Respiratory approachRespiratory approach

Approach to chronic coughApproach 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 forA- signs of allergyB- nasal polypsC- signs of immunodeficiencyE- lymph nodesF- cardiac murmursE-organomegalyF- skin rashes

• InvestigationA- CBCB- LFTE- CXR, Sinus and previous XraysF- Sweat chloride testE- Immune screenF- PH monitoringG- 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 asthmaC- 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 attackIndication 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 pneumoniaRecurrent pneumonia

• Definition

• Most popular causes in children:

- Cystic fibrosis

- PCD

- Immunedeficiency

- Recurrent aspiration( CP patients)

pneumoniaspneumonias

• Indications to look for underlying cause:

- Severe

- Persistent

- Unusual organisms

- Recurrent

Cystic fibrosisCystic fibrosis

• Definition

• Systems involved:

- respiratory, killing

- GI

- Reproductive system

CFCF

• Other manifestations:

- Hypotonic, hypoelectrolytemic dehydration with alkalosis( infants, recurrent)

- Syndrome of Anemia, edema and Anemia

- Neonatal cholestasis

CFCF

• Diagnosis:

- Sweat chloride

- Gene mutation

- Nasal potential difference

CFCF

• Treatment:

- respiratory: Antibiotics the cornerstone of treating CF

- GI: enzyme replacement, vitamins, diet

- Liver disease

- complications

Airmay obsrtructionAirmay obsrtruction

• Cardinal sign: Stridor

• Classification

- Acute( toxic and notoxic) and chronic

- Congenital or aquired

• StridorStridor : : ( Inspiratory stridor )( Inspiratory stridor )

- - Harsh sound produced by vibration of upper airway Harsh sound produced by vibration of upper airway structurestructure

-- Indicates upper airway obstruction Indicates upper airway obstruction

• HoarsenessHoarseness: : Indicates involvement of vocal cordsIndicates involvement of vocal cords

• Respiratory distress / suprasternal Respiratory distress / suprasternal retractionretraction

stridorsstridors

• Toxic :- Acute epiglotitis- Bacterial tracheitis-Retropharyngeal abcess and retrotonsillar

abcess(quinze)Nontoxic:CroupForeign body

• CROUP (also CROUP (also termed laryngotracheitis or termed laryngotracheitis or laryngotracheobronchitislaryngotracheobronchitis): ):

Is a respiratory conditionIs a respiratory condition, , that is usually that is usually triggered by an acute viral infection of the triggered by an acute viral infection of the upper airway.upper airway.

The infection leads to swelling inside larynx The infection leads to swelling inside larynx and trachea but may also extend to the and trachea but may also extend to the bronchi produces the classical symptoms bronchi produces the classical symptoms of a "barking" of a "barking" cough, , stridor, and , and hoarseness..