1. Pediatric Infectious Obstructive Airway Diseases Fred Hill, MA, RRT

2. Obstructive Airways Diseases of Children Epiglottitis Croup Bronchiolitis

3. Epiglottitis: Etiology and Incidence Acute inflammation and edema of supraglottic structures Causative agent - most often Haemophilus influenzae type B Typically affects children ages 2 to 6 years

4. Epiglottitis: Clinical Presentation Acute onset: Upper airway obstruction and fever Lethargic or agitated Child sits upright May be drooling Toxic appearance Temperature > 38  C

5. Epiglottitis: Diagnosis Lateral neck X-ray: “thumb sign”

6. Epiglottitis: Treatment Intubation Antibiotics: ampicillin and chloramphenicol

7. Croup: Etiology and Incidence More correctly: Laryngotracheobronchitis Inflammation and edema of subglottic structures Viral in origin: Parainfluenzae types I & II, RSV, others. Occasionally, Mycoplasma pneumoniae Children: 6 months to 3 years

8. Croup: Clinical Presentation & History Common cold precedes LTB by 1-3 days Low grade fever Barking cough (worse at night) Stridor, hoarseness Retractions, tachypnea Recovery period: 2 to 6 days

9. Croup: Diagnosis Lateral or AP X-ray of the neck: “steeple sign”

10. Bronchiolitis: Etiology and Incidence Lower airways: inflammation, edema, secretions Transmission: contact with infected secretions Prevalent in fall and winter Viral: RSV and parainfluenzae viruses, others Children <2 years

11. Bronchiolitis: Clinical Presentation & History Preceded by common cold, upper RTI Congested cough Wheezing, perhaps wet crackles Tachypnea Hyperinflation Low grade fever

12. Bronchiolitis: Diagnosis Chest X-ray: –Hyperinflation –Peribronchial thickening –Patchy consolidation –Sternal bowing

13. Bronchiolitis: Treatment Most often mild form, doesn’t require hospitalization, primarily supportive Hospitalization –Supplemental O 2 for hypoxemia Sp O 2 <92%, Pa O 2 <70 mm Hg –Mechanical ventilation –Ribavirin (Virazole): now controversial

14. Comparison ItemEpiglottitisCroupBronchiolitis Usual age of incidence2 to 6 years6 months to 3 years<2 years Area of obstructionSupraglottic areaSubglottic areaBronchioles X-ray findingsThumb signSteeple signHyperinflation Rate of occurrence0.015%10%29% % of cases hopitralized100%<2 %2% Major infective agentHaemophilus influenzae Parainfluenza virusesRSV Primary tx in hospitalArtificial airway Antibiotics Hydration Oxygen Hydration Oxygen Other txs in moderate to severe cases Mechanical ventilation Racemic epinephrine Dexamethasone Helium-oxygen Artificial airway Mechanical ventilation Beta 2 agents Ribavrin Artificial airway Mechanical ventilation