Clinical features useful for early detection of pneumonia

An icddr,b study found additional simple clinical features helpful to distinguish the cause of rapid breathing in children with diarrhoea, in order to facilitate appropriate treatment in time.

Fast breathing is often seen in children with diarrhoea who are also suffering from pneumonia. It is a clinical feature suggested by the World Health Organization (WHO) to identify probable pneumonia infection in children.

On the other hand, diarrhoeal children with or without pneumonia often present with metabolic acidosis - loss of fluid leads to loss of bicarbonate and simultaneously increases the acidity of their blood. The lungs of these children breath faster to compensate for this acidosis, making it difficult to determine if rapid breathing is being caused by dehydration alone or pneumonia.

“When children are admitted to our hospitals, it is very important to identify what causes them to breath fast. If this is due to pneumonia, timely start of antibiotics without waiting for rehydration can reduce the risk of deaths,” says Dr Jobayer Chisti, icddr,b senior scientist and head of clinical research and senior author of the study published in PLOS One.

On World Pneumonia Day, the WHO aims to raise awareness about pneumonia,which remains a major cause of death among children under five.

Data from this study, conducted in icddr,b hospitals, show that diarrhoeal children who had a cough and/or lower chest wall indrawing in addition to rapid breathing were more likely to have pneumonia, irrespective of the presence or absence of metabolic acidosis due to dehydration.

“Rehydration of dehydrated children with ORS requires considerable time and if we wait for their full rehydration, administration of antibiotics may be too late if fast breathing had been caused by pneumonia but not by dehydration,” says Dr Sharika Nuzhat, medical officer at icddr,b hospitals and author of the study.

These findings will help us to identify children with pneumonia quickly and start their treatment without any delay, she says.

“Death in children with the co-morbidity of diarrhoeaand pneumonia compared to those without diarrhoeais significantly higher,” says Dr Chisti who has developed a low-cost version of the bubble-CPAP oxygen therapy for children with pneumonia.

Interventions to protect against, prevent and treat pneumonia are part of the worldwide Pneumonia Day observance to generate action against the disease that claims life of a child in every 35 seconds.