Acute Respiratory Infections

ACUTE RESPIRATORY INFECTIONS
Infections of the respiratory tract are perhaps the most common human
ailment. While they are a source of discomfort, disability and loss of time for
most adults, they are a substantial cause of morbidity and mortality in
young children and the elderly.
Acute respiratory infections (ARI) may cause inflammation of the respiratory

tract anywhere from nose to alveoli, with a wide range of combination of
symptoms and signs. ARI is often classified by clinical syndromes depending
on the site of infection and is referred to as ARI of upper (AURI) or lower
(ALRI) respiratory tract.
The upper respiratory tract infections include common cold, pharyngitis and
otitis media. The lower respiratory tract infections include epiglottitis,
laryngitis, laryngotracheitis, bronchitis, bronchiolitis and pneumonia.
Problem statement
Every year ARI in young children is responsible for an estimated 3.9 million
deaths worldwide. About 90 per cent of the ARI deaths are due to
pneumonia which is usually bacterial in origin.
The incidence of ARI is similar in developed and developing countries.

However, while the incidence of pneumonia in developed countries may be a
slow as 3-4 per cent, its incidence in developing countries range between 20
to 30 per cent. This difference is due to high prevalence of malnutrition, low
birth weight and indoor air pollution in developing countries .
In India, in the states and districts with high infant and child mortality rates,
ARI is one of the major causes of death. ARI is also one of the major
reasons for which children are brought to the hospitals and health facilities.
Hospital records from states with high infant mortality rates show that upto
13% of inpatient deaths in paediatric wards are due to ARI. The proportion
of death due to ARI in the community is much higher as many children die at
home. The reason for high case fatality may be that children are either not
brought to the hospitals or brought too late
Epidemiological determinants
Agent factors
The microbial agents that cause acute respiratory infections are numerous
and include bacterias and viruses.
Host factors
Age: Incidence of ARI is very high among under-five children, infants being
hit hardest in the developing countries.
Sex: Incidence of ARI is more among male children than among female
children in the ratio of 1.7:1.
1. Low birth weight: A LBW child is highly susceptible for any infection, more
so for ARI and when ARI occurs in a LBW baby, the infection becomes more
severe suddenly than in the healthy counterpart, resulting in increased
morbidity and mortality.
2. Failure of breastfeeding: This deprives the child of maternal antibodies,

more so from colostrum, pre disposing the child for a great risk of many
communicable diseases including ARI.
3. Undernutrition: This in general decreases the immune mechanism and

vitamin-A deficiency in particular decreases the integrity of respiratory
epithelium predisposing the child for ARI which becomes severe and
persistent (chronic) predisposing the child for complications and death.
4. Lack of primary immunization: Lack of routine primary immunization as

per the schedule constitutes a major risk factor for acquiring the respiratory
diseases such as tuberculosis, measles, diphtheria and whooping cough;
Pneumonia being the commonest complication.
5. Young infant age (i.e. neonatal period): During the first one or two
months after birth the newborn is extremely vulnerable to ARI. Poor
standard of living worsens the situation.
6. Vitamin A deficiency: This not only decreases the integrity of respiratory

mucous membrane but also reduces the secretion of mucus in the
respiratory tract, predisposing the bacteriae to stick to the mucous
membrane easily resulting in the disease.
7. Antecedent viral infection: Antecedent viral infection of respiratory tract

not only predisposes the bacteria of oropharynx to invade down resulting in
secondary bacterial infection, but also impairs the child’s immune status and
damages the bronchial epithelium as in measles.
Environmental Factors
1. Air pollution: Air pollution following industrialization and urbanization,

predisposes the people for respiratory infections. Thus ARI incidence is more
among urban children than among rural children.
2. Smoking: Both active and passive smoking predisposes the people for
ARI. Thus, the children of cigarette and beedi smokers are more prone for
ARI.
3. Season: The incidence of ARI is more in winter season because of indoor
living and overcrowding.
Social Factors
There are many social factors, responsible for the prevalence of ARI in the
community, such as poverty, illiteracy, ignorance, lack of personal hygiene,
overcrowding, poor standard of living, lack of sanitation, nonutilization of
health services, etc.
These are all predisposing factors.
Epidemicity of a disease: Most ARI are endemic. However, some ARI such as
measles, pertussis, influenza have potentiality of occurring in epidemics,
when the case fatality rate will be very high.
Mode of transmission: ARI is primarily transmitted by droplet

infection. Epidemics and pandemics occur through airborne
route, i.e. by droplet nuclei.
Incubation period: This varies according to etiological agents
Clinical features include running nose, cough, sore throat, difficult

breathing and ear problem. Fever is also common in acute respiratory
infections. Most children with these infections have only mild infection, such
as cold or cough. However, some children may have pneumonia which
is a major cause of death. In less developed countries, measles and
whooping cough are important causes of severe respiratory tract infection
CONTROL OF ACUTE RESPIRATORY INFECTIONS
CLINICAL ASSESSMENT
• History taking and clinical assessment is very important in
the management
NOTE THE FOLLOWING

