Pediatric Lung Diseases

Overview

Because the human respiratory tract is accessible to the outside world, allowing air in and carbon dioxide out, it is an easy entrance route for viruses that can cause sickness. Diseases affecting the respiratory system - the nose, throat, and lungs - are quite prevalent, particularly in youngsters who have not yet developed immunity to common viruses and bacteria that can cause such issues.

These six common childhood respiratory diseases may impact your child at some point:

Bronchopulmonary dysplasia

Babies born preterm have a higher chance of having lung issues. When a newborn is growing, the lungs are one of the last organs to mature. As a result, when a kid is delivered prematurely, his or her lungs are not fully formed.

In a study of 100 children delivered at 23 weeks in the United States, 60 died before hospital discharge, the majority from respiratory failure. Bronchopulmonary dysplasia is the most prevalent lung disorder affecting premature neonates (BPD).

BPD is one of the most serious consequences of preterm delivery, affecting 23 percent of kids born at 28 weeks and 73 percent of newborns born at 23 weeks. It is distinguished by fast and laborious breathing, gasping and coughing, and difficulty maintaining normal oxygen levels, which frequently need mechanical ventilation.

BPD is often diagnosed when a newborn continues to demand supplemental oxygen and has indications of respiratory difficulties after the age of 28 days. Treatment is to maintain breathing until the growing lungs are competent, although BPD frequently causes breathing difficulties in later childhood and adulthood. There are no cures for the illness, and more research is required to discover effective therapies for newborns born with undeveloped lungs.

 

Asthma

Asthma is a dangerous respiratory condition that causes wheezing, trouble breathing, and coughing. It can cause irreversible lung damage over a lifetime. Asthma affects around 16% of black children and 7% of white youngsters. While we don't know what causes asthma, we do know how to avoid or at least lessen the severity of asthma episodes. Asthmatic children and their caretakers report fewer episodes, missing school days, and hospital visits today. An asthma action plan is helping more youngsters learn to regulate their asthma.

The specific cause of asthma is unknown, however it appears to be multifaceted. Both hereditary and environmental variables appear to have a role. Although a positive family history is a risk factor for asthma, it is not essential nor sufficient for the condition to develop. Multiple prenatal and childhood environmental exposures have been linked to the development of asthma.

Maternal smoking, which appears to raise the risk of wheezing in childhood and likely increases the chance of asthma development, is one of the most well-studied risk factors during the prenatal period. Other reported prenatal risk factors include maternal food and nutrition, stress, antibiotic usage, and Cesarean delivery, however research on these has been less definitive.

Asthma symptoms include coughing, wheezing, chest tightness, and shortness of breath. Symptoms are frequently episodic and can be induced by a variety of reasons, including upper respiratory tract infections, exertion, allergen exposure, and airway irritants such as cigarette smoke. They may be even terrible at night.

As previously stated, there is a basic trifecta of asthma, eczema, and allergies, and it is important to have a personal or family history of these components because young children may not have a formal diagnosis. In youngsters, RAD (reactive airway disease) or recurring WARIs (wheezing associated respiratory infections) may come before a formal diagnosis of asthma.

 

How do you assess a child for asthma?

Physicians use a mix of medical history, physical examination, and laboratory testing to diagnose asthma and distinguish it from other lung problems.

• Spirometry: a device used by your child's doctor to evaluate lung function Spirometry, or the measurement of lung function with a spirometer, is one of the most basic and common pulmonary function tests and may be required to:
  
  • • Determine how well the lungs receive, hold, and utilize air
    • Monitor a lung disease
    • Monitor the effectiveness of treatment
    • Determine the severity of a lung disease
    • Determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
      
      
• Peak flow monitoring (PFM): a device that measures how much air a person can blast out of their lungs. During an asthma attack or other respiratory flare-up, the big airways in the lungs gradually constrict. This slows the rate at which air leaves the lungs and may be tested with a PFM. This metric is critical for determining how successfully or poorly the condition is being managed.
  
  
• Chest x-rays: a diagnostic technique that produces pictures of inside tissues, bones, and organs on film using invisible electromagnetic radiation beams.
  
  
• Blood tests: analyze the amount of carbon dioxide and oxygen in the blood.
  
  
• Allergy tests

 

What happens during an asthma attack or asthma exacerbation in a child?

Children with asthma suffer acute episodes in which the airways in their lungs constrict and breathing becomes difficult. These issues are caused by the lungs' and airways' hypersensitivity.

