Management of the child with cough or difficult breathing

Abstract

Childhood respiratory disease creates considerable morbidity and mortality, especially amongst children living in low-income countries. Of the more than 10 million children who die annually from preventable diseases, pneumonia is responsible for 18.1%, while in low-income countries this percentage rises to 26%. It is calculated that 90% of these deaths from preventable diseases occur in 42 countries. Even in the face of the human immunodeficiency virus (HIV) epidemic, pneumonia is still responsible for 21% of deaths. HIV-infected children are at greatest risk for developing and dying from pneumonia. By the introduction of low cost standardised case management strategies for the management of pneumonia, increasing immunisation, reducing risk factors such as poor nutrition and environmental smoking and promoting breast-feeding, it is estimated that the death rate from pneumonia can be reduced by 50%. In this series the epidemiology of childhood acute respiratory infections (ARI) and the recognition and management of childhood pneumonia in resource-poor settings will be highlighted as well as the scientific justification for the standard case management of childhood pneumonia. As cases of pneumonia are better managed, other childhood respiratory diseases such as asthma and tuberculosis (TB) will be discovered, which also require a standard approach to management. The management of asthma and TB in resource-poor settings will also be discussed.