Revista médica Salud respiratoria

pneumonia and Bronchiolitis

University Foundation of the Andean

Area Respiratory Therapy
2020
 Revista médica Salud respiratoria

PNEUMONIA

Pneumonia is an acute inflammatory

process of the lung parenchyma,
generally of infectious etiology (either
viral or bacterial); It presents with
occupation of the air space,
interstitial, and, on some occasions,
of the pleura, secondary to alterations
in the defense mechanisms of the SYMPTOMS
lower airway, which allows the action It is very easy to confuse pneumonia,
of a pathogen that will trigger at first, with a common cold. Some of
activation of the immune response the symptoms of pneumonia include:
and inflammatory, and thus will
generate accumulation of fluid, Cough: As the disease progresses,
leukocytes, and cellular debris in the the cough is accompanied by mucus
alveolus, with subsequent decrease in and when the mucus worsens it may
lung compliance, increase in contain blood.
resistance, alveolar collapse and 1. Fever.
alteration of ventilation-perfusion, 2. Hypothermia in older adults.
which, in turn, will lead to to typical 3. Pain in the chest and
symptoms and signs.
abdomen.
4. Difficulty breathing.
5. Lack of appetite.
The World Health Organization
6. Fatigue.
(WHO) established that 7.6 million
children under the age of 5 die every
year, and that pneumonia is one of
the main causes, with an estimated
worldwide incidence of between 1,000
and 12,000 per 100,000 children, with
important percentages of
hospitalization.
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in contaminated water, vomit or
food.

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1482197948

Causes of pneumonia https://sp.depositphotos.com/vector-

images/lung.html
The germs that cause
pneumonia vary in each case.
However, they can be grouped
into:
RISK FACTORS
Bacteria: about 80% of
pneumonias are of bacterial There are some risk factors for the
origin. Streptococcus development of pneumonia, such as
pneumoniae, Staphylococcus poor breastfeeding or the absence of
aureus, Haemophilus it during the first two years of life,
influenzae, and Klebsiella are exposure to tobacco smoke,
some of the bacteria that can malnutrition or conditions of poverty,
cause pneumonia. and comorbidities such as
prematurity, low weight at birth,
Viruses: like adenovirus. congenital heart defects,
Fungi and parasites. gastroesophageal reflux and
immunocompromised, among others.
Other Germs: Mycoplasma
pneumoniae, Legionella, and
Chlamydia, which are neither
viruses nor bacteria, can cause
pneumonia.
Foreign matter in the
respiratory tract: by breathing
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PHYSICAL EXAM
On physical examination in the initial
evaluation of children under 5 years ETIOLOGY OF PNEUMONIA
with cough, the IMCI strategy ACQUIRED BY AGE
recommends taking tachypnea into
account as a very sensitive sign for
the diagnosis of pneumonia; other
signs of auscultation are found,
which, although less sensitive, can
guide the diagnosis. The latter are:
non-changing crepitus, increased
vocal thrill, tubal murmur, and dull or
submature percussion.

CLASSIFICATION
Very severe pneumonia at risk of
sepsis (or very serious disease)