• The lungs and airways overreact to certain triggers causing:
  • • The lining of the airways to become inflamed and swollen
    • Tightening of the muscles that surround the airways
    • Increased production of mucus
• Breathing becomes harder and may hurt
• There may be coughing
• There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways

 

Treatment of Asthma

It is critical that children with asthma receive appropriate therapy. An allergist can help you build an action plan with treatment goals for your kid to get your child on the right track for long-term management. Your kid can sleep through the night, avoid missing day care or school, and breathe more comfortably with the appropriate therapy. The treatment plan should assist you in determining when your child's asthma is under control, when it is time to change medications, and when emergency assistance is required.

The intensity and frequency of your child's symptoms will determine their therapy. Your allergist may recommend two types of medications to treat pediatric asthma:

• Quick relief: Any kid with asthma need a quick-relief medication to address the loud symptoms of the condition, such as coughing, wheezing, shortness of breath, or an asthma attack. This medication (usually an inhaler) should be kept with your kid at all times and used as soon as symptoms appear.
• Long-term control: Some youngsters require this sort of medication to manage the silent and hazardous element of asthma, airway inflammation. This drug is used on a regular basis to keep asthma symptoms and episodes at bay.

Both medications can be administered to children using an inhaler with a spacer or a device known as a holding chamber, which helps to ensure that all drug enters the lungs. A nebulizer is another alternative, which is an equipment that incorporates compressor tubes and a mask to aid distribute the drug. Your allergist, nurse, or pharmacist can show you how to use both so you can figure out which is best for your kid.

When taken as indicated, asthma medications are extremely safe and effective. Some studies have showed that long-term control medications may modestly impede growth in children, although treating their asthma symptoms is critical to their health.

Each autumn, children with asthma should also get a flu vaccination. Even though the injectable version of the vaccine includes very little egg protein, it is safe for children who are allergic to eggs.

Work with school personnel to ensure that they are aware of your kid's treatment plan and know what to do if your child has an asthma episode. Certain asthma drugs may be kept on hand at the nurse's office at your school. Include coaches and other caregivers in the strategy. Discuss the asthma strategy with your kid for school and other locations where the child will be alone. Teach your kid what to do if they experience an asthma attack, come into contact with allergies or other triggers, or fail to take their medication.

Allergies and asthma do not have to limit your child's development. Visit an allergist, begin therapy, and see your child's problems fade away. Your youngster will emerge, energetic and enjoying their best life! 

 

Bronchiolitis

Bronchiolitis is a frequent childhood chest ailment caused by a viral infection of the lungs. Inflammation and mucus build up in the airways as a result of the illness, making breathing more difficult.

Bronchiolitis is most frequent in kids under six months old, although it can occur in babies as young as 12 months. Bronchiolitis is typically not treated with medications. Babies need to relax and have little meals more frequently so that they do not become overly exhausted during feeding and do not become dehydrated.

If your infant gets bronchiolitis, avoid contact with other people for the first few days since the virus that causes it is infectious.

 

Signs and symptoms of bronchiolitis

The sickness begins as a cold, with your infant experiencing a moderate cough and a runny or plugged nose. After one or two days, your baby's cough may worsen and they may experience breathing difficulties. Among their symptoms are:

• Fast breathing
• Noisy breathing that sounds wheezy
• Breathing that is hard work – you may see the ribs or skin under the neck sucking in or nostrils flaring when they are breathing; younger babies may bob their heads when breathing
• Irritability and fever
• Difficulties eating or drinking.

Symptoms often peak on the second or third day, and your infant may be unwell for up to ten days. Their cough might last up to four weeks.

 

Bronchiolitis Diagnosis

The clinical diagnosis of bronchiolitis is made. Blood tests and imaging examinations are only required to rule out other possibilities. The ordering of serology and other laboratory procedures to identify the virus is strictly academic. The presence of the virus in the blood has no correlation with symptoms or illness progression. Bronchiolitis laboratory tests are valuable for epidemiological research but have limited practical relevance.

A chest x-ray should be ordered only if a complication such as pneumothorax or bacterial pneumonia is suspected. Urine cultures can be acquired in children who have no other source of infection and whose temperatures continue to rise. Concurrent urinary tract infections are known to occur in roughly 5% to 10% of cases.

Bronchiolitis Management

Symptomatic treatment is the characteristic of bronchiolitis therapy in children. All babies and children diagnosed with bronchiolitis should be thoroughly evaluated for hydration status, respiratory distress, and the presence of hypoxia.

Children with mild to moderate symptoms might benefit from therapies such as nasal saline, antipyretics, and a cool-mist humidifier. Children who exhibit significant symptoms of acute respiratory distress, hypoxia, and/or dehydration should be hospitalized and closely monitored. These youngsters require immediate hydration. In children with bronchiolitis, beta-adrenergic agonists such as epinephrine or albuterol, as well as steroids, have not been demonstrated to be beneficial. These youngsters should instead be given humidified oxygen and nebulized hypertonic saline. It is critical to keep the child hydrated, especially if he or she is unable to feed. It is sufficient to use oxygen treatment to keep saturations just over 90%.

