Get documents about "Health rapid breathing
Document Sample
10 Thursday 4th June, 2009 The Island
Health
underlying pneumonia in children of all have to be made without knowing the
.
age groups The first is an increase in the causative bug, then the selection of the
rate of breathing. A rate of over 60 per antibiotics depends on several related fac-
minute in the first month of life, over 50 in tors. One relies a lot on the currently
a child up to one year of age and over 40 prevalent types of organisms and one s
per minute in those above one year of age t e ts
own experience in treating pa i n in such
on
are the general cut-off p i ts to demarcate iutos
s t a i n . The emergence over the last
significant increases in the rate of breath- decade of some bacteria which are resist-
n.
i g These are resting rates of breathing ant to one or more commonly used antibi-
but it is noteworthy that these could be otics are causing grave concern in many
t o , e t-
independently elevated by agita i n r s r
pats of the world. Some of these types of
lessness, crying and by fever.The other organisms have been detected in Sri
sign that is quite useful is the presence of Lanka as well. These cases tend to
in-drawing or retraction of the chest cage respond poorly to treatment and oft n e
with breathing. These two features are not need more recent, sophisticated and
only useful in the diagnosis of pneumonia expensive drugs for their management.
but also in the assessment of the severity n e tain situations, especially when
I cr
of the disease. These features are so h e i tance of the child is low or there is
terss
riual n iw f h at ht
valuable pa t c l r y i v e o t e f c t a some sort of compromisation of the
these can be usefully evaluated by non- immune functions, pneumonia could be
medical people and even by parents . much more severe and also may be
High fever, vomiting, rapid breathing caused by unusual or atypical organisms.
accompanied by grunting, distressing r i u a l m o tant as the
These are pa t c l r y i p r
cough, chest pains on breathing and noisy antibacterials that work against these are
breathing are other features that are seen, ut i etv
q i e d fferent to those that are eff c i e
particularly in the older children. Fever against the usual or commoner organisms.
may not be such a prominent symptom in Some of these unusual organisms include
some cases, especially in viral pneumo- fungi and yeasts. Pneumonia caused by
nias and pneumonias due to unusual such bugs need protracted courses of
treatment.
Following an attack of pneumonia that
has been adequately and appropriately
treated, the lungs will generally recover
Pne
completely. Even experienced clinicians
are sometimes surprised at the degree of
recovery that has been secured even aftr e
rather large portions of the lungs are quite
Dr. B.J.C.Perera
“
severely involved. It speaks so much for
Consultant Paediatrician the powers of recovery of the human lung.
f hr s n nelig
However, i t e e i a u d r y n
l h i
f a l t e d fferent types of respirato- causative factor then the risk of a recur-
O
um
ry diseases that occur in children, rence is increased. Apart from these, there
pneumonia deserves pride of is no tendency for recurrences as a gener-
place because of its importance regarding al rule. Over the last decade or so it has
morbidity and mortality together with the become possible to protect against some
perception of it as a rather severe disease forms of pneumonia with vaccines. In this
by the general public. It is responsible for country, the recently introduced
Pneumonia is a very a significant proportion of deaths in chil- Haemophilus influenzae b (Hib) vaccine
significant cause of dren under five years of age, especially in
the developing world. The World Health
protects against one of the more severe
forms of pneumonia. The Hib vaccine has
morbidity and mor- Organisation estimates that these dis- beeen used in the West for several years
tality in children. It ae il ilos n h hr ol.
e s s k l m l i n i t e t i d w r d The and has a proven track record. A pneumo-
lt s ihs n h is w er f
morta i y i h g e t i t e f r t t o y a s o coccal vaccine, given for certain special
is quite a problem ie n hs s seily o n h is
lf adti i epcal s i tefrt cases, protects against the commoner
in very young chil- er f ie t s ey uh ra
y a o l f . I i v r m c a t e table dis- form of pneumonia caused by an organ-
dren, particularly ease and it should be possible to lower
this appalling morta i y r t w t t e c r-
lt ae ih h u oped world while bacterial pneumonias organisms. Several investigations such as
ism known as Streptococcus pneumoniae.
More recently a heptavalent pneumococ-
those in the first rently available medical treatment strate- predominate in the developing world. The blood counts, blood cultures and x-rays of cal vaccine effective against seven types
two years of life. gies. Even in our countries, problems
occur with this disease either due to delay
i
dfferentiation of viral from bacterial pneu-
monias is somewhat important as the
the chest are useful in the diagnosis of the
disease and in assessment of the possible
of the bacterium has been introduced. This
vaccine is quite expensive and costs thou-
Rapid breathing and in seeking proper treatment or due to inad- treatment strategies of the two groups o f causative organism. The x-ray of the chest sands of rupees for each dose. It is an
chest indrawing are equate and inappropriate treatment. eet
conditions are somewhat diff r n . is most useful as it could give information optional vaccine available only in the pri-
very important fea-
The term pneumonia literally means h ohsiae aiiis e
However, t e s p i t c t d f c l t e n c- regarding the type and severity of lung vate sector. It has produced very
inflammation of the lung. Although some essary for definitive diagnosis of viral involvement. However in the case of chil- favourable results in some countries of the
tures that point hns ie ri n
t i g l k i r ta ts, inhaled noxious gases pneumonias are not universally available dren, particularly the very young, even in developed world in which it is used rou-
towards the diagno- r ffin products such as kerosene
and pa a
are known to cause inflammation of the
in the developing world.
