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Final Wheezing in Infants

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Moustafa Kandeel

on 26 November 2012

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Transcript of Final Wheezing in Infants

Approach to diagnose Wheezing in infants Wheezing What is wheezing??
Is wheezing a common presentation in infants ??
Why is wheezing a common sign in infants??
Is "Bronchial Asthma" the only cause of wheezing in infants??
How can I reach the diagnosis?? History Examination Investigation Cough Dry Mucopurulent Asthma GERD RSV Bronchiectasis Cystic Fibrosis Age of onset Early after birth Congenital Anomalies Ciliary dyskinsea Tracheobronchial anomalies Congenital vascular abnormalities Wheezing after feeding GERD Tracheoesophageal
fistulas Laryngeal clefts Seasonality Winter Spring Infection RSV Multiple illnesses Persistent pulmonary infection
Chronic diarrhea
Failure to thrive Cystic fibrosis Primary ciliary
dyskinesia Continuous rhinitis from birth Immunodeficiency
syndromes History of other
atopies Family history of asthma & other atopies Bronchial Asthma Sudden onset Foreign Body
Aspiration Asthma Predictive index Early Wheezer Transient
Wheezer Persistant
Wheezer How can you determine??? Asthma predictive index Persists after 5yr old If resolved before 5 yr old Asthma predictive index +ve API <3 episodes/year >3 episodes/ year Loose +ve Stringent +ve 77% chance of active asthma
from ages 6 to 13 years Recurrent attacks during first 3 years of life
1 major criterion
2 minor criteria Local Examination General Examination Inspection Chest shape Signs of respiratory distress Barrel shape Asthma Palpation Tracheal position TVF Shift Lung collapse
Unilateral emphysema Increase Consolidation Percussion Dullness Hyper-resonance Lung collapse
Consolidation Hyperinflation Auscultation Air entery Character Harsh
vesicular Bronchial Normally present in infants Consolidation Adventitious Sounds Adventitious Sounds Rhonchi Sibilant Sonorous Conscious level

Heart rate

Respiratory rate

Blood pressure

Fever Altered in severe cases Tachycardia Infection
Severe asthma
Cardiac patient Tachypnea Hypotension Dangerous sign Infection Body built Decreased Cystic fibrosis
Immune deficiency
GERD Decubitus Orthopnic Prone Lt side HF Tracheomalacia Cyanosis Centeral severe respiratory distress Nail clubbing Chronic hypoxia Chronic toxemia bronchiectasis Cystic fibrosis Multiple infections Neck position Immune deficiency disease. Hyperextension Vascular ring Lab investigation Radiological investigation If asthma is suspected CBC

Serum IgE

Pulmonary function tests

Allergen inhalation challenge

Skin allergy test Eosinophilia >100 IU If GERD is suspected Intraesophageal pH Probe
monitoring If respiratory infection is suspected C-Reactive protien Sputum culture Serum immunoglobulins If cystic fibrosis is suspected Sweat chloride test

Sputum microbiolgy

Genotyping >60 mmol/L Increased Neutrophils
Pseudomonas aeruginosa Delta F508 Chest X-Ray Cystic fibrosis FB inhalation CT & MRI Lung Collapse Lung Mass Bronchoscopy FB Congenital atresia Barium swallow Vascular ring Thank You Infants are prone to wheeze
due to: Small calliber
of the airway Compliant
chest wall High number of neutrophils and lymphocyte 1ry ciliary dyskinesia Genetic cause Asthma (associated with outdoor allergen) Eg. Bronchomalacia Eg. Vascular ring Multiple infection
Skin manifestations
Failure to thrive (Pulmonary and extra-pulmonary) Determine severity Mild obstruction Severe obstruction Diminished Localized Generalized FB Infection
Acute severe
asthma Eg. Mass Sitting Asthma In case of cough allergen asthma FEV1 Mechanism of narrowing Something inside Increase wall thickness Compression from outides Population studies have shown that approximately one in three children has at least one episode of wheezing prior to their third birthday Causes of wheezing Acute Chronic
(Recurrent) FB
Infection (Most commonly RSV) Common Recurrent viral infections
Bronchial asthma (Early wheezer)
GERD Uncommon Gnentic causes: Cystic fibrosis
1ry ciliary dyskinesia Congenital anomalies: Anomalies in bronchial tree Anomalies in vessels Partial bronchial atresia Vascular ring Compression from outside: Lung mass
Mediastinal mass Heart failure:

Others: Bronchiectasis - Immune diffiency syndrome
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