Children who undergo significant respiratory distress may develop respiratory failure. These youngsters may require specialized care, such as mechanical breathing or non-invasive assistance. A high-flow nasal cannula is a new non-invasive treatment option for children with bronchiolitis. Clinical studies are under underway.

Passive RSV vaccination with palivizumab is provided for patients at highest risk of severe disease. During RSV season, this necessitates monthly injections of the medicine, which is not only costly but also impractical for most newborns.

The American Academy of Pediatrics currently recommends using palivizumab during the first year of life for children with a gestational age of less than 29 weeks, symptomatic congenital heart disease, chronic lung disease of prematurity, neuromuscular disorders that make clearing the airways difficult, airway abnormalities, and immunodeficiency. Prophylaxis may be continued in the second year of life for children who require ongoing treatments for prematurity-related chronic lung disease or who remain immunocompromised.

 

Primary ciliary dyskinesia (PCD)

Primary ciliary dyskinesia (PCD) is an autosomal recessive hereditary disorder in which the tiny organelles (cilia) of the respiratory system do not operate properly. Mucous evacuation from the lungs, paranasal sinuses, and middle ears is hampered by iliary dysfunction. Mucous bacteria and other irritants cause recurrent respiratory infections. Kartagener syndrome is a kind of PCD characterized by a heart and other internal organs that are mirrored (situs inversus). There have been a few occurrences of X-linked and autosomal dominant inheritance.

 

Signs & Symptoms of Primary ciliary dyskinesia

The severity of symptoms associated with primary ciliary dyskinesia varies between people. Coughing, gagging, choking, and lung atelectasis are common symptoms that appear immediately after delivery (neonatal respiratory distress). Persistent sinus, middle ear, and lung infections, as well as chronic coughing, excess mucus, and hearing loss, are common in affected individuals. Recurrent respiratory infections can cause irreversible scarring and dilation of the bronchi (bronchiectasis), as well as serious lung damage.

Because cilia are also found in the ventricles of the brain and the reproductive system, ciliary failure can have an impact on other bodily systems. Males who are affected are usually sterile because their sperm motility is impaired. In females, PCD may also be linked to infertility and ectopic pregnancy.

Cilia movement may possibly have a role in organ location in the developing embryo. Kartagener syndrome, in which internal organs such as the heart, liver, spleen, and intestine lie on the opposite side of the body, affects around 50% of people with PCD (situs inversus totalis). Some people with PCD have a disorder called heterotaxy (situs ambiguus), which causes internal organs to be improperly positioned and shaped. About 12% of PCD patients have heterotaxy, and a portion of those have congenital cardiac abnormalities that can be significant and life threatening.

 

Primary ciliary dyskinesia Causes

Primary ciliary dyskinesia is commonly inherited as an autosomal recessive trait. Recessive genetic diseases arise when a person receives the same defective gene from both parents for the same characteristic. If a person inherits one normal gene and one illness gene, the person will be a carrier for the disease but will normally not display symptoms.

With each pregnancy, there is a 25% chance that two carrier parents will both carry the faulty gene and so have an afflicted kid. With each pregnancy, there is a 50% chance of having a kid who is a carrier like the parents. A kid has a 25% probability of inheriting normal genes for a given characteristic from both parents and being genetically normal for that trait. Males and females are both at danger.

Every person carries several faulty genes for diverse characteristics. Close relatives (consanguineous) parents are more likely than unrelated parents to possess the same defective gene, increasing the probability of having children with a recessive genetic condition.

 

Primary ciliary dyskinesia Diagnosis

Primary ciliary dyskinesia is firmly identified by analysis of lung or sinus tissue collected via biopsy or genetic testing. Under an electron microscope, certain structural abnormalities in these tissues can be seen. Early identification is critical in order to give preventive therapy to avoid or reduce respiratory system damage caused by recurring infections.

Screening for nasal nitric oxide levels (in people over the age of 5 who can comply with palate closure techniques) can assist identify individuals who may have PCD and should get a biopsy. Mutations in 44 genes are now known to be linked to PCD. These do not account for all cases of PCD, hence more PCD genes must be discovered. Commercial laboratories provide PCD clinical genetic testing for some of the 44 genes linked to the disease, and additional genes are added to their panels on a regular basis.

 

Treatment of Primary ciliary dyskinesia

Airway clearance treatment is utilized to preserve lung tissue as healthy as possible. This therapy may include regular sinus cavity and ear canal cleaning and suctioning. PCD is also treated with antibiotics, bronchodilators, steroids, and mucus thinners (mucolytics). Routine hearing evaluations are critical for young children, and children with hearing loss and speech issues may benefit from speech therapy and hearing aids. For severe, advanced lung disease, lung transplantation is a possibility. If there are cardiac abnormalities, surgery may be recommended.

