Acute respiratory infections (ARI)

Instructional Objectives: At the end of the lecture the student would be able to: 1-Define ARI in children. 2-Point out the occurrence of the disease. 3-Define the methods of risk assessment. 4-List the management plan according to age and the result of clinical evaluation.

(Acute Respiratory Infections) ARI (Acute Respiratory Infections) Acute infections of Ear lasting <14 days &/or Nose ,Epiglottis, Larynx, Trachea, Bronchi, bronchioles ,&/or Lungs with cough lasting <30 days.

Control of acute respiratory infections (ARI) program . ARI is a world wide problem &is the third child killer after diarrhea &Malnutrition. ARI forms the main cause of mortality &morbidity among children in developing countries & contribute to 30-60% of all attendance to outpatient departments of child health facilities

70% of which are upper R.T.I The incidence of pneumonia is 3-4%in children <5 years in developing countries. The majority of ARI are mild &can be treated at home without antibiotics

The most important objective of ARI program is to be able to identify the serious cases . Common causes: viruses followed by bacteria

Standard case management : Assessment ,classification &management I Assessment : Ask: How old is the child ? 2 months-5years :is he able to drink? <2 months :has the child stopped B.F. well Is he coughing ? Duration ? (<30 days :acute ,>30 days chronic) Does the child have fever? duration? Did the child have convulsion during the current illness?

Look &listen :(calm child) Count: Respiratory rate /minute Tachypnea is considered a danger sign if: Age RR/minute <2months 60+ 2- <12 months 50+ >=12 – 5 years 40+ Chest indrawing: During child breathing look for the indrawing in the lower chest wall Stridor: it indicates URT obstruction Wheeze: it indicates LRT obstruction

Look: Measure the Temp. The child is abnormally sleepy or drawsy sings of Malnutrition Measure the Temp. Fever (38c) or low body temperature (35.5c)

Management related classification: Cough or cold (no pneumonia ) Cough No fast breathing No chest indrawing Pneumonia Fast breathing

Sever pneumonia Cough Fast breathing Chest indrawing Very sever disease Danger signs are: Convulsion Sleepy child Stopped feeding well Not able to drink Stridor Under nutrition

Group(1): 2 months-5 years

Very sever disease : Sever pneumonia: Refer urgently hospital Give 1st dose of antibiotic Treat wheezing if present If cerebral malaria is suspected give antimalarial Sever pneumonia: Refer urgently hospital Give first dose of antibiotics Treat fever if present Treat wheezing if present

Pneumonia : Advice mothers to give home care Give an antibiotics Treat fever if present Treat wheezing if present Advise mother to return with child in 2 days for reassessment ,or earlier if child get worsen

No pneumonia (cough or cold) If coughing more than 30 days refer for assessment Assess &treat ear problems & or sore throat Advice mother to give home care Treat fever &wheezing

Reassess in 2 days a child who is taking an antibiotics for pneumonia : If he gets worse: Not able to drink, has chest indrawing, has other dangerous signs (Refer urgently to hospital) If he remains the same: Change the antibiotics or refer If he improves: Breathing slower, no fever, Eating better (Finish the 5 days of antibiotics)

Group (2): age <2 months

Very sever disease: Refer urgently to hospital Keep infant warm Stopped feeding well Convulsion Sleepy or difficult to wake Stridor Wheezing Fever or low body temperature Refer urgently to hospital Keep infant warm Give first dose of antibiotic

Sever pneumonia: Severe chest indrawing or Fast breathing Refer urgently Keep infant warm Give first dose of antibiotic If referral is not feasible ,treat with antibiotic &follow closely

no pneumonia (cough or cold): No chest indrawing, No fast breathing Advice on home care: Keep infant warm Breast feeding frequently Clean nose if interferes with feeding Give extra fluid & sooth throat & relieve cough with a safe remedy

(This child may have Pneumonia) Advice the parents to return quickly if: Breathing becomes difficult Breathing becomes fast feeding becomes a problem The young infant becomes sicker The child is not able to drink (This child may have Pneumonia)

Antibiotics which can be used: Cotrimoxazol, Amoxicillin, Ampicillin, procaine penicillin. Antipyretic for fever: use Paracetamol Wheezing is treated with nebulized B agonists or oral salbutamol in mild cases