Respiratory diseases
- Asthma
- Cystic Fibrosis
- Sleep
- Home ventilatory support
- Acute respiratory illness
- Community partnerships
Asthma
Australia has one of the highest incidences of asthma in the world and asthma remains the most common disease in childhood. One in four Australian children will have at least one episode of asthma per year. The department cares for over 600 children with asthma, the majority of which are outpatients.
The management of asthma in children cannot be directly extrapolated from adult care due to the differences in the pattern of asthma, the natural history, the potential for side effects, mechanisms for drug delivery and anatomical factors. For the majority of children, asthma will either resolve or at least improve with age and to date there is no evidence to suggest that treatment influences the natural history of asthma.
There is a large variation in the pattern and severity of asthma in childhood. Optimal asthma management is very rewarding, allowing a child to achieve normal quality of life, normal levels of cardiopulmonary fitness and normal growth. Children are more susceptible to side effects of long-term medication, therefore it is important to ensure that a balance is achieved between the intensity of the treatment and the severity of the asthma.
Wheezy infants
Wheeze in infancy may be due to a number of diseases such as bronchiolitis, cystic fibrosis, gastroesophageal reflux, an inhaled foreign body, viral illness or congenital lung abnormalities. If it is persistent or severe, referral to a tertiary centre should be considered for investigation and treatment.
Exercise Induced Asthma
EIA is common in children, affecting up to 90% of children with asthma. Children with asthma may be unfit because EIA limits their endurance. However, with appropriate management and training, children with asthma can achieve normal levels of fitness. Children should be encouraged rather than discouraged from participating in normal sporting activities.
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Cystic Fibrosis
Cystic Fibrosis is a genetic illness without a cure. In Victoria it is usually diagnosed in the first 2 months of life through the newborn screening programme (commenced in 1989). CF primarily affects the lungs, pancreas, liver, reproductive organs and sweat glands. The management of a patient’s cystic fibrosis is a multidisciplinary team approach, with close cooperation and collaboration with the patient and their family. This involves a high level of commitment from families with the need for regular treatment at home which includes daily chest physiotherapy, oral antibiotics, a special diet, enzymes, salt tablets and nebulizer treatments. It is impossible to predict the outcome for any individual with CF but over the last few decades the outlook has improved significantly and continues to do so as a result of multidisciplinary and increasingly standardised care in specialist CF centres.
Most patients with CF are required to take enzyme capsules before they eat a meal or snack so that their food is digested normally and can be absorbed. The dose of capsules varies according to each patient’s individual needs however, the dose usually increases as the patient grows older. Patients also require a high fat, high calorie and high salt diet with approximately one and a half times the amount of calories per day compared to a person without the disease.
As an outpatient, patients are reviewed by the CF multidisciplinary team every two to three months to assess their medications, diet, chest physiotherapy and psychosocial needs. If there is a significant decrease in lung function and an increase in symptoms, an admission to hospital is usually required. This is usually for a period of 10-14 days for intravenous antibiotics, intensive chest physiotherapy, and daily review by the physiotherapist, dietitian, medical consultants and CF counsellor. Oral antibiotics will be continued for at least a week after discharge from hospital.
RCH cares for 300 children with CF and complies with nationally and internationally recognized infection control protocols for outpatient consultations and inpatient admissions. When visiting the outpatient clinic patients with different bacterial strains of infection are reviewed on separate days to decreases the risk of cross-infection. In the hospital, a patient with CF is never nursed in the same room as another patient with CF, and they are nursed in a single room if one is available. Cross infection measures are closely followed by all staff in relation to hand washing, cleaning of equipment and staff allocation.
The aims of treatment are to allow people with CF to live a normal life with a minimum of lung disease and optimal growth. Most males and some females with CF are infertile however, IVF techniques now offer the possibility of parenthood for people with CF. Please do not hesitate to contact me if you require further
For more detailed information regarding the management of children with cystic fibrosis at the hospital please refer to the Cystic Fibrosis Management Handbook (PDF 1.3 MB)
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Sleep
The Melbourne Children’s Sleep Unit (MCSU) at Monash Medcial Centre is a renowned sleep centre for research and clinical studies. It is a joint initiative of Southern Health (Monash Medical Centre), Women’s and Children’s Health (Royal Children’s Hospital) and Monash University (Ritchie Centre). It is the only Paediatric Sleep Centre in Victoria. It cares for children with sleep related disorders including:
Respiratory Disorders
Other Sleep Disorders
It is currently situated at Monash Medical Centre and performs 16 sleep studies a week.
The MCSU can be contacted on 9594 5656.
Patient appointments may be made at MMC 9594 2900 or RCH (Respiratory) 9345 5818 (Sleep) 9345 5466.
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Home ventilatory support
The department provides nursing support for parents and hospital staff caring for children requiring
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supplemental oxygen at home
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tracheostomies
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non-invasive ventilation (CPAP and bilevel ventilation).
The complexity of care for these children has increased in recent years and with improved techniques is likely to increase further in the coming years. A close working relationship with the Melbourne Children’s Sleep Unit and the Chronic Ventilation Service at the Austin and Repatriation Hospital is established to assist with the care of these patients into adult life.
Acute respiratory illness
The department is responsible for the management of all inpatient admissions for acute bronchiolitis, croup, complex pneumonias, inhaled foreign bodies and congenital abnormalities of the lung.
1. Acute viral bronchiolitis
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants however other viruses such as parainfluenza virus may also be responsible. The disease is most common in the winter months in infants less than 12 months of age.
2. Croup
Acute laryngotracheobronchitis (croup) is the major cause of acute laryngeal obstruction in infants in Australia. Other causes are acute epiglottitis and diptheria although these are now uncommon following successful vaccination programs. Acute bacterial tracheitis should also be considered. Croup is most common in children under the age of 5 years but it may occur in older children. The most common cause is an infection with a parainfluenza virus during the winter months.
3. Complex pneumonias
Pneumonias associated with a large effusion or empyema require specialised treatment in close cooperation with the paediatric surgeons. A thoracoscopy or thoractomy is often required in addition to intravenous antibiotics. Management should be undertaken in a tertiary centre.
4. Congenital abnormalities of the lung
The department, in conjunction with the thoracic surgeons, cares for those children with complex congenital abnormalities of the respiratory system.
Community partnerships
The Victorian Paediatric Respiratory Service conducts several outreach clinics in regional Victoria, southern NSW and Tasmania to assist in the management of children and adolescents with cystic fibrosis. The department conducts clinics in
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Geelong
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Ballarat
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Albury-Wodonga
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Northern Tasmania
Consultant physicians also provide an outpatient consultative service to other Melbourne metropolitan hospitals including the Northern Hospital and the Mercy Hospital for Women.
