, fluids and warm humidified environment. For severe croup, nebulized steroid can be given. 5.Diphtheria: It is a highly infectious disease and is caused by Corynebacteriumdiphtheriae. It has largely been eradicated in developed nations through wide-spread vaccination.Lower Respiratory Tract Infections Lower respiratory tract infections are likely to be more serious and are more common in infants. Causative agents include viruses and bacteria. They vary with the childs age and the site of infection. Infection may occur by direct spread from airway epithelium or via the blood stream.1. Pneumonia: It is characterized by inflammation of the lung parenchyma with consolidation of alveoli. Usually, following an URTI the patient develops worsening fever, cough, and breathlessness, tachypnea and consolidation (dullness to percussion, decreased breath sounds, and bronchial breathing). Treatment is with antibiotics. 2. Bronchiolitis: Inflammation of the bronchioles caused by the Respiratory Syncytial Virus (RSV). An infant under twelve months of age develops cough, wheeze and shortness of breath over one or two days. Bronchiolitis may cause asthma by inducing long term inflammation. Antiviral drugs are given for supportive treatment. Infants who are too short of breath to feed may require nasogastric or intravenous fluids. Oxygen is given to maintain blood oxygen levels and mechanical ventilation may be required in severe cases.

3. Whooping Cough (Pertussis): It is a highly contagious disease caused by the bacterium Bordetella pertussis It is spread by droplet infection. During a paroxysm of coughing (often worse at night) the child may go blue and vomit. Nosebleeds and subconjunctival hemorrhage may occur after vigorous coughing. Symptoms can persist for 3 months. Complications including pneumonia, convulsions, apnea, bronchiectasis, and death, are more common in infants under 6 months of age. DTP vaccine prevents the disease. Erythromycin given early in the disease reduces infection.4) Asthma Asthma is a chronic disease of the respiratory system in which the airway occasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant (or allergen), cold air, exercise or exertion, or emotional stress. Asthma is a multifactorial disorder caused by a combination of genetic predisposition and environmental factors. The airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which respond to bronchodilators. Management: Maintenance therapy: Education of the child, family and other carers. Avoidance of provoking factors. Medication. Immediate management: High-flow oxygen via facemask Salbutamol or terbutaline via nebulizer Pulse oximetry oxygen saturation