Chronic Cough/Bronchiectasis – Pediatrics: Difference between revisions
From Guide to YKHC Medical Practices
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'''Pathophysiology:''' Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and | '''Pathophysiology:''' Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and loss of elasticity of bronchi. Loss of muco-ciliary function leads to difficulty clearing secretions. | ||
<br/>'''Risk Factors:''' | <br/>'''Risk Factors:''' | ||
*low birth weight | *low birth weight | ||
| Line 5: | Line 6: | ||
*Early recurrent respiratory infections | *Early recurrent respiratory infections | ||
*Previous injury | *Previous injury | ||
* | *Environmental effects (lack of piped water, household crowding, woodstove in the house) | ||
'''Demographics:''' Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000. low income. | '''Demographics:''' Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000. low income. | ||
<br/>'''Signs/Symptoms:''' Chronic wet cough | <br/>'''Signs/Symptoms:''' Chronic wet cough | ||
<br/>'''Diagnosis:''' Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) and CT scan confirmed Bronchiectasis | <br/>'''Diagnosis:''' Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) and CT scan confirmed Bronchiectasis | ||
<br/>'''Management:''' | <br/>'''Management:''' | ||
*Reduce infection-inflammation: treat early and exacerbations 'aggressively' with antibiotics, airway hygiene clearance, vaccinations | *Reduce infection-inflammation: treat early and exacerbations 'aggressively' with antibiotics, airway hygiene clearance, vaccinations | ||
*Improve other factors | *Improve other factors contributing: attention to nutrition, detect complications, pollutants | ||
*Systemic care: regular review, multi- | *Systemic care: regular review, multi-disciplinary care, education, enhance self care and management | ||
*Collaboration with Seattle Children's Hospital Pulmonologists who generally see patients in a Bethel Field Clinic 3-4 times a year | |||
'''Critical Times for Affected Patients:''' during exacerbations, if untreated can lead to early COPD and death | '''Critical Times for Affected Patients:''' during exacerbations, if untreated can lead to early COPD and death | ||
===Resources/References=== | ===Resources/References=== | ||
* [[media:Bronchiectasis.pdf|Bronchiectasis: Prevention and Management 2016]] ( | * [[media:Bronchiectasis.pdf|Bronchiectasis: Prevention and Management 2016]] (PowerPoint Presentation by Rosalyn Singleton, MD) | ||
* Singleton RJ et al. [https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.22763 Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis]. ''Pediatr Pulmonol'' 2014. | * Singleton RJ et al. [https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.22763 Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis]. ''Pediatr Pulmonol'' 2014. | ||
* Redding et al. [https://www.sciencedirect.com/science/article/pii/S0012369215510817?via%3Dihub Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis]. CHEST 2014:146;762-4 | * Redding et al. [https://www.sciencedirect.com/science/article/pii/S0012369215510817?via%3Dihub Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis]. CHEST 2014:146;762-4 | ||
Revision as of 10:02, 2 December 2020
Pathophysiology: Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and loss of elasticity of bronchi. Loss of muco-ciliary function leads to difficulty clearing secretions.
Risk Factors:
- low birth weight
- Prematurity
- Early recurrent respiratory infections
- Previous injury
- Environmental effects (lack of piped water, household crowding, woodstove in the house)
Demographics: Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000. low income.
Signs/Symptoms: Chronic wet cough
Diagnosis: Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) and CT scan confirmed Bronchiectasis
Management:
- Reduce infection-inflammation: treat early and exacerbations 'aggressively' with antibiotics, airway hygiene clearance, vaccinations
- Improve other factors contributing: attention to nutrition, detect complications, pollutants
- Systemic care: regular review, multi-disciplinary care, education, enhance self care and management
- Collaboration with Seattle Children's Hospital Pulmonologists who generally see patients in a Bethel Field Clinic 3-4 times a year
Critical Times for Affected Patients: during exacerbations, if untreated can lead to early COPD and death
Resources/References
- Bronchiectasis: Prevention and Management 2016 (PowerPoint Presentation by Rosalyn Singleton, MD)
- Singleton RJ et al. Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis. Pediatr Pulmonol 2014.
- Redding et al. Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis. CHEST 2014:146;762-4
- Lewis, T. et al. Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children. CHEST. 125(5):1665-1673, May 2004. doi.org/10.1378/chest.125.5.1665
- Healthy Homes Study
- YKHC Clinical Guideline for Bronchiectasis