Cystic fibrosis

Cystic fibrosis (CF) is a hereditary disease that affects about 10,800 persons in the United Kingdom. You are born with CF and cannot get it later in life, yet one in every 25 of us inherits the defective gene that causes it, often unknowingly.

The CF gene regulates the flow of salt and water in and out of cells. People with CF have a buildup of thick, sticky mucus in their lungs, digestive system, and other organs, resulting in a variety of severe symptoms that impact the entire body.

 

How is cystic fibrosis diagnosed?

Cystic fibrosis can be detected during newborn screening, which is performed as part of the heel-prick test given to all newborns in the UK, and positive findings are followed up with a sweat test. If someone has a family history of CF, a spouse with CF, or a kid with the ailment, they can obtain carrier testing to discover if they contain the defective gene that causes CF, which only involves a simple mouthwash or blood test.

There are alternative methods for testing for cystic fibrosis during pregnancy, which pose certain dangers and are normally reserved for pregnancies with a high risk of cystic fibrosis. Learn more about cystic fibrosis diagnosis, including newborn screening, carrier testing, and prenatal testing, as well as how the illness is diagnosed in adulthood.

 

How is cystic fibrosis treated?

It is critical that patients with cystic fibrosis receive adequate therapies so that they can live longer, healthier lives.

 

How does cystic fibrosis affect the body?

Cystic fibrosis causes the body to create thick mucus, which has a variety of consequences. Everyone with CF will have a somewhat distinct set of symptoms and severity. Explore our interactive body to learn more about how CF affects the lungs and digestive system, as well as the numerous difficulties CF can bring.

 

Pediatric Interstitial Lung Disease

Children's interstitial lung disease, also known as diffuse lung disease, refers to a diverse set of uncommon respiratory illnesses that damage the tiny airways and/or the walls of the lung's alveolar sacs, where gas exchange occurs.

Each kind of interstitial lung disease is unique, but they all restrict the body's capacity to obtain the oxygen it requires. While certain kinds of interstitial lung disease can be controlled and improved over time, many are progressive and can result in permanent lung scarring.

 

Diagnosing interstitial lung disease

Interstitial lung disease can be difficult to identify, but correct and timely diagnosis is critical for optimal therapy and care. It is critical to select a facility that has the diagnostic knowledge and skills required to diagnose certain respiratory disorders. Our cutting-edge pediatric pulmonary clinic provides modern diagnostic tests such as:

• Advanced CT scan capabilities, including controlled ventilation chest CT
• Infant pulmonary function testing
• Bronchoscopy and bronchoalveolar lavage
• Pediatric genetic analysis
• Lung biopsies, when needed
  

 

Treating interstitial lung disease

Our trained pediatric pulmonology team will collaborate with your family to tailor your child's treatment to his or her exact condition. Treatments will vary depending on the precise diagnosis and your child's medical history, and may include:

• Oxygen therapy, and mechanical ventilation if required
• Nutrition services
• Anti-inflammatory drugs such as certain antibiotics, systemic corticosteroids (including pulse therapy), hydroxychloroquine
• Therapies to clear mucus from the lungs, such as hypertonic saline, oscillatory positive expiratory pressure therapy or high frequency chest wall oscillation
• Intravenous immunoglobulin therapy

 

Prevention

Vaccines and vaccination programs are efficient methods of avoiding some diseases, such as pneumonia, tuberculosis, and whooping cough. Vaccination programs typically cover 90% of the population and have successfully reduced the prevalence of illnesses such as whooping cough, measles, and infection with the bacteria Haemophilus influenzae and Streptococcus pneumoniae (pneumococcus) in all European nations. There is currently no vaccine available for respiratory syncytial virus (RSV).

 

Conclusion

Premature newborns are more likely to have respiratory issues right after delivery (also known as neonatal). This is due to their lungs not having had enough time to properly mature. However, even full-term newborns might have respiratory problems if they are unwell. Most newborns with chronic lung illness at birth will survive with the assistance of our doctors, nurses, and other personnel. Many people outgrow the majority of their lung difficulties over time.

Difficulty Symptoms include fast and difficult breathing, grunting, flaring nostrils, and weight loss, among others. A number of tests may be performed on your kid, both to establish a diagnosis and to monitor therapy. All of the physicians, nurses, and technicians that work with your kid have received specialized training. Furthermore, they are all highly skilled in the specialized procedures required to operate securely with even the smallest newborn. The treatment team's primary goal will be to assist your youngster breathe more freely. This decreases physiological stress and allows the lungs to grow and mend on their own.