All patients with cough and one or

more of the following signs will be

considered within this classification: •
Children under 2 months with fever or
hypothermia. • Signs consistent with
risk of sepsis or shock (tachycardia,
slow capillary refill, altered
consciousness, low urinary output,
hypotension). • Children under 2
months with decreased appetite, or
over 2 months with inability to eat or
drink liquids. • Seizures. • Severe
malnutrition.
THERAPEUTIC APPROACH
• Stabilize; patients must be managed
in more complex institutions; start
remission.
• Oxygen therapy independent of
oximetry.
• Ensure continuous monitoring.
• Give IV fluids to improve perfusion
• Start empirical age-based antibiotic
for the first few hours:
Severe pneumonia
If the child does not meet any of the
criteria for very severe pneumonia,
assess:
• Children older than 2 months with
signs of respiratory distress
Revista médica Salud respiratoria
(subcostal runs with or without
tachypnea; may be accompanied by
nasal flapping and whining).
Hypoxemia: O2 saturation <90% in
ambient air, at the height of Bogotá.
THERAPEUTIC APPROACH
• Hospitalize in the corresponding
institution, according to the criteria
already noted.
• Support measures: similar to those
of very severe pneumonia.
• Oxygen therapy independent of
oximetry.
• Antibiotic therapy
Pneumonia (ambulatory
management)
All patients with any of these
characteristics will be considered
within this classification:
• Presence of tachypnea: 2-11
months, 50 or more breaths per
minute; 1-4 years, 40 or more breaths
per minute, with or without
auscultatory findings for pneumonia
(wheezing or high-pitched / thick
crunch at the end of each inspiration,
or tubal murmur), with none of the
indicators of severe pneumonia or
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pneumonia in a septic patient and in • Support measures at home: fever
the absence of a broncho-obstructive management with acetaminophen 10-
component. 15 mg / kg / dose every 6-8 hours.
• Continue feeding; oral hydration,
with fractionated liquids.
• Normal oximeter (O2 saturation>
90% in ambient air, at the height of • Frequent nasal washing, as needed.
Bogotá). In children with O2
• The use of symptomatic treatments
saturation bordering the environment,
(antihistamines, cough suppressants,
the decision to drive on an outpatient
decongestants, mucolytics, sprays, or
basis vs. Hospitalization will depend
bronchial hygiene maneuvers) is not
on the IMCI classification, age, and
recommended.
social and geographic factors, among
others. • Report alarm signs and recommend
consulting immediately if any of them
appear.
Note: Regardless of whether this
• Control two days after discharge.
classification is applied based on
severity, every case of ARI managed
by a doctor must involve an approach
to nosological diagnosis,
complemented by the information that
is relevant in each particular case.
Pneumonia can be distinguished from
other respiratory tract infections by
the use of simple clinical signs, such
as respiratory rate and circulation.

THERAPEUTIC APPROACH

If the conditions of the environment

and those of the home allow it, the
management should be ambulatory.
• Antibiotic therapy: amoxicillin (80-
100 mg / kg / day), divided into 2-3
doses, for 5-7 days
Transmission
Pneumonia can spread through
various routes. Viruses and bacteria
commonly present in the nose or
throat of children can infect the lungs

when inhaled. They can also spread
by air, in droplets produced by
coughing or sneezing. In addition,
pneumonia can spread through the
blood, especially in childbirth and in
the immediate aftermath. More
research is needed on the various
pathogens that cause pneumonia and
their modes of transmission, as this
information is critical to the treatment
and prevention of the disease.
Revista médica Salud respiratoria
effectively preventing pneumonia, it
reduces the duration of the disease.
The number of children who get
pneumonia can also be reduced by
correcting environmental factors such
as indoor air pollution (for example,
by providing clean indoor kitchens at
affordable prices) and by promoting
proper hygiene in crowded homes.
Children infected with HIV are given
the antibiotic cotrimoxazole daily to
reduce the risk of pneumonia.

Prevention

Prevention of childhood pneumonia is

a fundamental component of any
strategy to reduce infant mortality.
Immunization against Hib,
pneumococci, measles, and
whooping cough is the most effective
Bronchiolitis
way to prevent pneumonia.
Refers to the first Broncho-obstructive
Proper nutrition is key to improving a episode that affects children younger
child's natural defenses, starting with than 2 years, characterized by signs
exclusive breastfeeding for the first of infection of the upper respiratory
tract, two or three days prior, followed
six months of life; in addition to
by respiratory distress with wheezing
 Revista médica Salud respiratoria
and or crepitus. It presents with acute In order of importance they are:
inflammation, edema, necrosis of Parainfluenza, Adenovirus, Influenza,
epithelial cells, and lymphomonocytic human metapneumovirus.
infiltration of the mucosa and hyper Mycoplasma in older children and
secretion that involves air trapping Chlamydia can give similar pictures.
and the production of areas of
atelectasis; on auscultation, there are
fine inspiratory crackles or expiratory
wheezing and in general it has a
seasonal behavior.
It is a problem of the first magnitude,
due to its high seasonal incidence, as
well as the consumption of resources
it generates. It is the leading cause of
hospital admission for respiratory
problems in children younger than 1
year, with a peak between 2-6 months
of age.
Pulmones enfermos no saludables con
el virus de la enfermedad enojado,
2020
Bronquiolitis/Dibujo de bebé, ilustration,

Associated risk
factors
The following signs and symptoms are
reasons to seek immediate medical
attention:

2020

Etiology
Respiratory syncytial virus (RSV)
is the cause of 20-40% of cases,
in epidemic times up to 60% in
hospitalized patients are RSV +.
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 Avoid contact with people who
have complaints or other
respiratory illnesses.
 Wash your hands often or use an
alcohol-based disinfectant.
 Avoid touching your eyes, nose or
mouth.
 Get vaccinated every year against
the complaint.

