Paediatrics: Bronchial disease
Bronchial disease: The main symptoms of acute bronchitis in children are cough and fever.
Acute bronchitis leads to hacking cough and phlegm production that often follows upper respiratory tract infection. This occurs because of the inflammatory response of the mucous membranes within the lungs' bronchial passages. Viruses, acting alone or together, account for most of these infections.
In children, chronic bronchitis follows either an endogenous response (eg, excessive viral-induced inflammation) to acute airway injury or continuous exposure to certain noxious environmental agents (eg, allergens or irritants). An airway that undergoes such an insult responds quickly with bronchospasm and cough, followed by inflammation, edema, and mucus production. This helps explain the fact that apparent chronic bronchitis in children is often actually asthma.
The main symptoms of acute bronchitis in children are cough and fever. Two infections - Bordetella pertussis and Mycoplasma pneumonia - may produce symptoms that persist for some weeks. Another condition often diagnosed in infants without fever or distress is ‘wheezy bronchitis’, or ‘recurrent bronchitis’. This condition has been the topic of much debate over the years as to whether these infants have asthma or not, and whether they should be treated as such.
Bordetella pertussis infection typically induces three stages of illness:
- Catarrhal (1-2wks): mild symptoms with fever, cough, and coryza.
- Paroxysmal (2-6wks): severe paroxysmal cough, followed by inspiratory whoop and vomiting. Convalescent (2-4wks): lessening symptoms that may take a whole month to resolve.
A whooping cough-like syndrome may be caused by Bordetella para-pertussis, Mycoplasma pneumonia, Chlamydia, or adenovirus.
There may be a typical history. In young infants, however, whoop is often absent, and apnoea is a more common finding. In older children and parents, there may be a history of persistent and irritating cough.
Examination and investigation
A thorough examination is needed. In infants, you will need to make sure that the problem is not pneumonia:
- Eyes: subconjunctival hemorrhages are common.
- Chest X-ray (CXR).
- Blood count: leucocytosis and lymphocytosis.
- Pernasal swab: culture of Bordetella pertussis.
- Infants: admission is required for those with a history of apnoea, cyanosis, or significant paroxysms. Close monitoring is required, particularly in infants, since seizures, encephalopathy, and death.
- Isolation: patients should be isolated for 5 days after starting treatment with antibiotics.
- Immunization: recommended for children <7yrs who have been in close contact if they are not protected. Immunization reduces the risk of an individual developing infection by 90%, but the level of protection declines steadily through childhood.
- Prophylactic antibiotics: should be given to close contacts.
Erythromycin for 14 days (or clarithromycin for 7 days) to reduce infectivity but this may have minimal effect on the cough.