Pediatric Respiratory and Allergy
Core concepts
Understand the pattern recognition approach to pediatric respiratory disease: upper vs lower, acute vs chronic, and obstructive vs restrictive. Know asthma pathophysiology (chronic airway inflammation, reversible obstruction), diagnosis in children (clinical, spirometry with bronchodilator response, FeNO), and stepwise management with inhaled corticosteroids as controller therapy. Recognize bronchiolitis (RSV, <2 years, wheeze/crackles, supportive care; avoid routine bronchodilators and steroids) versus asthma. Know croup (barking cough, stridor, dexamethasone), epiglottitis (drooling, tripod, toxic - airway emergency), and foreign body aspiration (sudden onset, unilateral findings). Understand cystic fibrosis (meconium ileus, failure to thrive, recurrent infections, sweat chloride) and primary ciliary dyskinesia. Know allergy: IgE-mediated anaphylaxis (epinephrine first), food allergy, and allergic rhinitis.
Traps
- Giving antibiotics for bronchiolitis or using routine steroids/bronchodilators - not indicated.
- Missing epiglottitis because the child is not drooling yet; avoid examining the throat if suspicion is high.
- Confusing croup (viral, barking) with bacterial tracheitis (toxic, high fever).
- Forgetting that a normal chest X-ray does not exclude a foreign body (consider inspiratory/expiratory films or bronchoscopy).
- Delaying epinephrine in anaphylaxis while giving antihistamines.
Worked example / rule of thumb
A 10-month-old with 3 days of coryza, wheeze, and crackles with mild distress: diagnose bronchiolitis, give supportive care (oxygen if hypoxic, hydration), and avoid routine bronchodilators/steroids/antibiotics. Rule of thumb: stridor = upper airway; wheeze = lower airway; barking cough = croup; drooling + toxic = epiglottitis (airway emergency).