December 2005    
       Breathing health

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Q&A: Breathing health

Looking pediatric uveitis in the eye

Helping parents and baby sleep better


Impact of cerebellar damage

Infant iron deficiency screening


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By Dawn Ericson, MD

Dawn Ericson, MD, is director of the Division of Respiratory Diseases' Outpatient Clinic and an assistant in Medicine. She specializes in asthma, cystic fibrosis, exercise physiology and pediatric pulmonology.

How do colds and other respiratory infections affect breathing?
The common cold is actually an upper respiratory infection, so there's no surprise that breathing is affected. The viruses that cause the cold inflame the membranes that line the nose and throat. Of course, this is a very common infection, especially for children, and the mild, hacking cough that often accompanies it doesn't point to the kind of respiratory distress needing intensive treatment.

In contrast, infections of the lower respiratory tract, including the lungs, require more care. Bronchiolitis is one such infection, especially common among infants 2 to 6 months old. With bronchiolitis, the network of tiny airways in the lungs becomes compromised as each of these airways, or bronchioles, swell. This results in an obstruction of airflow in and out of the lungs. Respiratory syncitial virus (RSV) is the most common cause, but other viruses and some strains of bacteria may also play a role.

The symptoms of bronchiolitis are similar to those of a cold, and include a runny nose, congestion, fever and cough. But while most cases are mild and can be treated at home, more involved treatments, like IV fluids, oxygen therapy and suctioning of the nose and mouth, might be needed depending on severity of the infection.

Can bronchiolitis be diagnosed at the primary care level?
Yes, as can conditions like asthma and stridor. Sometimes, though, a pediatrician may want to further investigate the cause of a problem. Stridor, for example, is a high-pitched noise a patient makes on inspiration. Causes of stridor can range from viral croup, to a structural abnormality of the airway, to laryngospasm related to gastroesophageal reflux or vocal cord dysfunction. Detailed testing may be necessary to evaluate these possibilities.

Asthma is a chronic, inflammatory disease in which airways react to certain allergens by narrowing. Causes also include upper respiratory infections and inhaled irritants, like second-hand smoke. Coughing, wheezing, trouble breathing and tightness in the chest are all common symptoms. Again, detailed testing can reveal other root problems and complications.

What types of cases are referred most often?
Our primary referrals for pulmonary consultation are for recurrent cough and recurrent wheeze. For many of these patients, we end up confirming a diagnosis of asthma. Based on lung function testing, we can often recommend changes in therapy that an unaided assessment of symptoms can't always accomplish. Sometimes the evaluation reveals that a vocal cord problem, gastroesophageal reflux, aspiration or another more rare diagnosis is the underlying cause of the recurrent respiratory symptoms.

Recurrent or severe pneumonia is another common referring diagnosis. We've also seen an increase over the last several years of children with a severe pneumonia, associated with a pleural effusion—fluid that accumulates between the lung and the chest wall. Most of these patients are hospitalized during the acute illness, then are followed in the pulmonary clinic for a period of time. Fortunately, patients with this kind of pneumonia typically regain normal lung function.

Referral for evaluation and management of cystic fibrosis (CF) is also quite common, since we are one of the largest CF centers in the country. Symptoms of persistent cough and recurrent respiratory infection are characteristic of CF and often trigger further evaluation.

What would you recommend pediatricians tell parents to promote good respiratory health in their children?
Absolutely do not smoke, for starters. There is an association between asthma and obesity, so eating well and exercising regularly is, in addition to promoting overall health, a boon to your pulmonary health. Avoiding recurrent respiratory infections, especially throughout our cold New England winters, is also important. This means washing your hands frequently with soap and water or alcohol-based hand sanitizer gels. Exposure to certain allergens like dust seems to be associated with increased development of allergies and potentially asthma, so using environmental control measures like minimizing the amount of carpet, bedding and upholstered furniture to screen out dust mites at home certainly makes a lot of sense. But surprisingly enough, this doesn't necessarily apply to pets. It's unclear whether exposure to cats or dogs increases a child's likelihood of developing allergies or asthma.

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