• Age of the child.
• Duration of cough.
• Whether the child is able to drink (2-5 Mo).
• has the young infant stopped feeding well (child less than 2 Mo)
Any antecedent illness such as measles.
• If the child is excessively drowsy or difficult to wake.
• Did the child have convulsions.
• Is there irregular breathing. • Short periods of apnoea.
• History of child turning blue.
• History of treatment during illness.
• Fever if any.
Physical examination
Look and listen for the following :

(1) COUNT THE BREATHS IN ONE MINUTE
(2) (2) LOOK FOR CHEST INDRAWING
(3) LOOK AND LISTEN FOR STRIDOR
(4) LOOK FOR WHEEZE
(5) See if the child is abnormally sleepy or difficult to wake. An
abnormally sleepy child is drowsy most of the time when he or she should be
awake and alert.
(6) Feel for fever or low body temperature
(7) CHECK FOR SEVERE MALNUTRITION :
(8) Cyanosis is a sign of hypoxia.
CLASSIFICATION OF ILLNESS
A. Child aged 2 months upto 5 years

Classifying the illness means making decisions about the type and severity
of disease. The sick child should be put into one of the four classifications :
I. Very severe disease
II. Severe pneumonia
III. Pneumonia (not severe}
IV. No pneumonia : cough or cold
I. Very severe disease
The danger signs and possible causes are :

a. Not able to drink : A child who is not able to drink could have severe
pneumonia or bronchiolitis, septicaemia, throat abscess, meningitis or
cerebral malaria.
b. Convulsions, abnormally sleepy or difficult to wake :
A child with these signs may have severe pneumonia resulting in hypoxia,
sepsis, cerebral malaria or meningitis. Meningitis can develop as a
complication of pneumonia or it can occur on its own.
c. Strider in calm child : If a child has strider when calm, the child may be in
danger of life-threatening obstruction of the air-way from swelling of larynx,
trachea or epiglottis.
d. Severe malnutrition : A severely malnourished child is at high risk of
developing and dying from pneumonia.
II. Severe pneumonia
The most important signs to consider when deciding if the child has
pneumonia are the child's respiratory rate, and whether or not there is chest
indrawing. A child with chest indrawing may not have fast breathing if the
child becomes exhausted, and if the effort needed to expand the lungs is
too great. Then the breathing slows down. In such cases, chest indrawing
may be the only sign in a child with severe pneumonia
III. Pneumonia (not severe)

A child who has fast breathing and no chest indrawing is classified as having
pneumonia (not severe). Most children are classified in this category if they
are brought early for treatment.
IV. No pneumonia : cough or cold

Most children with a cough or difficult breathing do not have any danger
signs or signs of pneumonia (chest indrawing or fast breathing). These
children have a simple cough or cold. They are classified as having "no
pneumonia : cough or cold". They do not need any antibiotic
B. Classifying illness of young infant

Infants less than 2 months of age are referred to as young infants. Young
infants have special characteristics that must be considered when their
illness is classified. They can become sick and die very quickly from bacterial
infections, are much less likely to cough with pneumonia, and frequently
have only non-specific signs such as poor feeding, fever or low body
temperature. Further, mild chest indrawing is normal in young infants
because their chest wall bones are soft.
Management of a child having very severe disease
Management of pneumonia in a child aged 2 months upto 5

years
Prevention of Acute Respiratory Infections
Present understanding of risk factors of respiratory tract infection in

childhood indicates several approaches for primary prevention. In developing
countries, improved living conditions, better nutrition and reduction of
smoke pollution indoors will reduce the burden of mortality and morbidity
associated with ARI.
Other preventive measures include better MCH care. Immunization is an
important measure to reduce cases of pneumonia which occur as a
complication of vaccine preventable disease, especially measles. It is obvious
that community support is essential to reduce the disease burden. Families
with young children must be helped to recognize pneumonia. Health
promotional activities are specially important in vulnerable areas
Immunization
Vaccines hold promise of saving millions of children from dying of