The commonest presentation of pneu-
the presence of major involvement of the
lungs, the changes in the chest x-ray may
t n l Unfortunately, there are no vaccines
i e y.
available against some of the other
sis. Early treatment lung, the most important causes of pneu- monia is a child showing signs of a cough not be that extensive. Chest x-ray changes microbes that cause pneumonia in chil-
helps to cure the monia include infection of the lung by iute. t s
associated with breathing diff c l i s I i are not essential for a diagnosis of pneu- dren.
viruses, bacteria and other microorgan- h eeiy
usually associated with fever, t e s v r t monia. It is also true to say that the mere word
problem and there isms. The term pneumonia is reserved for of which may vary widely. In some children s e i l y f o r p-
The disease may, e p c a l i n t p o pneumonia causes a great deal of dis-
“
is no significant
long-term lung
function abnormali-
ties after recovery.
involvement of the aerated portions of the
lung and it seriously interferes with the gas
exchanging properties of the lung. In
severely affected cases it simply leads to
rsi euto n h rvso f ie
adatcrdcini tepoiino lf-
giving oxygen to the tissues of the entire
body.Dfferent medical terminologies are
i
used to delineate different types of pneu-
monia. When the area of involvement is
h l n s tats l w y h l n t e s t
teiless r sol wie i ohr i
has an explosive onset. However, t e
presentation tends to vary with the age of
the child. In the very young child, pa t c
larly in the first couple of months, non-spe-
cific symptoms such as refusal of feeds,
lethargy and behaviour disturbances are
importa t f a u e o t e d s a e I i v ta
n etrs f h ies. t s i l
h
r i u-
to realise that although such symptoms do
erly treated in the early acute stage, devel-
op certain complications. One such prob-
lem is progression of the disease to the
ta e f e p r t r a l r
s t o rsiaoyfiue.I ti s t n h s ta e
the lung damage is so extensive that it
interferes with the normal functioning and
gas exchange through the respiratory sys-
tem. This type of scenario would generally
need management in an Intensive Care
tress and panic amongst most parents I
conjures up unpleasant visions of severely
lte.
ill children and even fataiis Although it
could be a severe illness, in very many
cases it could be handled quite well with
the help of the currently available drug
armamentarium and the facilities available
n o p tas
i h s i l. The key to success is early
diagnosis. In the right hands a complete
.t
restricted to an anatomical area or lobe of not directly point towards a primary lung nt
U i . Another complication is the situation recovery could be expected in all but the
a lung, it is known as Lobar Pneumonia problem these are important symptoms where the infection does not settle proper- most severe cases or those that compli-
while in situations where the areas of that need expert evaluation. While in the ly and leads to a state of what is called
involvement are scattered around the fine older children certain classical diagnostic unresolved pneumonia . The furthermost cate other major underlying illnesses. !
branches of breathing tubes within the sounds are heard using a stethoscope, in tage of this is the formation of a lung
s
lung it is known as Bronchopneumonia . younger children these may even be abscess. Once it progresses into this
When all types of pneumonias are entirely absent even in very severely tage, very aggressive treatment may be
s
assessed worldwide it is noted that viral affected cases. However, there are two needed. The pneumonia is sometimes
pneumonias are commoner in the devel- features that are reliable indicators of complicated by the presence of fluid or
pus in the chest cavity which accommo-
dates the lungs. Unlike in a lung abscess
where the pus is collected within the
lung, in these cases the fluid or pus
accumulates between the lung and the
chest wall. If the amount of fluid inter-
feres with the functioning of the lung then
the fluid may need to be removed. The
presence of pus in the chest cavity will
necessitate surgical drainage. These lat-
ter two complications are generally seen
with bacterial pneumonias.
When a definitive diagnosis is possi-
f ia n atra
ble, the treatments o v r l a d b c e i l
pneumonias vary significantly.There are
no effective antiviral drugs against many
of the viruses that cause pneumonia. In
such cases ancillary measures are
adopted and careful monitoring of the
functioning of the lungs is employed. If
things get out of hand, it may be neces-
ay o
s r t take over the breathing of the
child using artificial breathing machines
r etltr.
o vniaos
In the case of bacterial pneumonias,
n oe n
antibiotics play a very importa t r l i
iut o eiiey
treatment. When it is diff c l t d f n t l
say whether it is viral or bacterial then The writer would appreciate
antibiotics are used empirically.The doc- some feed-back from the read-
tors would use their experience and ers. Please e-mail him at
expertise to decide which of the wide bjcp@sltnet.lk or write to him at
range of antibiotics available should be the following address :-
selected in a given pa i n . I a c u a i e
tet f astv Dr, B.J.C.Perera, Consultant
organism could be determined by the Paediatrician, Asiri Medical
t s performed then the selection of an
e ts Hospital, 181, Kirula Road,
appropriate antibiotic is not that much of Colombo 5.
a problem. When empirical decisions
