Breathing Better

“Respiratory illnesses account for more than 50 per cent of clinic consultations and about 35 per cent of hospital admissions. It is also one of the leading causes of death in children under the age of 5 years in Malaysia, along with infectious diseases, injuries, congenital disorders and neurological problems,” says Dr Salehuddin Samsudin, Consultant Paediatrician and Neonatologist at the Sime Darby Medical Centre ParkCity. 

The most vulnerable are children less than 6 months old, premature infants and the immune compromised. According to Dr Salehuddin, asthma and upper and lower respiratory tract infections are the main respiratory diseases that are seen in paediatrics. Asthma affects about 10 to 15 per cent of children and is the commonest chronic respiratory illness in childhood. Although asthma may present at a very early age, it is very difficult to make an accurate diagnosis in children under the age of 5 years. This is because there are many other respiratory illnesses that can mimic asthma in this age group such as bronchiolitis, viral pneumonia or mycoplasma pneumonia. A strong family history of allergies, eczema and asthma makes the diagnosis more likely. Children with asthma have recurrent reversible narrowing of their lower airways. They usually have sudden breathlessness, coughing or wheeze, which is often worse at night or with exercise.

Dr Salehuddin says that asthma is often treated with bronchodilators (medications that relax the bronchial muscles) in the more severe episodes but in many recurrent cases a good preventive strategy is to use inhaled steroids. “Compliance with treatment and regular contact with your paediatrician is important to ensure the symptoms remain under control. It is also essential to avoid any known triggers such as house dust mites, pollen and cigarette smoke.”

The most important intervention is for the parent to stop smoking. He adds that even if parents smoke outside the house, there will be enough smoke particles on them and their clothing to trigger an attack in susceptible children. “Upper respiratory tract infections such as middle ear infection, tonsillitis and pharyngitis (throat infections) are mostly caused by viral infections.

However, there are bacterial organisms such as streptococcus that normally live in one’s nose and throat, which could also invade and cause ear and throat infections. Other more virulent organisms can also be passed on from one person to another via direct contact or droplets,” explains Dr Salehuddin.

Lower respiratory (usually below the trachea) or chest infections on the other hand, can be severe but are less common than upper respiratory tract infections. The same organisms that cause upper respiratory tract infections can also cause lower respiratory tract infections. Pneumonia, bronchiolitis and whooping cough are sometimes preventable by taking the necessary vaccinations.

“Parents should look out for symptoms of high fever, productive or wet cough with fast and increased work of breathing which usually accompanies chest infections,” advises Dr Salehuddin.

A careful clinical examination will usually show that the child has rapid breathing with increased respiratory effort, a crackling noise when listened with a stethoscope or reduced air entry, which could be a sign of fluid collection or a collapsed lung. A chest X-ray would be able to confirm the diagnosis safely even in very small babies. 

“Treatment is usually with oral or intravenous antibiotics and oxygen or respiratory support in more severe cases. There is no evidence that cough medications can alter the natural progression of the disease although it is often used to improve the coughing symptoms,” he says.

Although respiratory illnesses in children can get severe at times, identifying signs and symptoms early on and seeking immediate treatment will help keep the illnesses at bay.

This article was contributed to Tab A Doctor by,
Dr Salehuddin Samsudin, Consultant Paediatrician and Neonatologist, Ramsay Sime Darby Health Care, ParkCity Medical Centre