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[Aspiration bronchopneumopathies]
Insights
Pulmonary disease due to inhalation (PDI) requires careful diagnosis beyond infection, focusing on swallowing difficulties and specific symptoms. Early identification of underlying causes like dysphagia is crucial for effective management and preventing lung damage.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Neurology
Background:
- Pulmonary disease due to inhalation (PDI) is often misdiagnosed as infection in children.
- Accurate diagnosis requires evaluating specific PDI signs such as drooling, nasal food regurgitation, choking, vomiting, and regurgitation.
Observation:
- PDI diagnosis is straightforward when it's secondary to known conditions affecting swallowing (dysphagia), like cerebral palsy or muscular diseases.
- Diagnosing dysphagia as an early sign of autonomic nervous system dysfunction, such as familial dysautonomia, is more challenging but critical.
- Oesophageal causes of PDI include anomalous arteries compressing the oesophagus, oesophageal duplication, and achalasia.
- Gastro-oesophageal reflux is a common PDI cause, though its role in nocturnal asthma symptoms is debated.
- Certain medications (Beta2 agonists, corticosteroids, theophylline) can exacerbate gastro-oesophageal reflux and should be used cautiously.
Findings:
- Rare conditions like laryngotracheo-oesophageal clefts and tracheoesophageal fistulas present diagnostic challenges, often leading to delayed diagnosis.
- Repeated aspiration can lead to serious lung complications, including diffuse interstitial fibrosis or bronchiectasis.
Implications:
- Emphasizes the need for a high index of suspicion for PDI in pediatric respiratory cases.
- Highlights the importance of thorough clinical evaluation for swallowing dysfunction and associated symptoms.
- Underscores the potential for severe pulmonary sequelae if PDI is not promptly diagnosed and managed.
Abstract:
Diagnosis of pulmonary disease due to inhalation (PDI) is based on the assumption that not all paediatric pulmonary disease is attributable to infection. Moreover, an accurate investigation of all typical signs of PDI is necessary: drooling, pouring of food from the nose, choking, frequent vomiting and regurgitation. Specific aetiological diagnosis is not difficult when PDI represents only the epiphenomenon of well defined diseases which have disturbed deglutition (e.g. premature birth, cerebral palsy, muscle disease). It is difficult but more important to find the cause of dysphagia when dysphagia itself represents the first sign of dysfunction of the autonomic nervous system (e.g. familial dysautonomy). There are different PDI due to oesophageal dysphagia, e.g. the anomalous artery which presses the oesophagus against the trachea, oesophageal duplication, achalasia. The most frequent cause is gastro-oesophageal reflux, although recently its role in producing symptoms at night in the asthmatic child in much less. Gastro-oesophageal reflux is increased by the Beta2, agonists, the corticosteroids and theophylline. Therefore these drugs, especially theophylline, have to be used with discretion, also if gastro-oesophageal reflux is only suspected (e.g. frequent vomiting by the infant). Anomalous communication between the oesophagus and airways, particularly the laryngotracheo-oesophageal cleft and the isolated tracheoesophageal fistula, are rare diseases and difficult to diagnose. Therefore diagnosis can be delayed for months or even years. Prognosis is extremely variable: repeated inhalation will, however, cause diffuse interstitial fibrosis or, more rarely, a bronchiectasic lesion.