1. Shortness of breath & the child with wheeze
The child with acute respiratory distress
Dr Matthew Hurley
NIHR Academic Clinical Lecturer (Assistant Professor)
Honorary ST8 Paediatric Respiratory Medicine
Nottingham University Hospitals NHS Trust

3. Learning outcomes
Be aware of the 2 different pathways for shortness of breath
Know the normal RR for different ages and the signs of respiratory distress
Be able to identify the difference between viral induced wheeze and asthma and know the treatment for both
Appreciate when to refer, treatment and appropriate homecare advice for patients with bronchiolitis and asthma

4. What is common How to treat them When to be worried What not to miss
Learning outcomes II
What is common How to treat them When to be worried What not to miss

5. Causes of breathlessness
Bronchiolitis
Virus-induced wheeze (episodic wheeze)
Upper airway infection
Inhaled foreign body
Asthma
LRTI Cardiac failure
Metabolic (DKA)
Anaemia

6. Normal values

7. Pathophysiology
Bronchiolitis vs
Virus-induced wheeze
Asthma

9. Bronchiolitis persistent cough and
either tachypnoea or chest recession (or both)
and either wheeze or crackles on chest auscultation (or both).
apnoea (small babies)

10. When to refer apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.

11. When to consider referring
a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume, taking account of risk factors and using clinical judgement)
clinical dehydration.

12. Risk factors
chronic lung disease (including bronchopulmonary dysplasia)
haemodynamically significant congenital heart disease
age - young infants (under 3 months)
premature birth, particularly under 32 weeks
neuromuscular disorders
immunodeficiency

13. Treatment

14. Do…
No medication
Advice on natural history
Safety-netting

15. Bronchial responsiveness….
Episodic wheeze
Multi-trigger wheeze
Asthma

17. Severity

18. Treatment

19. Prednisolone…..

20. Prednisolone…

21. Beware!

22. Beware!

23. Beware!

24. Summary
Bronchiolitis, episodic wheeze and asthma are (probably) different entities and need to be treated differently
Education is the treatment for bronchiolitis
Steroids for the few for wheeze

25. Discussion…