The document discusses acute upper respiratory infections in children. It defines acute upper respiratory infections and lists common causes like viruses. It describes the symptoms, signs, and typical progression of a common cold. Diagnosis is usually made clinically based on symptoms. Treatment focuses on relieving symptoms like fever, nasal congestion, and cough through rest, hydration, nasal saline, and over-the-counter medications. Complications can include secondary bacterial infections.

1. Тhe department of Pediatrics
of the V.N. KarazinV.N. Karazin
Kharkiv National UniversityKharkiv National University
Acute respiratory
diseases of upper respiratory
tract in children.
Acute bronchitis in children.
Lecturer: Ass.Prof. Rakovska L.

2. The plan of the lecture:
1. Definition of acute upper respiratory infections
2. Etiology, pathogenesis of common cold
3. Clinical manifestation, diagnosis, differential diagnosis,
treatment and prophylaxis of common cold
4. Acute pharyngitis, tonsillitis, laryngitis, epiglottitis in
children. Etiology, clinical signs, diagnostics.
5. Definition and classification of acute bronchitis in
children.
6. Etiology, pathogenesis, clinical signs, diagnosis,
differential diagnosis, treatment and prophylaxis of
acute bronchitis in children.

3. RESPIRATORY TRACT
• The respiratory tract is
divided into two categories,
which is based anatomy.
• The upper respiratory tract:
the mouth, nose, throat,
and larynx.
• The lower respiratory tract:
the trachea, bronchial
tubes, and the lungs.
Respiratory infections are infections in
any area of the respiratory tract!

4. Pediatric Respiratory System
• Large head, small
mandible, small neck
• Large, posteriorly-placed
tongue
• High glottic opening
• Small airways
• Presence of tonsils,
adenoids

5. Pediatric Respiratory System
• The muscle and elastic tissue is undeveloped
• Chest wall bones are soft.
• Horizontal ribs, primarily diaphragm
breathers.
• The position of diaphragm is high.
• The thorax is short and barrel-shaped (barrel
chest).
• Increased metabolic rate, increased O2
consumption

6. Pediatric Respiratory System
• Cillium movement is poor
• Large number of cells that produce mucus, the
mucosa is rich in vascularity.
• Immaturity of immune system: low levels of
secretory and serum immunoglobulin A,
interferon in the upper respiratory tract,
reduced also functional activity of T-cell
immunity.

7. • Upper respiratory
infections are
often referred to
as "colds.“
• Bronchitis and
pneumonia are
infections of the
lower respiratory
tract.

8. • Colds may also be termed coryza,
rhinitis, sniffles, nasopharyngitis, and
rhinopharyngitis, but usually also
involves the sinus mucosa and is more
correctly termed rhinosinusitis.

9. • Acute Viral Upper Respiratory Tract
Infections – is a large group of infectious
diseases which are caused by viruses,
transmitted by droplet way,
characterized by catarrhal syndrome
with predominant changes in upper
respiratory tract mucosa.

10. • The common cold is a self-limiting
illness caused by any one of more
than 250 viruses.

11. URTI. ETIOLOGY
• Viruses cause >90% of Upper Respiratory
Tract Infections (URTI):
• Rhinoviruses (>100 serotypes),
• Coronaviruses,
• Adenoviruses,
• Respiratory syncytial virus (RSV),
• Influenza viruses,
• Parainfluenza viruses (5 types)
• Rheoviruses (3 serotypes),
• Enteroviruses.

12. URTI. ETIOLOGY
• Rhinovirus is shed in large amounts, with
as many as 1 million infectious virions
present per mL of nasal washings.
Rhinovirus; Coryza Viruses; Common Cold Virus
http://www.lookfordiagnosis.com/mesh_info.php?term=Rhinovirus&lang=1
Around 30-50% of
colds are caused
by rhinoviruses.

13. URTI. ETIOLOGY
• Mycoplasma pneumoniae can occasionally
present with common cold symptoms before
developing into more extensive respiratory
disease.
• Other pathogens include Histoplasma
capsulatum, Chlamydia psittaci, and Coxiella
burnetii.

14. • Despite what is reported in folklore, no
good clinical evidence suggests that
colds are acquired by exposure to cold
weather, getting wet, or becoming
chilled.

