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Sino-bronchial syndrome in children with asthma
Insights
Recurrent wheezing in children may stem from bacterial sinusitis. Treating this underlying sinus infection with antibiotics significantly improved asthma symptoms and cleared lung infections.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Infectious Diseases
Background:
- Recurrent wheezing in children is a common clinical challenge.
- Identifying underlying causes of persistent asthma symptoms is crucial for effective management.
- Bacterial sinusitis is a potential, often overlooked, contributor to chronic respiratory issues in children.
Purpose of the Study:
- To investigate the role of bacterial sinusitis in children presenting with recurrent, severe wheezing.
- To evaluate the clinical and radiological outcomes of treating sinusitis in this pediatric population.
Main Methods:
- Thirty children (2-12 years) with recurrent wheezing underwent assessment for sinusitis and lower respiratory tract infections.
- Diagnostic methods included clinical evaluation, X-rays of sinuses and chest, and microbiological analysis of respiratory secretions.
- Treatment involved 6-8 weeks of bactericidal drugs, with bronchodilators used as needed.
Main Results:
- All participants had maxillary or pan sinusitis; 26 had associated pneumonitis or bronchiectasis.
- Bacterial pathogens (Streptococcus species) were identified in 27 children.
- Antibiotic treatment led to significant radiological clearing of sinus and chest lesions and marked clinical improvement.
Conclusions:
- Bacterial sinusitis is a significant underlying factor in poorly controlled pediatric asthma with recurrent wheezing.
- Sinus X-rays should be considered in managing difficult-to-treat asthma.
- Prompt diagnosis and treatment of bacterial sinusitis can resolve chronic respiratory symptoms in children.
Abstract:
Thirty children in the age group of 2 to 12 years were brought with a history of recurrent non-seasonal moderate to severe wheezy episodes associated with symptoms of nasal congestion, sneezing and occasional headache. All of them had maxillary or pan sinusitis with 26 having associated right, left or bilateral lower lobe pneumonitis or bronchiectasis. Serum immunoglobulins were normal in 22 and was not done in eight. There was positive (2 to 4+ above negative control) skin test response to dust and dust mite in 15 of the 22 children tested. Throat swabs/sputum or nasal secretions grew B-hemolytic streptococcus or streptococcus pneumoniae in twenty-seven. All the children were put on bactericidal drugs for 6 to 8 weeks and bronchodilators were used when needed. At the end of 6 to 8 weeks follow-up X-ray of sinuses and chest showed significant clearing of the lesions which coincided with marked clinical improvement. Sinus X-ray should be considered in bronchial asthma resistant to medical management since untreated bacterial sinusitis can be an underlying cause of chronic poorly controlled asthma.
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