People with chronic bronchitis or asthma

"Me retiré porque no podía soportar el olor a
cigarrillo", 2019.
sometimes get acute bronchitis. In these
cases, acute bronchitis is most likely a
complication of the existing condition.
Bronchitis of this type is not caused by an
infectious virus, making it less likely to be
contagious.

Transmission
Yes. Most of the time, acute bronchitis is
caused by a virus, such as the flu virus
(influenza). However, many different
viruses (all highly contagious) can cause
acute bronchitis.

Viruses are spread mainly from person to

person by the droplets generated when a Signs
person becomes sick, sneezes, or During the first few days, the signs
speaks and you inhale it. Viruses can and symptoms of bronchiolitis are
also spread through contact with an similar to those of a cold:
infected object. This happens if you touch
something that has viruses and then
 Cold
touch your eyes, nose, or mouth.
 Nasal congestion
Cough
To reduce the risk of getting viruses that  Mild fever (not always
can cause bronchitis: present)

After this, for a week or more,


shortness of breath or wheezing may
occur when the child breathes out
(wheezing).
Many babies also have an ear
infection (otitis media).
Complications
Complications of severe bronchiolitis
can include:
 Blue lips or skin (cyanosis),
caused by lack of oxygen
 Breathing pauses (apnea),
which is most likely to occur in
premature babies and babies
within the first two months of
life
 Dehydration
 Low oxygen levels and
respiratory failure
If this happens, your child may have
to be in the hospital. Severe
respiratory failure may require a tube
to be inserted into the windpipe to
help the child breathe until the
infection has run its course.
If your baby was born prematurely,
has a heart or lung condition, or has
a depressed immune system, watch
closely for the first signs of
bronchiolitis. The infection can
quickly get worse. In such cases,
your child will normally need to be
hospitalized.
Revista médica Salud respiratoria
Prevention
Because the viruses that cause
bronchiolitis spread from person
to person, one of the best ways
to prevent it is to wash your
hands frequently, especially
before touching your baby when
he has a cold or other respiratory
illness. Wearing a face mask at
this time is appropriate.
If your child has bronchiolitis,
don't leave the house until the
illness has passed to prevent it
from spreading to others.
Other common sense ways to
help curb the infection include:
Limit contact with people who
have a fever or a cold. If your
child is a newborn, especially a
premature newborn, avoid
exposure to people with colds,
especially in the first two months
of life.
Clean and disinfect surfaces.
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Cleans and disinfects surfaces
and objects that people touch
frequently, such as toys and door
knobs. This is especially
important if a family member is
sick.

Cover coughs and sneezes.

Cover your mouth and nose with
a tissue. Then throw the tissue
away and wash your hands or
use an alcohol-based hand
sanitizer.

Use your own glass. Don't share

glasses with others, especially if
someone in your family is sick.
Wash your hands often. Wash
your and your child's hands
often. Have an alcohol-based
hand sanitizer on hand for you
and your child when they are
away from home.

Breast-feed. Respiratory infections

are significantly less common in
breastfed babies.
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References
 Coordinadora general Carmen  Sociedad Colombiana de
Graciela Zamora Reyes Pediatra. Pediatría Regional Bogotá.
Profesional especializada, (2012). Bronquiolitis. 25 de ago.
Secretaría Distrital de Salud. De 2012, de Clínica del Country
Grupo de consulta y apoyo para Sitio web:
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Enfermera. Catalina Vásquez N /120826204901-
eumóloga pediatra. Profesional, 14fc232fecaf491a9d04ba212761
grupo Infección Respiratoria, 10c6
Ministerio de Salud y Protección  Bronquiolitis Signs and
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