Pediatric Annals

FROM THE GUEST EDITOR 

Lower Respiratory Tract Infections in Children

Michael R Bye, MD

Abstract

For most pediatricians, hardly a day goes by without seeing several children with coryza, cough, fever, rhonchi wheezes, and crackles. A day without any of these would be reportable, unless you forgot to unlock your office door that day. In this issue of Pediatrie Annals, we discuss the common causes of these complaints. We were asked not to venture above the larynx. We found it necessary to avoid bronchitis due to a paucity of good studies, making it difficult to write an article based on solid evidence. We decided to avoid simply writing an article based on experience. We hope you find this issue helpful.

Although the bronchiolitis season is winding down, Dr. Ngai and I review the current and past management of the disease. We discuss the sequelae of bronchiolitis, but the thrust of the article is what to do for the patient. The bottom line is that if a child is oxygenating and eating adequately, doing nothing is the best approach. It certainly works most consistently for most patients. For those who need intervention, we discuss the possibilities. Because an ounce of prevention is worth a pound of cure, we discuss prevention in those infants at higher risk of serious disease with respiratory syncytial virus.

Drs. Ampofo and Saiman provide a thorough discussion of tuberculosis, including a comprehensive review of the organism, its manifestations in children, how children get it, and what to do about it.

Dr. Sheares discusses the child with recurrent pneumonia. An approach based on the radiographie findings is provided. We hope this will reduce the shotgun approach too often taken in treating these patients. We also hope to reduce the antibiotic exposure of many of diese children.

Although Penn beat Columbia in football this year, we still allowed Dr. Weiner to contribute an article on respiratory tract infections in cystic fibrosis. Children with cystic fibrosis are living longer, doing better, and growing more normally. We have to keep up with their respiratory problems, the greatest cause of morbidity and mortality. Dr. Weiner discusses the current concepts of why these children are infected so severely with such unusual organisms, and provides the rationale for the current approach to their airway infections.

Dr. Ewig thoroughly reviews the croup syndromes. He discusses the etiologies of and some of the differentiating features between some of the "croups," which he points out may be different ends of a spectrum. He brings us up-to-date on the controversies over the best way to deliver corticosteroids to these patients and reviews the data showing that we finally have agreed that corticosteroids are the best therapy for croup.

Dr. Zar gives us a global perspective on the problem of respiratory tract infections in children. Dr. Zar did her pediatrie residency at the Schneider Children's Hospital in New Hyde Park, New York, and was a pediatrie pulmonary fellow at Columbia University. She then returned to her homeland of South Africa, and was struck by the stark differences in ability to provide care, even after spending 3 years in Washington Heights in New York City. If you hear her talk on this subject, or read what she wrote for this issue, you will be struck by the importance apparently given to children's health issues in that part of the world. Her data on mortality are overwhelming. What is most appalling is that so much of that morbidity and mortality could be eliminated by simple immunization of and adequate nutrition for children, and by antiretroviral therapy for HIVinfected women in late pregnancy and at the time of delivery to prevent maternal-fetal transmission.

Finally, as an adjunct…

For most pediatricians, hardly a day goes by without seeing several children with coryza, cough, fever, rhonchi wheezes, and crackles. A day without any of these would be reportable, unless you forgot to unlock your office door that day. In this issue of Pediatrie Annals, we discuss the common causes of these complaints. We were asked not to venture above the larynx. We found it necessary to avoid bronchitis due to a paucity of good studies, making it difficult to write an article based on solid evidence. We decided to avoid simply writing an article based on experience. We hope you find this issue helpful.

Although the bronchiolitis season is winding down, Dr. Ngai and I review the current and past management of the disease. We discuss the sequelae of bronchiolitis, but the thrust of the article is what to do for the patient. The bottom line is that if a child is oxygenating and eating adequately, doing nothing is the best approach. It certainly works most consistently for most patients. For those who need intervention, we discuss the possibilities. Because an ounce of prevention is worth a pound of cure, we discuss prevention in those infants at higher risk of serious disease with respiratory syncytial virus.

Drs. Ampofo and Saiman provide a thorough discussion of tuberculosis, including a comprehensive review of the organism, its manifestations in children, how children get it, and what to do about it.

Dr. Sheares discusses the child with recurrent pneumonia. An approach based on the radiographie findings is provided. We hope this will reduce the shotgun approach too often taken in treating these patients. We also hope to reduce the antibiotic exposure of many of diese children.

Although Penn beat Columbia in football this year, we still allowed Dr. Weiner to contribute an article on respiratory tract infections in cystic fibrosis. Children with cystic fibrosis are living longer, doing better, and growing more normally. We have to keep up with their respiratory problems, the greatest cause of morbidity and mortality. Dr. Weiner discusses the current concepts of why these children are infected so severely with such unusual organisms, and provides the rationale for the current approach to their airway infections.

Dr. Ewig thoroughly reviews the croup syndromes. He discusses the etiologies of and some of the differentiating features between some of the "croups," which he points out may be different ends of a spectrum. He brings us up-to-date on the controversies over the best way to deliver corticosteroids to these patients and reviews the data showing that we finally have agreed that corticosteroids are the best therapy for croup.

Dr. Zar gives us a global perspective on the problem of respiratory tract infections in children. Dr. Zar did her pediatrie residency at the Schneider Children's Hospital in New Hyde Park, New York, and was a pediatrie pulmonary fellow at Columbia University. She then returned to her homeland of South Africa, and was struck by the stark differences in ability to provide care, even after spending 3 years in Washington Heights in New York City. If you hear her talk on this subject, or read what she wrote for this issue, you will be struck by the importance apparently given to children's health issues in that part of the world. Her data on mortality are overwhelming. What is most appalling is that so much of that morbidity and mortality could be eliminated by simple immunization of and adequate nutrition for children, and by antiretroviral therapy for HIVinfected women in late pregnancy and at the time of delivery to prevent maternal-fetal transmission.

Finally, as an adjunct to the article by Drs. Ampofo and Saiman, Dr. Leibel provides a resident's perspective on tuberculosis.

Okay, a sentence or two on our experience with bronchitis. Most of the time, antibiotics are unnecessary. Bronchitis is usually caused by a viral infection. If bronchitis recurs, or persists, it is most likely asthma. Bronchitis is from the Latin, inflammation of the airways; asthma is inflammation of the airways. Because those of us who took a logic class learned that different things equal to the same thing are equal to each other, most cases of recurrent bronchitis represent asthma.

10.3928/0090-4481-20020201-05

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