15. URTI. EPIDEMIOLOGY
• Most frequent from autumn to spring.
• Receptivity in early age children, from 6 month to 5
years is high (40-80%).
• Most children have about 4 - 6 acute respiratory
infections each year, and 10% to 15% of children have
at least 12 colds each year.
• Very common are 2 peaks: starting nursery (2–3 years)
and starting primary school (4–5 years).
• The annual number of colds decreases with age, to 2 to
3 colds each year by adulthood.
• These infections tend to be even more frequent in
urban communities than in rural areas.

16. URTI. Mechanism of transmission
• A source of infection are
patients with URTI, and
virus-carriers.
• Droplet with inhalation of
small or large airborne
drops during coughing,
sneezing, speaking by
contact with contaminated
hands, toys ets. (hand-to-
face or -mouth contact).
• Also fecal-oral (Adenovirus,
Rheovirus infection).

17. URTI. Incubation period and
progression of disease
• The upper respiratory viral replication cycle
begins 8 to 12 hours after initial infection.
Symptoms usually begin 1 to 5 days after
initial infection. Symptoms peak 2–3 days
after symptom onset, whereas influenza
symptom onset is constant and immediate.
• The symptoms usually resolve spontaneously
in 7 to 10 days but some can last for up to
three weeks

18. URTI. PATHOGENESIS
viral inoculation
is the nasal mucosa,
although the conjunctiva
local reproduction
of the virus
start of
immune reactions
inflammatory process,
destructive changes

19. URTI. Pathophysyology
nasal discharge
local
inflammatory
response
sneezingthroat irritation
nasal
congestion

20. URTI.
Localizing Symptoms
• Nose dryness or irritation
• nasal congestion and nasal
obstruction
• rhinorhea (runny nose),
• sneezing
• sore throat or throat
irritation ("scratchy" throat)
• hoarse voice (hoarseness)
• cough (dry, non-productive
cough)
• 'pink eye'

21. • Nasal discharge may be clear initially but
often turns yellow-green within a few
days.
• Nasal obstruction can interfere with
sleep and/or feeding.

22. URTI. COMMON SYMPTOMS
• Fever (may be absent
or mild)
• muscle aches and
weakness
• fatigue, malaise,
• headaches,
• shiver,
• irritability, restlessness
• loss of appetite
• sleep disturbance

23. URTI. PHYSICAL EXAMINATIONS
• a change in the color or consistency of nasal
secretions,
• edema and erythema of nasal mucosa,
oropharyngeal erythema without any
exudate, or ulceration
• tonsils are mainly intact (exept adenoviral
infection)
• mildly enlarged nontender cervical lymph
nodes

24. URTI. Complications
Secondary bacterial infections:
• pneumonia,
• sinusitis,
• otitis media.
Wheezing .
• Colds may cause acute exacerbations of
asthma, emphysema or chronic bronchitis.

25. The most common risk factors for
complications:
• Minimal breastfeeding
• Prematurity, especially birth at less than 35 weeks’
gestation
• Age younger than 3 months at the time of infection
• Chronic lung disease
• Congenital heart disease
• Congenital immunodeficiency
• Severe neuromuscular disease
• Allergic rhinitis,
• Anatomic facial variations,
• Dental infections, and inhalation of irritants.

26. • Common cold is a clinical diagnosis.
An initial diagnosis often is made
from symptoms alone.

27. URTI. LABORATORY STUDIES
Laboratory studies often are not helpful.
• Identification of virus: Commercial rapid tests
are available for detection of respiratory
syncytial virus (RSV) and influenza; monospot
test (EBV).
• CBC – mainly leucopenia with a
lymphomonocytosis or normocytosis
• A nasal smear for eosinophils may be
useful in the evaluation for allergic rhinitis.
• Throat swab. Used in complicated
tonsillitis/pharyngitis.

28. URTI. DIFFERENTIAL DIAGNOSIS
• allergic rhinitis,
• foreign body (especially with unilateral nasal
discharge),
• structural abnormalities of the nose or
sinuses,.
• bacterial sinusitis,
• streptococcal pharyngitis
• tonsillitis .

29. URTI. DIFFERENTIAL DIAGNOSIS
Rare causes of rhinorrhea:
•choanal atresia or stenosis,
•congenital syphilis (with "snuffles"),
•nasopharyngeal malignancy,
•Wegener granulomatosis.

