17 Lower Airway

Foreign Body Airway Obstruction

• Path: foreign body

• pt: < 3, go unattended, sudden onset dyspnea

• symptoms

  • intrathoracic: in lung/bronchioles, expiratory wheezies (expiration closes airway)

  • extrathoracic: inspiratory stridor (extrathoracic airway closes) (ENT)

• diagnosis

  • 2 view xray. Coin sign. Very difficult to see

    • In trachea: negative on AP, positive on lateral

    • Not in trachea: positive on AP

• treatment

  • antibiotics

  • retrieve foreign body

    • Bronchoscopy if in lungs

    • endoscope if in GI

    • laryngoscope if ENT.,

• FBAO = foreign body airway obstruction

Asthma

• path: obstructive, reversible, inducible with trigger

• pt: norma pt with attacks

  • allergies, atopy, asthma

• symptoms: wheezing, dyspnea

• diagnosis

  • PFT: FEV1/FVC reduced

  • reversed with bronchodilators

  • induced with methacholines

• treatment

  • avoid triggers

    • get rid of pets, carpets, pillows

    • smoking cessation

  • Increase in severity, add more meds

  • SABA, rescue inhaler

  • add short ICS

  • increased ICS dose, or add leukotriene antagonists

  • add LABA

  • last option: oral steroids

Bronchiolitis

• path: RSV

• pt: < 2 yo, winter months

• symptoms: wheezing, dypnea

• clinical diagnosis

  • no xray ruleout pneumonia

  • no beta agonist ruleout asthma

  • no CBC ruleout sepsis

• treatment

  • do not give beta agonist, steroids, abx

  • admit, give O2, fluids, symptoms peak at day 3-4

• f/u

  • can progress to hypoxemia and ARDS.,

CF

• path: AR CFTR gene

• symptoms

  • newborn: meconium ileum

  • older kid: recurrent pulmonary infections (bad cilia)

  • FTT: no pancreatic enzyme

  • mom: salty baby

• diagnosis

  • prenatal screening

  • Screen + sweat Cl test

    • infant: > 40

    • older: > 60

• treatment

  • lung: aggressive pulmonary toilet, pseudomonas abx

  • pancreas: pancreatic enzymes, ADEK