Lower respiratory tract infection
The lower respiratory tract infection are the infection consisting of
the trachea (wind pipe), bronchial tubes, the bronchioles, and the
lungs, including the bronchitis and pneumonia. According to The World
Health Report 2004 – Changing History(1), in 2002 lower respiratory
track infection were still the leading cause of deaths among all
infectious diseases, and accounted for 3.9 million deaths worldwide and
6.9% of all deaths that year.
Bronchitis is defined as a condition of an inflammation of the
mucous membranes of the bronchi, the larger and medium-sized airways
that carry airflow from the trachea into the lung parenchyma(7). Most
cases of Bronchitis are as a result of recurrent injure to the airways
caused by inhaled irritants and cigarette smoking(6).
C. The complications
1. Increased risk of early viral lower respiratory infections of the new born
There isan increased risk of hospitalisation for acute lower respiratory
infection up to age 2 years in children delivered by elective caesarean
section. In the study to examine the associations between the number of
hospital admissions for bronchiolitis and pneumonia and elective
caesarean delivery, showed that Delivery by elective caesarean was
independently associated with infant admissions for bronchiolitis but
not pneumonia. Elective caesareans or delivery without labour may result
in impaired immunity in the newborn leading to increased risk of early
viral lower respiratory infections(27).
2. Autoimmune rheumatic diseases
Patients suffering from autoimmune rheumatic diseases have significantly
higher risk of developing various infections compared to the healthy
population. In the study included patients suffering from systemic lupus
erythematosus (n = 30), rheumatoid arthritis (n = 37) or Sjögren’s
syndrome (n = 32), with stable underlying diseases status. In November
2010, 47 patients, including 35 subjects vaccinated annually during
2006-2010, found that the incidence of influenza or bacterial
complications (bronchitis) among vaccinated patients was significantly
lower, compared to the non-vaccinated group. Importantly, there was no
case of exacerbation of the underlying disease. The last vaccination in
2010 reduced the risk of influenza by 87%, but previous bacterial
infections (bronchitis and pneumonia) increased influenza risk
significantly(28).
3. Asthma
In the study to investigate whether chronic bronchitis, asthma, or
baseline methacholine airway responsiveness can explain the
heterogeneity in lung function response to boilermaker work, showed that
although chronic bronchitis and asthma were associated with a greater
loss in lung function in response to hours worked as a boilermaker, and
therefore they acted as effect modifiers of the exposure-lung function
relationship, airway hyperresponsiveness did not. However, the high
prevalence of airway hyperresponsiveness found in the cohort may be a
primary consequence of long-term workplace exposure among
boilermakers(29).
4. Bronchiectasis
According to the study of Risk of infections in bronchiectasis during
disease-modifying treatment and biologics for rheumatic diseases by
Rheumatology B Department, Cochin Hospital, Paris France, lower
respiratory tract infectious events are frequent among patients
receiving biologics for chronic inflammatory rheumatic disease
associated with bronchiectasis. Biologic treatment and pre-existing
sputum colonization are independent risk factors of infection
occurrence(30).
5. Cystic fibrosis, airway hyperresponsiveness and neutrophilic bronchitis
There is a report of four patients with asthma, airway
hyperresponsiveness and neutrophilic bronchitis who harboured abnormal
cystic fibrosis transmembrance conductance regulator (CFTR) gene
mutations. It serves both to alert clinicians to consider CFTR-related
disease in both young and elderly patients with persistent neutrophilic
bronchitis, and to highlight the potential utility of future genetic
testing for CFTR abnormalities in patients with asthma and recurrent
bronchitis or pansinusitis, and the role of nebulized hypertonic saline
as a therapeutic option in these patients(31).
6. Recurrent haemoptysis
There is a report of an 8-year-old boy presented with recurrent chest
pain and haemoptysis since 3 years of age. He had taken multiple courses
of antitubercular treatment without any symptomatic relief. His chest
x-ray showed opacity consistent with right sided lung collapse. Further
detailed work-up including high-resolution CT scan of thorax, pulmonary
angiogram and radionucleide study confirmed intrathoracic gastrogenic
cyst(31a).
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Sources
(1) http://www.who.int/whr/2004/en/
(6) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130746/
(7) http://www.lung.org/lung-disease/bronchitis-chronic/understanding-chronic-bronchitis.html
(27) http://www.ncbi.nlm.nih.gov/pubmed/22039179
(28) http://www.ncbi.nlm.nih.gov/pubmed/23221145
(29) http://www.ncbi.nlm.nih.gov/pubmed/12065377
(30) http://www.ncbi.nlm.nih.gov/pubmed/22046967
(31) http://www.ncbi.nlm.nih.gov/pubmed/22332135
(31a) http://www.ncbi.nlm.nih.gov/pubmed/23291818
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