30. • Pharyngitis is an inflammation of the
pharynx.
• Etiology: adenoviruses, rhinovirus, EBV
(mononucleosis), enteroviruses (herpangina),
and primary HIV infection; group A b-
haemolytic streptococcus (Streptococcus
pyogenes), Chlamydophila pneumoniae, and M.
pneumoniae.

31. Pharyngitis
• Streptococcal
pharyngitis is relatively
uncommon before 2 to
3 years of age, but the
incidence increases in
young school-age
children, then declines
in late adolescence and
adulthood.

32. • Pharyngitis . Symptoms.
• sore throat, cough, dysphagia and fever. The
pharynx, soft palate, and tonsillar fauces are
inflamed and swollen.
• If involvement of the tonsils is prominent, the
term tonsillitis or tonsillopharyngitis is often
used.

33. • Tonsillitis: typically involves inflammation of
the tonsils.
• Etiology: adenovirus, EBV, group A b-haemolytic
streptococcus.
• Symptoms: fever, sore throat, tonsils are
enlarged, red, swollen and covered with a white,
yellow, blood-tinged exudate. The anterior
cervical lymph nodes are enlarged and tender to
touch.
• Throat culture is the diagnostic "gold standard"
for establishing the presence of streptococcal
tonsillopharyngitis.

34. Tonsillitis

35. URTI. TREATMENT
• If the child has a runny nose or cold
(without a cough, difficult breathing, an
ear problem or a sore throat), the child
needs home care only.
• Advise the mother how to give home care
and treat any fever, if present.

36. URTI. TREATMENT
There is no specific therapy
for the common cold.
Management consists of
symptomatic therapies.
• Bed rest up to
normalization of body
temperature.
• Vitaminized milk-vegetable
food.
• Drinking warm fluids to
maintain hydration (tea)

37. URTI. TREATMENT
• Clear the young infant's nose if it interferes with
feeding.
• Using nasal saline drops with bulb syringe nostril
aspiration (this treatment can help infants with
congestion and obstruction).
• Nasal decongestants (xylometazoline,
oxymetazoline, or phenylephrine), are available as
intranasal drops or nasal sprays, but are not
approved for use in children younger than 2 years
old.

38. URTI. TREATMENT
• Antihistamines.
First-generation antihistamines reduce
rhinorrhea by 25% to 30%, which seems to be
related to the anticholinergic effect rather
than the antihistaminic properties. Second-
generation or "nonsedating" antihistamines
have no effect on common cold symptoms.
• Cough suppressants in case of dry cough
(dextramethorphan, Glaucin, Libexin, Tusuprex,
etc).

39. Control of fever
• If axillaries temperature < 38,5 C in children
more then 3 month antipyretic treatment is
usually unnecessary. In children before 3 month
and in case of perinatal CNS damage, severe
heart diseases, febrile convulsions in the history
antipyretic treatment is necessary if axillaries
temperature < 38,0 C.
• Acetaminophen (paracetamol 10-15 mg/kg not
often than every 4 hours (not more than 5 times
per day) or ibuprophen 5-10 mg/kg per dose, not
often than 6 hours.

40. • Aspirin is contraindicated for
children before 12 years, because it
has been associated with Reye's
syndrome, a potentially fatal liver
disorder!!!

41. • Antibacterial therapy is not
beneficial for the common cold.
• Antibiotics kill bacteria, not viruses, and
are of no use in treating a cold.
• Antiviral treatment may be used in
severe causes

42. •‘Treat a cold it lasts a
week, don’t treat and it
lasts 7 days.’

43. Cold Prevention
• There are no proven methods for prevention of
colds other than good hand washing and
avoiding contact with infected persons. No
significant effect of vitamin C or echinacea for
prevention of the common cold has been
confirmed.

44. Cold Prevention
• There is no vaccine to prevent colds.
• There are two major reasons vaccines are
not being sought for colds.
– 1) almost every person who gets a cold recovers
without any complications,
– 2) with over 250 viral types, producing an
effective vaccine against most or all viral
types is nearly impossible with current
techniques.

45. Laryngitis: is an inflammation of
the larynx
• Etiology: viruses (adenovirus, influenza
virus, parainfluenza virus and rhinovirus)
and often a bacterial co-infection, including
either S. aureus, S. pneumoniae, or H.
influenzae type b.

