DYSPNEA

BY A-7
RESPIRATORY SYSTEM
2005

Case
A 1 year 1 month boy was brought to the
hospital with history shortness of breath
since 3 days ago. Other history are
productive cough and fever. When born,
his weight was 3 kg, spontaneus born, and
enough of months. No shortness of breath
before.

KEY WORDS

A 1 year 1 month boy.

Dyspnea
Fever
Productive cough
A normal baby

Questions

What cause shortness of breath & fever ?

The differential diagnosis for this case are.
Clinical manifestation from the DD ?
Etiology of DD
What about the morphology and
classification of the microorganism ?

Questions

The patomechanism of DD ?
How would we investigate this patient?
What is the management for this case ?
What about the complication & prognose?

ACUTE BRONCHITIS

 Bronchitis is an inflammation of the lining of the

bronchial tubes, the airways that connect the
trachea (windpipe) to the lungs. This delicate,
mucus-producing lining covers and protects the
respiratory system, the organs and tissues
involved in breathing. When a person has
bronchitis, it may be harder for air to pass in and
out of the lungs than it normally would, the
tissues become irritated and more mucus is
produced.

 Acute bronchitis is a lower respiratory tract

infection that causes reversible bronchial
inflammation. Acute bronchitis is usually
caused by a viral infection (95 %) but can
also be caused by a bacterial infection.
Most of the cases were caused by
Respiratory syncitial virus.

Normal Bronchus

Bronchitis

 Acute bronchitis often starts with a dry, annoying

cough that is triggered by the inflammation of
the lining of the bronchial tubes. Other
symptoms may include:
cough that may bring up thick white, yellow, or
greenish mucus
headache
generally feeling ill
chills
fever (usually mild)
shortness of breath
soreness or a feeling of tightness in the chest
wheezing (a whistling or hissing sound with
breathing)

DIAGNOSIS
The cough in acute bronchitis may
produce either clear or purulent sputum.
Physical examination : wheezing, rhonchi,
a prolonged expiratory phase or other
obstructive signs may be present.

TREATMENT
Take the child to the doctor if he shows symptoms of
bronchitis.
Acute bronchitis is usually caused by a virus. Using
antibiotics is not helpful.
The best treatment is to rest, drink plenty of fluids, and
use an over-the-counter medicine to treat the pain and
fever.
Coughing helps bring up mucus and get rid of germs.
Use a cough medicine that eases, but does not stop
coughing. Ask your doctor.
Using a humidifier may help relieve symptoms. Wash the
humidifier each day.
In some cases, the doctor will recommend using a
medicine called a bronchodilator that makes breathing
easier.

PREVENTION
Acute bronchitis lasts no more than a few
days or a few weeks.
To prevent the spread of germs, wash
hands often.

ASTHMA BRONCHIOLE

DEFENITION
Asthma is characterized by episodic,
reversible bronchospasm resulting from
an exaggerated bronchoconstrictor
response to various stimuli

EPIDEMIOLOGY
Affects about 5% of adult and 7% to 10%
of children

CLASSIFICATION
1) Extrinsic asthma
2) Intrinsic asthma

1) Extrinsic asthma
-asthmatic episode is typically initiated by a
type I hypersensitivity reaction induced by
exposure to an extrinsic antigen
- 3 types:
i) atopic asthma-most common type
ii) occupational asthma
iii) allergic bronchopulmonary
aspergillosis
- serum Ig E levels are elevated

2) Intrinsic asthma
-the triggering mechanism are non
immune such as cold, psychological
stress, exercise and etc
-usually no personal and family history
of allergic manifestations
-serum Ig E levels are normal

Clinical manifestation

Dyspnea
Cough
Wheezing
Fever
Chest tightness
Tachypnea
Hyperinflation chest

Phatogenesis
Allergen at tracheobronchial tree
Trigger mast cell with surface Ig E forming Ag-Ab complex in type 1 hypersensitivity
Mast cell degranulation
Release mediators
PG, histamine, Bradykinin, Leukotriens, PAF

Acute inflammation
Thick sputum production,
Edema, Infiltration with
neutrophils and
eosinophils

Bronchial smooth muscle

contraction
Maximal on expiration
Distal air trapping
Wheezing

Physical examination
Inspection:

-prolonged expiration
-hyperinflation chest
-breathlessness

Austulcation:

-wheezing

Laboratorium:

-thick, tenacious mucus plugs

Microscopic:

-histocyte
-Curschmann spirals
-Charcot-Leyden

Blood:

-Elevated eosinophil
-Elevated Ig E @ normal

TREATMENT
2 types:
Inhibit smooth muscle contraction
Beta adrenergic agonist
Methylxanthines
Anticholinergic

Prevent @ reverse inflammation

Glucocorticoids
Mast cell-stabilizing agents

BRONCHOPNEUMONI
A

DEFINISI

Bronchopneumonia is an
inflammation of the bronchus
in response to invasion by on
infectious agent that is
introduced into the lungs
through hematogeneus
speard on inhalation

ETIOLOGY
Viral infections
These are characteriized by the
accumulation of mononuclear cells in the
submucosa and perivascular
space,resulting in partial obtruction of the
air way.
Bacterial infections
The alveoli fill with proteinaceous
fluid,which triggers a brisk influx of red
blood cells and polymorphonuclear cells .