pneumonia. Three vaccines have potential of reducing deaths from
pneumonia. These vaccines work to reduce the incidence of bacterial
pneumonia.
1. MEASLES VACCINE
Pneumonia is a serious complication of measles and the most common cause
of death associated with measles worldwide. Thus, reducing the incidence of
measles in young children through vaccination would also help to reduce
deaths from pneumonia. A safe and effective vaccine against measles is
available for past 40 years.
2. HIB VACCINE
Haemophilus influenzae type B (Hib, is an important cause of pneumonia
and meningitis among children in developing countries. Hib vaccine has been
available for more than a decade. It reduces dramatically the incidence of
Hib meningitis and pneumonia in infants and nasopharyngeal colonization by
Hib bacteria. It's high cost has posed obstacle to its introduction in
developing countries.
3. PNEUMOCOCCAL PNEUMONIA VACCINE

a. PPV23
b. PCV
The Integrated Global Action Plan for the Prevention and

Control of Pneumonia and Diarrhoea
The Integrated Global Action Plan for the Prevention and Control of
Pneumonia and Diarrhoea (GAPPD) proposes a cohesive approach to ending
preventable pneumonia and diarrhoea deaths.
It brings together critical services and interventions to create healthy

environments, promotes · practices known to protect children from disease,
and ensures that every child has access to proven and appropriate
preventive and treatment measures.
The specific goals for 2025
Reduce mortality from pneumonia in children less than 5 years of age to

fewer than 3 per 1000 live births
Reduce mortality from diarrhoea in children less than 5 years of age to fewer
than 1 per 1000 live births;
Reduce the incidence of severe pneumonia by 75% in children less than 5
years of age compared to 2010 levels;
Reduce the incidence of severe diarrhoea by 75% in children less than 5
years of age compared to 2010 levels;
Reduce by 40% the global number of children less than 5 years of age who
are stunted compared to 2010 levels.
Theses goals are ambitious and will require significant political will and
mobilization of additional resources if they are to be reached.
Coverage targets to be maintained or reached have also been set to define

efforts needed to attain the above goals.
These are:
By the end of 2025:
90% full-dose coverage of each relevant vaccine (with 80% coverage in

every district);
90% access to appropriate pneumonia and diarrhoea case management
(with 80% coverage in every district);
at least 50% coverage of exclusive breast-feeding during the first 6 months
of life;
virtual elimination of paediatric HIV.
By the end of 2030:
universal access to basic drinking-water in health care facilities and homes;

universal access to adequate sanitation in health care facilities by 2030 and
in homes by 2040;
universal access to handwashing facilities (water and soap) in health care
facilities and homes;.
universal access to clean and safe energytechnologies in health care facilities
and homes.

Acute Respiratory Infections

Uploaded by

Copyright:

Available Formats

Acute Respiratory Infections

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Acute Respiratory Infections

Uploaded by

Copyright:

Available Formats

ACUTE RESPIRATORY INFECTIONS

Acute respiratory infections (ARI) may cause inflammation of the respiratory

The incidence of ARI is similar in developed and developing countries.

2. Failure of breastfeeding: This deprives the child of maternal antibodies,

3. Undernutrition: This in general decreases the immune mechanism and

4. Lack of primary immunization: Lack of routine primary immunization as

6. Vitamin A deficiency: This not only decreases the integrity of respiratory

7. Antecedent viral infection: Antecedent viral infection of respiratory tract

1. Air pollution: Air pollution following industrialization and urbanization,

These are all predisposing factors.

Mode of transmission: ARI is primarily transmitted by droplet

Incubation period: This varies according to etiological agents

Clinical features include running nose, cough, sore throat, difficult

NOTE THE FOLLOWING

Look and listen for the following :

A. Child aged 2 months upto 5 years

The danger signs and possible causes are :

II. Severe pneumonia

III. Pneumonia (not severe)

IV. No pneumonia : cough or cold

B. Classifying illness of young infant

Management of pneumonia in a child aged 2 months upto 5

Present understanding of risk factors of respiratory tract infection in

Vaccines hold promise of saving millions of children from dying of

3. PNEUMOCOCCAL PNEUMONIA VACCINE

The Integrated Global Action Plan for the Prevention and

It brings together critical services and interventions to create healthy

The specific goals for 2025

Reduce mortality from pneumonia in children less than 5 years of age to

Coverage targets to be maintained or reached have also been set to define

By the end of 2025:

90% full-dose coverage of each relevant vaccine (with 80% coverage in

By the end of 2030:

universal access to basic drinking-water in health care facilities and homes;

You might also like