46. Croup
Gradually onset:
symptoms of URTI followed after
several days by the
characteristic hoarseness and
aphonia, barking cough (Seal
bark) , inspiratory stridor, and
signs of respiratory distress
due to laryngeal obstruction.
• Worsening at night
(acute laryngotracheitis or
laryngotracheobronchitis) is a form of laryngitis
in infant and young children.

47. Croup. Etiology
• Common: Parainfluenza types 1, 2, and 3
• Less common: Influenza viruses A, B
• Rare: Respiratory syncytial virus (RSV),
adenovirus, measles

48. • In clinical practice, the term "croup"is
usually used to describe acute
laryngotracheitis (viral croup) and acute
spasmodic laryngitis (spasmodic croup).
• Spasmodic croup is believed to be caused by
viruses, although important allergic and
psychological factors probably contribute to
the illness in some patients.

49. Croup. Epidemiology
• Usually occurs in late fall and winter, but
sporadic cases throughout the year
• Peak incidence at 18 months (typical range, 1
to 6 years)

50. Croup. Pathogenesis
• Virus-induced inflammation of larynx, vocal
cords, and trachea
• Subglottic (narrowest part of a child's upper
airway) tracheal edema restricts airflow

51. Physical Examination.
Main symptoms of viral croup:
• Inspiratory stridor (from turbulent airflow);
• Barking cough, that worsens at night;
• Hoarse voice (from vocal cord edema)
• Hypoxia only with severe croup
• Non-toxic appearance
N.B. Sometimes you will hear a wet noise if the child's
nose is blocked. Clear the nose and listen again.
Often, a child who is not very ill will have stridor only
when he or she is crying or upset, so be sure to look
and listen for stridor when the child is calm.

52. Degree of stenosing laryngitis (croup)
• Stenosis of 1 degree – symptoms of croup only during
crying and physical activity. The respiratory failure is
absent.
• Stenosis of 2 degree – respiration noisy, the hoarse
voice, barking cough, chest retraction presents at rest
and increasing during crying and physical activity .The
respiratory failure is moderately expressed. Peripheral
cyanosis.
• Stenosis of 3 degree – significant symptoms at rest.
Signs of hypoxia. The respiratory failure
• Stenosis of 4 degree - a stage of an asphyxia.

53. Additional Studies for diagnosis
50% of cases reveal abnormal
neck radiographs:
• Posteroanterior view:
Tapered subglottic narrowing
("steeple sign’’
•Lateral view: Overdistention
of hypopharynx

55. Croup. Differential Diagnosis
• Upper Respiratory Tract Infections
• Acute epiglottitis;
• Retropharyngeall, peritonsillar abscess;
• Bacterial tracheitis;
• Infectious mononucleosis;
• Diphtheria
• Angioneurotic edema;
• Subglottic stenosis;
• Tracheomalacia;
•

56. Croup. Differential Diagnosis
• Epiglottitis: is bacterial inflammation of the
epiglottis.
• Acute epiglottitis is rapidly progressive infection
of the epiglottis and contiguous structures that
may cause life-threatening airway obstruction.
• Etiology: H. influenzae type b.

57. Epiglottitis: Signs/Symptoms
• Rapid onset, severe distress in hours
• High fever
• Intense sore throat, difficulty swallowing
• Drooling
• Stridor
• Sits up, leans forward, extends neck slightly
• One-third present unconscious, in shock

58. Epiglottitis:

59. OMEGA SIGN
(Dr.FaceB..k)

60. Croup. Management (1 degree)
• Cool mist treatment
• Mechanism of action: soothes inflamed
mucosa, decreases viscosity of tracheal
secretions; may activate larynx mechano-
receptors to produce reflex slowing of
respiratory flow rate
• No clinical trials have demonstrated efficacy is
effective
• Caution: May intensify bronchospasm

61. Croup. Management (2 degree)
• Corticosteroids: Dexamethasone 0.6 mg/kg
PO or IM (max 10 mg), clinical improvement in
4 to 6 hours
• For mild-moderate croup, dexamethasone
0,15-0.30 mg/kg
For any patient with increased work of
breathing
• Mechanism of action: Decreases laryngeal
mucosal edema via anti-inflammatory action

