Respiratory assessment

Undertaking a comprehensive respiratory assessment is key in deciding the diagnosis and therefore determining the management of a child who presents with a respiratory problem. The key elements of a comprehensive respiratory assessment are:

• History of the presenting complaint
  
• Past history relating to the respiratory problem
  
• Family and social history
  
• Physical assessment of the child.

Once a comprehensive respiratory assessment has been undertaken a diagnosis can be established and treatment and supportive measures instigated.

Bronchiolitis

Bronchiolitis is a seasonal disease which most commonly affects infants aged 3–6 months. The infant presents with breathing difficulties, poor feeding, irritability, wheeze and, in the very young, apnoea. The symptoms of bronchiolitis are coryzal, a harsh cough, wheezing and tachypnoea. Only a small number of infants will require hospitalization. The most common cause of bronchiolitis is respiratory syncytial virus (RSV) which accounts for over 50% of cases. The effects of the virus are to cause inflammation in the small airways which leads to air trapping and a prolonged expiratory phase. Treatment for bronchiolitis is supportive and includes oxygen therapy and feeding support, either enteral or intravenous. Non-invasive ventilation may be required if the infant has persistent apnoea.

Upper airway obstruction