Approach_to_Under5_Wheeze_Presentation.pptx

Approach to under 5 is an important topic for PEDIATRICS age group mainly under-5 yrs of age

1. Approach to Under-5 Wheeze Evaluation and Management for Medical Students Presented by: [Your Name] Institution: [Your Institution]

2. Objectives - Define wheeze and its causes - Understand pathophysiology - Learn approach to diagnosis - Discuss management and follow-up

3. Definition • Wheeze: High-pitched musical sound due to airflow through narrowed airways • Predominantly expiratory • Symptom, not a diagnosis

4. Epidemiology • 30% of children have ≥1 episode before age 3 • 50% by age 6 • Most outgrow by school age

5. Pathophysiology Airway narrowing due to: - Mucosal edema - Smooth muscle constriction - Mucus plugging → Leads to turbulent airflow (wheeze)

6. Classification Episodic (viral) wheeze: only during viral infections Multi-trigger wheeze: with viruses and other triggers (allergens, exercise) 🔹 Episodic → likely to outgrow 🔹 Multi-trigger → may evolve into asthma

7. Differential Diagnosis - Asthma - Viral bronchiolitis - Foreign body aspiration - Pneumonia - GERD / aspiration - Tracheomalacia, vascular ring - Cardiac failure

8. History Taking - Onset, frequency, triggers - Nocturnal cough or exercise limitation - Response to bronchodilators - Family history (asthma, allergy) - Environmental exposure (smoke, pets)

9. Physical Examination - General: distress, cyanosis - Vitals: RR, HR, SpO₂ - Chest: wheeze location, phase - Growth and allergy signs

10. Investigations Mostly clinical diagnosis. If atypical or recurrent: - CXR, CBC, IgE, eosinophils - Sweat chloride (if persistent) - Spirometry (>5 yrs) - Allergy testing (if multi-trigger)

11. Assessment of Severity Mild: Wheeze only, SpO₂ >94% Moderate: Tachypnea, use of accessory muscles, SpO₂ 90–94% Severe: Marked distress, silent chest, SpO₂ <90%

12. Acute Management - Oxygen if SpO₂ <94% - Salbutamol (MDI/spacer or nebulized) - Ipratropium if severe - Oral steroids (Prednisolone 1 mg/kg ×3–5d) - Monitor response

13. Chronic/Recurrent Management - Identify pattern (episodic vs multi-trigger) - Trial of ICS if ≥3 episodes or interval symptoms - Montelukast optional - Review after 4–8 weeks

14. Parental Education - Inhaler technique - Avoid triggers (smoke, pets, cold) - Recognize warning signs - Follow written action plan

15. When to Refer - Recurrent severe episodes - Poor response - Structural/anatomic suspicion - Growth faltering or hypoxia

16. Prognosis - Many outgrow viral wheeze by 6 yrs - Multi-trigger more likely to persist - Early intervention improves outcomes

17. Summary - Wheeze = symptom, not diagnosis - Viral infection = commonest cause - Assess pattern, triggers, severity - Manage acute & recurrent episodes