62. Croup. Management (3 degree)
• Nebulized epinephrine:
Dose: 0,25-0,75 mL of 2,25% racemic
epinephrine solution in 2.5 mL of normal
saline
• For severe or worsening respiratory distress
• Mechanism of action: a-agonist capillary
arteriole constriction decreases mucosal
edema
• "Rebound" phenomenon (2 to 4 hours after
treatment) rare if dexamethasone also given

63. Croup. Management (4 degree)
• Helium-oxygen therapy (usually 70% He:30%
O 2 )
• Helium (low-density and low-viscosity gas)
improves laminar gas flow and decreases
mechanical work of breathing
• Endotracheal intubation may be required for
severe croup

64. Bronchitis
Bronchitis is an inflammatory disease of
bronchi of various etiology: infectious
(mostly viral), allergic, physical and
chemical (so-called irritative bronchitis).

65. Classification of bronchitis
• For the nature of inflammation: catarrhal, purulent,
atrophic bronchitis.
• For the course: acute, recurring, chronic bronchitis.
• Acute bronchitis: acute simple bronchitis.
• acute obstructive bronchitis.
• acute bronchiolitis
• Recurring bronchitis: Phases: exacerbation, remission
• Chronic bronchitis:
• 1. Primary, Secondary chronic bronchitis.
• 2. Phases: exacerbation, remission
• Chronic obliterating bronchiolitis:
• Phases: exacerbation, remission

66. ICD-10
• J20. Acute bronchitis
• J20.0. Acute bronchitis, caused by Mycoplasma pneumonia
• J20.1. Acute bronchitis, caused by Haemophilus influenza
• J 20.2. Acute bronchitis, caused by Streptococcus
• J 20.3. Acute bronchitis, caused by Coxsacke virus
• J 20.4. Acute bronchitis, caused by parainfluenza virus
• J 20.5. Acute bronchitis, caused by RSV
• J 20.6. Acute bronchitis, caused by rhinovirus
• J 20.7. Acute bronchitis, caused by ECHO virus
• J 20.8. Acute bronchitis, caused by other specified agents
• J 20.9. Acute bronchitis, unspecified.
• J21. Acute bronchiolitis
• J21.0 Acute bronchiolitis due to respiratory syncytial virus
• J21.1 Acute bronchiolitis due to human metapneumovirus
• J21.8 Acute bronchiolitis due to other specified organisms

67. Criteria of acute bronchitis
I.Clinical:
• cough – dry and rough at the beginning of
disease, gradually becoming productive;
• symptoms of intoxication are not expressed
greatly and quickly disappear;
• No symptoms of respiratory insufficiency

68. Criteria of acute bronchitis
Physical examination
• Percussion:
slight tympanic
resonance,
• Auscultation
rhonchi, dry and
various bubbling
rales, heard on
both sides of lungs.

69. Obstructive bronchitis –
• is a variant of acute
bronchitis, which
proceeds with
respiratory tract
obstruction because of
bronchospasm,
mucous edema,
hypersecretion and
pressure from
without.

70. Obstructive bronchitis.
Clinical sings
• Paroxysmal, “spastic” cough,
• Expiratory dyspnea, tachypnea
• Chest retraction, increased use
of accessory muscles
• Wheezing,
• Oral crepitations,
• Tympanic percussion sounds,
• Prolonged expiratory phase
• Dry and various bubbling rales.

71. Criteria of acute bronchitis
X-ray:
• strengthened lung figure, at the same time
absence of focal shadow;
• Rarefied lung pattern in lateral divisions of the
lungs and its thickening in the medial
divisions (occult emphysema)

72. Criteria of acute bronchitis
III.Laboratory:
• CBC:
–normal leukocyte count or leukopoenia,
lymphocytosis, monocytosis.
–ESR is not increased.

73. Differential diagnosis of acute bronchitis:
•acute bronchiolitis,
•pneumonia;
•obstructive bronchitis – with bronchial
asthma paroxysm, GERD.

