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LOWER RESPIRATORY TRACT DISEASES ( WHEEZING,BRONCHIOLITIS )

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WHEEZING


Differential Diagnosis of Wheezing

 

  1. asthma: recurrent wheezing episodes
  2. pneumonia: fever, cough, malaise
  3. bronchiolitis: first episode of wheezing (see Bronchiolitis Section)
  4. CF: prolonged wheezing unresponsive to therapy
  5. foreign body aspiration: sudden onset wheezing and coughing
  6. gastroesophageal reflux with aspiration: feeding difficulties
  7. congestive heart failure: associated FTT

BRONCHIOLITIS

 

  1. presents as first episode of wheezing associated with URI and signs of respiratory distress
  2. common, affects 15% of children in first 2 years of life
  3. peak incidence at 6 months, often in late fall and winter
  4. occurs in children prone to airway reactivity, i.e. increased incidence of asthma


Etiology

 

  1. RSV (75%)
  2. Parainfluenza, Influenza, Adenovirus


Clinical Features

 

  1. prodrome of URI with cough and fever
  2. feeding difficulties, irritability
  3. wheezing, respiratory distress, tachypnea, tachycardia
  4. children with chronic lung disease, severe CHD and
  5. immunodeficiency have a more severe course of the illness


Diagnosis

 

  1. chest x-ray : air trapping, peribronchial thickening, atelectasis, increased linear markings
  2. nasopharyngeal swab : direct detection of viral antigen (immunofluorescence)

Management


Mild distress

  1. supportive: oral or IV hydration, antipyretics for fever
  2. humidified oxygen and/or inhaled bronchodilator (Ventolin)

Moderate to severe distress

  1. humidified oxygen
  2. inhaled bronchodilator (Ventolin) or racemic epinephrine
  3. continue only if effective
  4. Atrovent and steroids are not effective
  5. rarely intubation and ventilation
  6. consider ribavirin in high risk groups: BPD, CHD, congenital lungdisease, immunodeficient
  7. case fatality rate < 1%

 

Indications for hospitalization

  1. hypoxia: oxygen saturation < 92%
  2. ersistent resting tachypnea > 60/minute and retractions after several Ventolin masks
  3. past history of chronic lung disease, hemodynamically significant cardiac disease, neuromuscular problem, immunocompromise
  4. young infants < 3 months old (unless extremely mild)
  5. significant feeding problems
  6. social problem, i.e. inadequate care at home
LOWER RESPIRATORY TRACT DISEASES ( WHEEZING,BRONCHIOLITIS ) LOWER RESPIRATORY TRACT DISEASES ( WHEEZING,BRONCHIOLITIS ) Reviewed by Radiology Madeeasy on October 05, 2010 Rating: 5
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