Keypoints respiratory. 01.09.01



                DOWN'S SYNDROME : RESPIRATORY DISORDERS

                                                                      Key Points

(mainly based on conference paper by Dr Iolo Doull at RSM conference. April 2001)

·  Primary cause of morbidity and/or hospital admission
      particularly in young children

·  Little published research. Significance of problems often
      underrecognised. Specialist investigation and treatment
      often necessary but often not sought..

·  Increased prevalence sleep related upper airway obstruction
      and lower airway disease

·  Underlying pathology often multifactorial

·  Lower airway problems - Contributory factors include:
          · Gastro-oesophageal reflux                                                                  · Large airway compression
          · Hypotonia                                                                                  · Small lower airway volume
          · Relative obesity                                                                           · Tracheobronchomalacia
          · Immune dysfunction                                                                         · Pulmonary hypoplasia
          · Cardiac disease                                                                            · Subpleural cysts

·  Upper airway problems ­ contributory factors include
          · Hypotonia                                                                                  · small upper airway volume
          · Obesity                                                                                    · increased secretions
          · mid-face hypoplasia                                                                        · nasal congestion
          · relative glossoptosis                                                                      · tonsils and adenoids

·  Important to recognise possibility of gastro-oesophageal
      reflux. Investigate as necessary and treat aggressively

·  Attempt to eradicate nasal congestion
          · Mechanical decongestion ­ Nuk decongester
          · Intermittent continuous low dose antibiotics
          · Trial cow's milk free diet

·  Treat chronic lower airway disease aggressively
          · Continuous prophylactic antibiotics
          · Regular inhaled corticosteroids


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DSMIG(UK) 2001   www.dsmig.org.uk                                                                                                                            16.01.02