74. Acute bronchitis. Treatment.
• General:
– antipyretics, and good fluid intake.
• Specific mainly viral, no antibiotics.
• In case of cough with mucous – expectorant
and mucolytic drugs
(ambroxol, acetylcysteine,
carbocysteine, etc)

75. Indications for use of antibiotics in
acute bronchitis
• The age below 6 months
• Severe clinical course of bronchitis (neurotoxicosis, etc)
• The compromised premorbid background (premature
birth, chronic diseases of lung or heart,
immunodeficiency)
• Suspected concomitant bacterial infection:
– Fever with elevation of body temperature above 39 C
– Flaccidity, refusal of food
– Pronounced intoxication
– Dyspnea
– Asymmetry of rales
– Leukocytosis, increased ESR

76. • The following antibiotics are used:
• Protected penicillins (Amoxiillin-clavunate)
• Cephalosporins (Cephalexin, Cephadrixyl,
Cephasolin, Cephotaxim, Cephtriaxon)
• Macrolids (Azitromycin, claritromycin)

77. Bronchiolitis
• is an acute viral lower respiratory tract
infection that results in an inflammatory
obstruction of the peripheral airways. It is
characterized by obstructive respiratory
insufficiency and cyclic course. Bronchiolitis is
mainly a disease of the first months of life.
• It is potentially life-threatening.

78. Bronchiolitis. Etiology
• Common: Respiratory syncytial virus
(RSV; 70% of cases)
• Less common: Parainfluenza, influenza,
adenovirus , metapneumoviruses
• Rare: rhinovirus, Mycoplasma
pneumoniae, Chlamydia, and
ureaplasma

79. epithelial
damage
inflammation
of the bronchioles
secretion
of mucous
necrosis of
Сiliated
epithelium
oedema
of the
submucosa
airway
obstruction
Pathophysiology

80. Bronchiolitis
CLINICAL MANIFESTATIONS
• Progressive respiratory illness
• In early phase it is similar to the common cold with
cough, coryza, and rhinorrhea, and low-grade fever .
• It progresses over 3 to 7 days to noisy, raspy
breathing and audible wheezing. Irritability, which
may reflect the increased work of breathing and may
increase itself with increased respiratory effort.
• In contrast to the classic progression of disease,
young infants infected with RSV may not have a
prodrome and may have apnea as the first sign of
infection.

81. Bronchiolitis. Symptoms
• Cyanosis nasolabial triangle,
• Tachypnea with usually shallow respirations.
• Wheeze, increased expiratory phase, and rales
• In more severe cases infants may become too
breathless to feed
• Asphyxial paroxysms are possible for infants of the
first months of the life);
• Persistent spastic cough.
• Tachycardia: especially when hypoxemia present.
• Fever: usually mild.
• Vomiting (posttussive).

82. Physical signs of bronchiolar
obstruction
• Intercostal retractions of flexible parts of breast
(subcostal/ intercostal recession)
• Percussion of the chest: hyperresonance (high
tympanic resonance)
• Auscultation: prolonged breathing out, diffuse
wheezes and crackles throughout the breathing
cycle on the both sides of lungs and a lot of fine
bubbling rales, crepitation on inspiration.
• Hypoxia is common in severely affected patients

83. LABORATORY AND IMAGING STUDIES
Routine laboratory tests lack specificity for
diagnosing bronchiolitis and are not required
to confirm the diagnosis.
The chest radiograph:
• hyperinflation due to small airways obstruction,
• air trapping,
• flattened or depressed diaphragms.
• The lung fields may appear normal or collapse
and/or consolidation may be seen occasionally.

84. • An X- ray of a child
with RSV showing the
typical bilateral
perihilar fullness of
bronchiolitis.

85. Laboratory:
• CBC: no specific findings. May be normal or
decreased white blood cells count,
lymphocytosis or mild leukocytosis.
• Rapid viral identification: usually a
“respiratory panel” is available to include
common seasonal respiratory pathogens by
antigen detection.
• Viral culture: results delayed but may be
useful to identify causative organism.

86. • Pulse oximetry is
generally adequate
for monitoring
oxygen saturation.
• Arterial blood gas in
severe cases of
bronchiolitis.
• Visual assessment of
oxygenation
correlates poorly
with actual blood gas
values.

