Pediatric Reactive Airway Disease Clinical Presentation

Updated: Feb 23, 2016
  • Author: Eric S Chin, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Presentation

History

The following information should be elicited:

  • Initiation of symptoms (More than a few days decreases the chance of quick reversal in the ED because of prolonged inflammation and mucous plug formation)
  • Upper respiratory infection (URI) symptoms, fever, and production of phlegm
  • Precipitating factors
  • Use of an bronchodilator inhaler; how often it was used in the past 24-48 hours prior to the ED visit; how often it was used over the past week or month
  • How many inhalers were used in the past month
  • How many puffs are being administered with each use and if the inhaler is being used with a spacer
  • Compliance with use of corticosteroid inhaler (Ask if it was used daily despite any symptoms of wheezing)
  • Date of last ED visit; how severe the current episode is compared with previous episodes [12]
  • Date of the last hospital admission
  • Number of admissions in the past year; number of intensive care unit admissions
  • History of intubation and how long ago it was
  • Recent use of oral steroids
  • Factors that usually initiate symptoms
  • Whether this is a typical episode
  • Presence of any underlying cardiac, GI, or immunologic diseases
  • Other current medications
  • Exposure to tobacco smoke and allergens (ie, cat dander)
  • Ability to tolerate fluids
  • Recent mental status changes
  • Baseline peak expiratory flow rate (PEFR)
  • History of atopic dermatitis or other allergic skin conditions [13]
  • Dry cough or wheezing that is often worse at night
  • History of recurrent wheezing and dyspnea
  • Wheeze or cough after active playing
  • Relationship to emotional expressions
  • Relationship to menses
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Physical

See the list below:

  • Fever
  • Tachycardia
  • Diaphoresis
  • Poor feeding
  • Flushing, cyanosis
  • Subcutaneous emphysema
  • Intercostal retractions
  • Increased anteroposterior diameter or pectus carinatum
  • Tachypnea, dyspnea
  • Wheezing
  • Coughing
  • Distant breath sounds, hyperresonance, poor air movement to result in wheezing ("silent chest")
  • Decreased peak expiratory flow rate
  • Inspiratory-to-expiratory ratio (normal ratios are 1:2 to 1:3)
  • Allergic shiner (dark semicircles of skin under the eyes)
  • Transverse nasal skin fold from repeatedly rubbing the nose
  • Flaring of nasal alae
  • Presence of nasal polyps and nasal secretions
  • Pulsus paradoxus (greater than a 10mm Hg difference in SBP during inspiration)
  • Murmur
  • Altered mental status
  • Clubbing
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Causes

See the list below:

  • Precipitants of asthma exacerbation
    • Infection -Respiratory syncytial virus (RSV) most commonly isolated from infants and preschool-aged children; Mycoplasma pneumoniae most commonly isolated from school-aged children
    • Tobacco smoke
    • Pet dander, cockroach and dust mite allergen
    • Molds
    • Pollen
    • Exercise
    • Weather changes
    • Stress
    • Drugs
  • A precipitant of bronchiolitis is respiratory infection, usually due to RSV.
  • Gastroesophageal fistula
  • Mediastinal mass (external compression of the airway)
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