symptoms and signs of respiratory diseases

1. Clinical Presentation of
Respiratory Diseases
Symptoms, Signs, Investigations,
IMNCI classification and Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. (God speaking to Prophet Muhammad (PBUH)
And, in fact, You have a great moral character
Al Quran surah Qalam 68:5

3. Causes of Death in children < 5 years
Infant & child deaths
• Pneumonia 19 %
• Others 18 %
• Diarrhoea 11 %
• Injuries 5 %
• Measles 1 %
Neonatal deaths
• Prematurity 20 %
• Asphyxia 13 %
• Neonatal sepsis 9 %
• Cong anomalies 5 %

4. Respiratory System

5. Clinical Features

6. Respiration – Abnormal Symptoms
• Runny / blocked nose
• Pain in throat
• Ear Pain / Ear discharge
• Cough
• Noisy breathing
• Respiratory distress
• Fever
• Poor feeding / Anorexia
• Bluish discoloration

7. Respiration – Abnormal Signs
• Nasal discharge
• Congested throat / Enlarged tonsils
• Ear discharge / Red bulging tympanic membrane
• Cough – Type and sound of cough
• Fast breathing / Tachypnea
• Chest in-drawing
• Stridor
• Wheeze
• Axillary temperature > 99.5
• Clubbing
• Cyanosis / Pulse Oximetry

8. Clinical Evaluation
of the Child with
Respiratory Symptoms

9. History – Ask about Symptoms
• Runny / blocked nose
• Pain in throat
• Ear Pain / Ear discharge
• Fever
• Cough
• Noisy breathing
• Feeding problems

10. Examination of Respiratory System in Children
• OBSERVE –
• LISTEN –
• AUSCULTATE –
• ENT –

11. Examination of Respiratory System in Children
• OBSERVE
• Color (Cyanosis)
• Respiratory rate
• Chest in-drawing
• LISTEN
• Stridor
• Wheeze
• AUSCULTATE – Heart and Lungs (front, back)
• ENT – Nose, Throat, Ears

12. Examination of Chest
• Inspection – Chest appearance, Movement, Rate, Recessions
• Palpation – Trachea, Cardiac Apex, Chest expansion, Vocal fremitus
• Percussion – Resonant / Impaired / Dull / Hyper-resonant
• Auscultation – Breath Sounds, Intensity, Character, Added Sounds

13. Common Causes of Runny / Blocked Nose
in Children
• Acute Rhinitis (common cold)
• Flu / Influenza
• Allergic Rhinitis
• Adenoids

14. Common Causes of Cough in Children
• Infections –
– viral / bacterial / mixed
URTI -- (nose, throat, ear)
LRTI -- (larynx, bronchi, lungs)
• Allergy – allergic rhinitis, asthma
• Environment – household smoking / air pollution

15. Types of Cough in Children
• Dry – URTI, Pharyngitis, Influenza
• Wet – Bronchitis, Pneumonia
• Croupy – Laryngitis, ALTB (Acute
LaryngoTracheoBronchitis)
• Wheezy – Asthma, Viral bronchiolitis,
bronchitis

16. Fast breathing in children
• Age average/normal Fast breathing
• < 2 months 50 60 or more
• 2 - 12 months 40 50 or more
• 1 - 5 years 30 40 or more

17. Chest Indrawing

18. Chest Indrawing

19. Causes of
Fast Breathing or Chest Indrawing
• Pneumonia
• Bronchiolitis
• Asthma
• Airway obstruction (causes stridor)
• Pleural effusion / empyema
• Congestive heart failure
• Renal failure
• Metabolic acidosis

20. STRIDOR
• A harsh inspiratory sound produced due to
Obstruction in or around the LARYNX
• Stridor when child is agitated - (mild obstruction)
• Stridor in the calm child - (more severe)

21. Causes of STRIDOR
• ALTB (Acute laryngotracheobronchitis) or Croup
• Diphtheria
• Foreign body in larynx or trachea
• Acute epiglottitis
• Allergic laryngitis
• Enlarged Tonsils (meeting in midline)
• Laryngomalacia (infants)

22. WHEEZE
A musical expiratory sound
produced due to
Narrowing
of the
bronchi and bronchioles

23. Causes of WHEEZE
• Asthma
• Bronchiolitis (infants)
• Acute bronchitis
• Cystic fibrosis
• Congestive Heart Failure (in infancy)

24. Chest Auscultation
• Intensity of Breath sounds
• Character of Breath sounds – Vesicular / Bronchial
• Wheezes / Ronchi
• Crepitations / crackles / rales
• Pleural Rub

25. Investigations

26. Common Investigations
(in selected patients)
• ESR, CBC, CRP
• X- ray Nasopharynx / Trachea
• X – ray Chest
• Throat swab (Rapid Antigen Detection Test)
• Throat swab culture
• Blood Culture (pneumonia)
• Pleural Fluid examination and microbiology
• HRCT chest
• Sputum examination and microbiology

27. Chest X - ray
Bronchopneumonia Lobar Pneumonia

28. Complications
Paraneumonic Pleural Effusion (Empyema)

29. IMNCI
A Strategy for
Outpatient Case Management
of Children
under five years of age

30. IMNCI
simplified OPD management
of
Respiratory Problems

31. IMNCI
Assess for Cough or Difficult Breathing
• Assess for General Danger Signs
• ASK: Does the child have Cough or Difficult Breathing ?
• IF YES, ASK: for how long ?
• Look, Listen, Feel:
 Count the breaths in one minute (Respiratory Rate)
 Look for Chest Indrawing (subcostal recessions)
 Look and listen for Stridor (harsh inspiratory sound)
 Look and listen for Wheeze (musical expiratory sound)
 Other signs:
o ……. Pulse Oximetry

37. Treat Cough or Difficult Breathing
• Severe Pneumonia or Very Severe Disease –
Referral / Admit
• Pneumonia -- Amoxycillin (oral)
-- Paracetamol (if fever)
-- Salbutamol (if wheezing)
• Cough and Cold -- Salbutamol (if wheezing)
-- safe, soothing remedies for cough

38. PREVENTION
of Respiratory Infections

39. Risk Factors for Acute Respiratory Infections

40. Prevention of Acute Respiratory Infection
• Vaccination –
Penta (DPT, Hib, Hep B),
Pneumococcal, Measles,
Influenza, Covid 19
• Breastfeeding, Nutrition, Micronutrients
• Masks and Social Distancing
• Hand washing,
• Control of smoking, air pollution, cold air