The Impact of Pneumonia on Development of Chronic Respiratory Illness in Childhood

Abstract

Pneumonia is the leading cause of mortality in children under 5 years of age in low- and middle-income countries. As most deaths are preventable, the primary focus has been on mortality reduction, with relative neglect of the potential long-term morbidity, particularly the development of chronic respiratory illness. Nevertheless, chronic respiratory illness is common among children in low- and middle-income countries and causes substantial morbidity. The aim of this article was to review the evidence for an association between pneumonia and the development of chronic respiratory illness, specifically bronchiectasis, chronic bronchitis, and bronchiolitis obliterans. In addition, the effects of modifying factors known to be associated with respiratory illness in children, including exposure to biomass fuel smoke, malnutrition, lack of access to healthcare, and poverty, were considered. Medline search using pneumonia and each of the chronic respiratory illness terms, limited to children, was conducted. Article abstracts were extracted and reviewed, and full articles retrieved where they met the search definitions. Studies reported an association between severe pneumonia and the development of chronic respiratory illness in a substantial proportion of children; few studies have been done in low- and middle-income countries and many have methodological limitations. Pneumonia has been most closely associated with the development of bronchiectasis, especially among certain high-risk children. Persistent bacterial bronchitis is a poorly defined clinical entity that may be a precursor for bronchiectasis. Postinfectious bronchiolitis obliterans has been well described, especially following adenovirus pneumonia. Limited evidence suggests an association between severe pneumonia and development of chronic respiratory illness. However, further research, especially after the introduction of new conjugate vaccines in low- and middle-income countries, is needed.