87. Bronchiolitis
DIFFERENTIAL DIAGNOSIS
• Pneumonia
• Acute bronchitis.
• Asthma
• Foreign body in the airway,
• Congenital airway obstructive lesion,
• Cystic fibrosis,
• Bronchopulmonary dysplasia,
• Cardiogenic asthma

88. Indications for hospitalization:
• young age (<6 months old),
• moderate to marked respiratory distress (sleeping
respiratory rate of >50 to 60 breaths/min),
• hypoxemia (Po2 <60 mm Hg or oxygen saturation <92%
on room air),
• apnea,
• feeding difficulty ,
• lack of appropriate care available at
home.
• Children with chronic disease
(bronchopulmonary dysplasia,
congenital heart disease,
neuromuscular weakness, or immunodeficiency)

89. Bronchiolitis
TREATMENT
• Supportive therapy
monitoring, control of fever,
feeding via NG tube,
adequate fluid intake with IV support if
necessary (avoid excessive hydration),
upper airway aspiration (suctioning),
oxygen administration

90. • Supplemental oxygen by nasal cannula or
headbox to keep saturations >96% is often
necessary, with intubation and ventilatory
assistance for respiratory failure or apnea.

91. •Most infants require only
supportive care for their
self-limited illness.

92. Pharmacologic treatment
• Bronchodilators: ß-2-agonist or alpha-
adrenergic agents (epinephrine) by inhalation.
• Corticosteroids: prednisone 1-2 mg/kg IV, IM
The benefit of bronchodilators and
corticosteroids is controversial.

93. • Antiviral treatment:
• Ribavirin, an antiviral agent that suppresses
viral RNA polymerase activity, may shorten
symptoms, and its use should be considered
for patients who are at risk for severe or fatal
infections (chronic lung disease or
immunosuppressive conditions).

94. • Antibiotics not indicated unless
secondary bacterial infection
detected.

95. Differentiating Viral from Bacterial
Infections
Variable Viral Bacterial
Leukocytosis Uncommon* Common
Shift to left
(↑ bands)
Uncommon Common
Neutropenia Possible Suggests
overwhelming
infection
↑ ESR Unusual Common
↑ CRP Unusual Common

96. Prognosis
• Acute severe obstructive symptoms usually
resolve in 3–5 days, but cough may last up to
10-14 days. Complete recovery expected for
most patients.
• Mortality is generally very low (<1 %), but is
higher in infants <6 months or with underlying
chronic conditions. Mortality rises to 33% if
ventilation is required.

97. COMPLICATIONS
• Otitis media: is most common (secondary; bacterial).
• Pneumonia: secondary, bacterial; occurs in < 1% of
hospitalized cases.
• Apnea
• Respiratory failure
• Cardiac failure: secondary to pulmonary disease or
rarely myocarditis
• Bronchiolitis obliterans: rare; usually associated with
adenovirus-induced bronchiolitis/pneumonia

98. PREVENTION
• Immunoprophylaxis:
• RSV–intravenous immunoglobulin (RSV-IVIg) with
high RSV antibody concentration and
palivizumab, an injectable RSV monoclonal
antibody, provide passive prophylaxis and are
recommended during the winter months for
prevention of RSV disease for patients at risk for
severe disease.

99. Recurrent bronchitis –
• is the disease with relapsing of acute
bronchitis 2 and more times a year during 1-2
years. The absence of clinical obstruction and
duration of clinical manifestation for 2 weeks
and longer every relapse are common.
• Phases of pathologic process: exacerbation,
remission.

100. Chronic bronchitis
• is a chronic spread inflammatory damage of
bronchi with rebuilding of mucous secretory
apparatus and sclerotic degeneration of deep
layers of bronchial wall.
• Phases of pathological process: exacerbation,
remission.

101. Chronic bronchitis
Clinical symptoms:
• - productive cough for several months during 2
years;
• - permanent various râles;
• - 2-3 relapses in a year during 2 years;
• - the signs of lungs ventilation disturbances in
remission phase.
Note: none of the above mentioned signs may be
regarded alone as reliable evidence of chronic
bronchitis. The sings must be considered in
complex in view of possible development of
chronic process.

102. Chronic bronchitis. Diagnostics.
X-ray, especially bronchography :
•increasing and deformity of lungs figure, the
disturbances of root of the lungs structure.
Bronchoscopy
•endobronchitis.
Primary chronic bronchitis is diagnosed after
exclusion of cystic fibrosis, bronchial asthma,
lungs and cardiovascular malformations, ciliary
dysgenesis.

103. Thank you for your
attention!