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Recurrent pneumonia in children and its relationship to bronchial hyperreactivity
Insights
Asthma is a frequent cause of persistent or recurrent pneumonia (PRP) in children. This condition may present initially without wheezing, highlighting the need for thorough asthma evaluation in pediatric PRP cases.
Area of Science:
- Pediatrics
- Pulmonology
- Allergy & Immunology
Background:
- Persistent or recurrent pneumonia (PRP) in children can stem from various underlying conditions.
- Identifying the etiology of PRP is crucial for effective management and improved patient outcomes.
Purpose of the Study:
- To investigate the underlying causes of persistent or recurrent pneumonia (PRP) in pediatric patients.
- To determine the prevalence of asthma and bronchial hyperreactivity in children with unexplained PRP.
Main Methods:
- Retrospective review of 81 children evaluated for PRP at a pediatric hospital.
- Analysis of patient history, clinical presentation, sweat chloride tests, immunoglobulin levels, and pulmonary function tests.
- Assessment for airflow obstruction, bronchodilator response, and methacholine challenge for bronchial hyperreactivity.
Main Results:
- Twenty patients had identified underlying causes for PRP.
- In children without an apparent cause, 49% had a history of allergy or family history of asthma.
- Pulmonary function testing revealed bronchial hyperreactivity in 92% of tested patients, with some showing airflow obstruction responsive to bronchodilators.
Conclusions:
- Asthma is a significant and common cause of persistent or recurrent pneumonia in children.
- Pediatric PRP may be an early manifestation of asthma, even in the absence of wheezing.
- Bronchial hyperreactivity is highly prevalent in children with unexplained PRP, supporting an asthma link.
Abstract:
To determine what conditions are most likely to cause persistent or recurrent pneumonia (PRP) in children, the records of 81 children referred to James Whitcomb Riley Hospital for Children for evaluation of PRP were reviewed. Twenty patients had an apparent underlying cause that predisposed them to PRP. Of the 61 remaining patients (mean age 3.8 years) without any apparent cause for PRP, 49% had a history of allergy or family history of asthma, 31% patients had a history of wheezing and 18% were wheezing during their initial visit. No patient had an elevated sweat chloride determination or immunoglobulin deficiency. Of the 12 patients who were able to be recalled for pulmonary function testing, three had airflow obstruction that responded to an inhaled bronchodilator (isoproterenol). Of the nine patients with normal function, eight responded to methacholine with a decrease from base line in the one-second forced expiratory volume of greater than 20%. In all, 92% of those tested had bronchial hyperreactivity. These results indicate that asthma is a common cause of PRP in children and that PRP may occur as the initial symptom even in the absence of wheezing.