Pneumonia and Asthma in Children

Worldwide, children of all ages may suffer from a number of infections involving their respiratory system. However, serious infections like pneumonia are very rare but a cause of serious concern. On the other hand, asthma also remains as the most common chronic health condition of childhood. As left untreated, these two conditions may have serious consequences; I felt the need to discuss this in my blog.

Pneumonia

Pneumonia is an infection that inflames the air sacs (alveoli) in one or both lungs. The lung may produce excess fluid or pus (purulent material) which accumulates in the airways. The lungs lose their spongy texture (as they are full of air in health) and appear like liver (collapse and consolidation with loss of air sacs). A large variety of microorganisms (bacteria, viruses and fungi) and chemicals (like oil) can cause pneumonia. It is not contagious. The first signs of pneumonia may be as subtle as a mild dry cough. Usually, pneumonia is associated with a good going fever, cough, tiredness, loss of appetite and breathless and distressed breathing.

The course of pneumonia can range in seriousness from mild to life-threatening but generally speaking, it is more serious in infants and younger children.

Depending on the type of entry of the microorganisms (bugs) into lung. Pneumonia is mainly of three types.

1. Community-acquired pneumonia– this type of pneumonia is caused by bacteria that follow flu like illness. By far, this is the most common type of pneumonia and affects the vast majority of children and elderly people. In this type of pneumonia, a large portion of the lungs are infected and the infection may spill into the sac lining the lungs (also called pleural effusion and empyema).

2. Hospital-acquired pneumonia– in this type of pneumonia, a child who has been admitted to the hospital for whatsoever reason, may catch infection from the hospital settings. This can be serious as the bacteria causing it may be more resistant to antibiotics and because the children who get it may already be very sick. Children who are seriously unwell and nursed in intensive care units (PICU or HDU) and those who are on breathing machines (ventilators) are at higher risk of this type of pneumonia (Ventilator associated pneumonia).

3. Aspiration pneumonia– Normally, the airways are kept safe by the swallowing process whereby food and water from the mouth enters the gullet (oesophagus) and air travelling through the nose enters the airway (trachea and bronchus) through the voice box (larynx). This is a complex junction and in situations where this control is lost (children under anaesthetics, those who have complex neurological problems like cerebral palsy or those who have suffered a head injury), may lead to accidental inhalation of food, drink, vomit or saliva into the lungs resulting in aspiration pneumonia.

Usual symptoms of pneumonia may include:

· Cough, which may be dry to start with or may produce phlegm

· Chest pain with breathing or coughing

· Shortness of breath

· Fever, sweating and shaking chills

· Respiratory distress The inward movement of the muscles between the ribs (recessions)

· Grunting after the baby has breathed out (grunts)

· Loss of appetite

Despite advances in medical care, pneumonia still remains the biggest killer disease in childhood globally. Bugs can spread from the lungs and enter the blood stream (sepsis) and has the potential to kill a child unless promptly treated by a pneumonia specialist — who is likely to be a respiratory paediatrician. Fortunately, with modern antibiotics and supportive management, even serious pneumonias can be treated efficiently and a full recovery is expected in almost all children.The pneumonia specialist doctors prescribe broad-spectrum antibiotics, which can fight a wide range of possible infections. These antibiotics are used to clear the infection and to prevent it from spreading to other parts of the body. Some babies require breathing machines or ventilators and oxygen therapy to help them breathe while the infection clears. A chest drain or further surgery to remove the pus may be required to remove the pus around the lungs. Now, as I have realised that not all paediatricians looks after children with such serious infections of lungs, I searched Google for pneumonia specialist near me and was able to locate the right person. In the bewildering and frightening times, I found pneumonia specialist near me signposting me to the right direction.

As with anything in health, prevention is better than cure. A healthy lifestyle including balanced diet, plenty of sleep, regular exercise, good hygienic practices, refraining from exposure to tobacco smoke can help prevent pneumonia. Additionally, some types of pneumonia can be prevented by vaccination, like, flu vaccine and pneumococcal vaccination.

Asthma

Asthma is the most common chronic childhood illness. In asthma, the main problem is with the bronchial tubes (airways) that carries air and oxygen into the lungs and allows the body to get rid of the carbon dioxide produced. The airway linings get swollen for a variety of reasons — this is known as airway inflammation. Airway inflammation can happen due to a variety of reasons but in many children, the exact cause may never be found. One of the most common causes of such airway inflammation is allergy to certain items (aeroallergens). Common aeroallergens include animal dander (cat, dog, rabbit, guinea pig, and horse dander), grass, house dust mite, mould and trees. Typically, on inhaling these allergens (triggers), a sensitised child may have an increase in the airway inflammation with subsequent release of strong chemicals that result in the production of sticky mucus (phlegm) and narrowing of the airways (bronchospasm). The muscles surrounding these breathing tubes tighten making breathing difficult. Other triggers may be non-allergic in nature like emotional events, exercise and exposure to smoke and other aerosols (like strong perfumes).

Asthma may run in families and there may be hereditary element of it. It is also common in children with other allergies like food allergy, allergic eczema and hay fever. Exposure to tobacco smoke and cold and damp climate may also act as triggers.

Although in many children asthma symptom can be very subtle, children suffering from asthma may show some or all of the following symptoms:

· Cough

· Wheezing that respond to inhaled medications (bronchodilators)

· Shortness of breath and difficulty in breathing

· Chest tightness

· Coughing at night

· Coughing on exertion

· Rarely, a bluish colour to the lips and skin (cyanosis)

Untreated asthma has a severe impact in the quality of life. It hampers the physical and emotional development of a child and may have a far reaching and long standing effect on reaching the adult potential. Educational underachievement is common and so are behavioural difficulties because of sleep disturbances. Most importantly, asthma still remains a medical condition that has the potential to kill. In my experience, I have seen many children that have not been diagnosed with asthma and this reflects sometimes a lack of awareness amongst parents and physicians. Yet, simple inhaled medications may suffice to bring a complete control on the symptoms and allow the child to live a normal and fruitful life. Usual this involves two types of inhalers given through a chamber (spacer). One of them is to be given during attacks (reliever or bronchodilator) and the other one is a low doe steroid (preventer). Finding a paediatric asthma specialist is sometimes difficult and again searching Google for best asthma specialist near me often is helpful in signposting in the right direction

Asthma is incurable and despite best efforts, asthma attacks are sometimes not preventable. However, as a general rule of thumb, removal or minimised exposure to potential triggers, a healthy life style that includes regular exercise and a good balanced diet and regular intake of prescribed medications can results in long term control of symptoms.