• History and physical examination

• The purpose of history-taking and physical examination is to confirm

that the preschool child has a wheezing disorder, to identify the
pattern of symptoms, the severity of the condition and any possible
trigger factors, and to look for features suggestive of another
diagnosis or associated condition
Physical Examination
•General
•Vital signs including SpO2 %
•Chest examination
Inspection:
–Respiratory distress
–Chest wall deformity (increased AP diameter)
– allergic shiners/nasal polyps
–Skin: eczema
•Palpation: chest wall asymmetry with expansion, tracheal
deviation
•Percussion: difference in vocal resonance
•Auscultation:
•Location of wheeze
•Character of wheeze
•Other breath sounds associated with wheeze
• While most children do not require further
• investigation, the decision should be guided by the
• history and examination finding and may include:

chest x-ray. Chest x-ray

 Diagnostic Evaluation
Initial evaluation depends on likely etiology;

chest radiograph
useful for evaluating
hyperinfiation (common in bronchiolitis and viral pneumonia),
signs of chronic disease such as bronchiectasis, or a space-
occupying lesion causing airway compression

bronchodilator may be diagnostic as well as therapeutic

because these medications can reverse conditions such as
bronchiolitis (occasionally) and asthma but will not affect a
fixed obstruction

Pulmonary Function Tests (PFT’s) Airway obstruction

assessment
Prevention:
1. No vaccine avariable
2. RSV immunoglobulin monoclonal antibody=palivizumab
•IM plavisomab before RSV season for Premature Patients & for patients with chronic Lung disease wich is monoclonal
antibody Used as prophylaxis, not in acute treatment
4. Avoid exposure to symptomatic pts
Prognosis:
 Most of cases recover within 1-2 weeks
 Mortality around 1% due to: apnea , respiratory failure, dehydration

 RPrognosis

 Approx 60% of infants who wheeze, will stop wheezing

 ecurrence may occure no long life immunity

CHD/ BPD/ Immuno-deficiency:

More severe disease, higher morbidity & mortality

Monoclonal antibody to RSV F protein (Palivizumab) I.M is given
before
and during RSV season for risky infants < 2 yr of age with:
Chronic lung disease
Gestational age is less than 35 weeks
Comorbidities e.g. congenital heart disease, immunodeficiency,
neuromuscular disorders
) In acute bronchiolitis:

Treat at home or hospital?

Hospitalize if risk factors for severe disease exist e.g.
Infants younger than 3 months
Severe respiratory distress or apnea, oral feedings intolerance
Preterm birth
Underlying comorbidit
 Treatment for wheezing
Because wheezing is almost always a symptom of an underlying condition,
treating it usually involves treating the condition.
When it comes to certain lung conditions, prescription anti-inflammatory
medications can decrease inflammation and excess mucus in the airways

After that, treatment depends on the cause. Some common causes and treatments
include:

Asthma. Your doctor will probably prescribe:

Treatment
Bronchodilator
Short-acting and rapidly acting β2-agonists are the most popular and most
commonly used first-line bronchodilators used to treat acute symptoms
including wheeze, cough, and shortness of breath..
more effective in children younger than 2

4.2. Inhaled steroids

Inhaled steroids can be used in recurrent wheeze . This treatment is effective in
persistent and late-onset wheezing, but it is not as effective in transient wheezing,

4.3. Systemic steroids

Systemic steroids can be used to treat wheezy patients, in whom a short course of
therapy (3–5 days) has been documented to be effective in reducing recurrent
wheeze after a rhinovirus infection in patients with eczema

) Ipratropium bromide:
- can be used as adjunct therapy
- also useful in patients with significant tracheal or bronchomalacia
Treatment
A. Mild attack : without respiratory distress ~ follow up.
B. Severe attack:
-¢- Hospitalization for: - Infants younger than 6 months
--¢- Humidified cool 0 2 inhalation.

-¢- IV. Fluids to avoid the high risk of aspiration

-¢- Inhaled bronchodilator ~ start with a trial dose & continue regarding the response
-¢- Adrenaline nebulizer ~temporary relief of bronchiolar obstruction.
-¢- Treat complications ~ digoxin for heart failure.
~ mechanical ventilation for respiratory failure.
-¢- Steroids ~ controversial
C. Antiviral: Ribavirin aerosol.
Indications: risky infants; with
- Age: younger than 6 weeks I prematures
- Chronic lung disease
- Congenital heart diseases.
- ImmunoDeficiency