CLINICAL
MANIFESTATION
Older infants: grunting may be
less common
;however,tachypnea,rectraction
s,and hypoxemia often are
present and may be
accompainied by a persistent
cough,congestion,fever,irritabili
ty,and decreased feeding.

 (A) Gram stain demonstrating grampositive cocci in pairs and chains and
(B) culture positive for Streptococcus
pneumoniae are shown.

PATHOPHYSIOLOGY
Infection by bacteria in
pneumonia IL-1 is released by
variety of cells to defense IL1 acts on thermoregulatory
center Increase of PG
synthesis Increased
temperature Fever

PATOPHYSIOLOGY
Organism Attachment to the
resp. epithelium Inflammatory
response Vasodilatation
pulmonary vasc. Increased
blood flow Hydrostatic press.
Increase Transudat Vasc.
Permeability increase Exudat
Oedema Consodilation of lung

IMAGING STUDIES
RADIOGRAPHY
This is the primary imaging
study used to confirm the
diagnosis of pneumonia.
ULTRASOUND
These studies are indicated
primarily in children with
complications such as pleural
effusions and failure to respond
to antibiotic treatment.

 Right lower lobe consolidation in a patient

with bacterial pneumonia is depicted.

 This x-ray demonstrates progression

of pneumonia into the right middle
lobe and the development of a large
parapneumonic pleural effusion.

LAB STUDIES
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General information
Sputum culture
Bronchoscopy
Blood culture
Lung aspirate

TREATMENT
Antibiotic depend on the
microorganism
O2 therapy

COMPLICATIONS
Pleural effusions and empyemas
Normally,there is a thin layer of
fluid (approximately 10 ml)
between the visceral and
parietal pleura,which help
prevent friction.This pleural
fluid is produced at 100ml\h.

PROGNOSIS
Overall,prognosis is good.Even in
children whose pneumonias
have been complicated by
empyema or lung abscess,long
term alteration of pulmonary
function is rare.

BRONCHIOLITIS

DEFINITION
Bronchiolitis is inflammation of the smaller

airways connecting the two.

Bronchiolitis is usually a viral infection. RSV is

responsible for the illness in most children.
Adenovirus, parainfluenza (croup), and other
viruses can also cause bronchiolitis.
Babies and toddlers whose bronchioles are
smaller and easier to plug, these viruses
often cause bronchiolitis when inhaled.

SIGN & SYMPTOMS

The first symptoms of bronchiolitis are usually

the same as those of a common cold:

stuffiness
runny nose
mild cough
These symptoms last a day or 2 and are
followed by worsening of the cough and the
appearance of wheezes

SIGN & SYMPTOMS

Sometimes more severe respiratory difficulties
gradually develop, marked by:
rapid, shallow breathing (60 to 80 times a
minute)
a rapid heartbeat
drawing in of the neck and chest with each
breath, known as retractions
flaring of the nostrils
irritability, with difficulty sleeping and signs of
fatigue
The child may also have a fever, a poor appetite,
and may vomit after coughing.

DIAGNOSIS
Diagnosis is often based on the history and

physical exam. A chest x-ray can give

additional information, as can a pulsoximeter
to measure oxygen levels. A specific swab for
RSV might be done to identify the cause of
bronchiolitis.

SELF LIMITING DISEASE

Mild bronchiolitis may last only for a day or

so. Often the disease lasts 5 to 12 days. The

first 3 days are the most critical.

TREATMENT
There are no specific medicines for treating

bronchiolitis at home. It is important to give plenty

of fluids to prevent dehydration. Also, a humidifier
or saline nose drops might be recommended to
thin the mucus.
Some children need supplemental oxygen or even
mechanical help to breathe. A powerful aerosol
treatment specifically against RSV is sometimes
used for hospitalized children.
Steroids and antibiotics are not usually helpful.

PREVENTION
Hand washing before anyone handles

susceptible infants.
Use a tissue when someone cough or sneeze.
Two products are now available to prevent
RSV infection in children at high risk for serious
disease. RSV-IGIV (RespiGam) and
palivizumab (Synagis) have been approved for
high-risk children.

REGU A7
- MUSLIH W.
RACHMAN
- KHAERIAH
- NURFATMIYANTI
GANI
- INDRA CHUANDY
- SRI APRIANITA
- PERDANA PUTRA
- SARINAH M.
RUMLAWAN
-

RINA LYSIA
SOFYAN BAKRI

JUFRI F. P.

NURMEILIA
- MUNEERAH J.
- SHAZREEN
SHAHARUDDIN
- SAKINAH
AMINUDDIN
- SITI ATHIRAH
KAMARUZZAMAN