Diagnosis and Management of Recurrent Respiratory Tract Infections in Children: A Practical Guide

Abstract

Context: Respiratory tract infections (RTIs) affect children all over the world and are associated with significant morbidity and mortality. RTIs are usually triggered by viruses, though bacterial infections are also common. Results: Children are particularly susceptible to RTIs due to the relative immaturity of their immune systems, and genetic factors (such as family history of atopy) and/or environmental factors (such as exposure to pollution and pathogens) also render certain populations more vulnerable to infection. Furthermore, RTIs tend to be recurrent and can result in multiple infections per year. The management of recurrent RTIs poses a tremendous challenge for physicians, who have a limited armamentarium with which to alleviate patients' symptoms, treat their disease, and prevent recurrences. Conclusions: Though antibiotics are rarely indicated, they are often still used to treat RTIs. The resulting increase in bacterial resistance, the lack of treatment efficacy, and drug-related side effects all underscore the need for alternative strategies to manage recurrent RTIs. This article uses a typical pediatric case study to review central issues in the diagnosis and management of recurrent RTIs in children, with an emphasis on the role of immunomodulation as a preventive strategy.

Immunity‐targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children

“…12 Antibiotic misuse has led to the emergence of resistant bacteria, meaning that higher doses and more advanced generations of drugs are required, and at present, some infected patients cannot be treated adequately. 13 Owing to the current unmet need for effective, alternative conservative therapies, efforts are being refocused towards preventative strategies including 5 behavioural intervention; avoidance of environmental risk factors such as passive smoking 14 and highly polluted city areas; vaccination, such as active targeted immunisation; targeted medical intervention; non-specific immunostimulation or immunomodulation (eg bacterial lysates) [15][16][17][18] ; nutrition, including vitamins (eg C or D) and microelements; and regular physical activity ( Table 1). Parents of children with recurrent RTIs may also discuss "immune-stimulating" therapies that they have seen advertised, such as herbal (eg Echinacea) and homoeopathic remedies, and animalderived products (eg cod liver oil and thymus extracts).…”

Perinatal maternal mental health is associated with both infections and wheezing in early childhood

“…Wheezing might be overestimated, as parents might label a single episode of noisy breathing as wheezing . Recurrent wheezing is less affected by this source of bias and is more likely to identify a pathologic condition, as well as recurrent upper respiratory infections . Mothers with higher GHQ12 scores could have been more likely to over‐report their offspring symptoms.…”

“…Wheezing was defined, according to the standardized ISAAC questionnaire, as at least one episode of wheezing or whistling in the chest in the past 12 months, while recurrent wheezing was defined as at least two episodes of wheezing. Upper respiratory tract infection was defined as at least one episode of otitis or pharyngitis, while we considered as recurrent upper infections at least four episodes . Lower respiratory tract infection was defined as at least one episode of bronchitis or bronchiolitis or pneumonia.…”

The effect of zinc and Vitamin A supplements in treating and reducing the incidence of upper respiratory tract infections in children

“…[34,35] In fact, the decrease in neutrophil count initiated by Zn supplement in this study is in agreement with previous studies that reported a potential Zn antioxidant effect by negatively affecting neutrophils and inflammatory cytokines and their generated reactive oxygen species (ROS) in normal healthy subjects. [36][37][38] In addition, lymphocytes count increased in all groups as vast majority 80-90% of RTIs are caused by viruses [39] and lymphocytosis occurs in acute viral infections. [40] The major increase was in zinc group.…”