Lower respiratory tract infection


Lower respiratory tract infection LRTI, while often used as a synonym for pneumonia, can also be applied to other types of infection including lung abscess and acute bronchitis Symptoms include shortness of breath, weakness, fever, coughing and fatigue

There are a number of symptoms that are characteristic of lower respiratory tract infections The two most common are bronchitis and pneumonia3 Influenza affects both the upper and lower respiratory tracts

Antibiotics are the first line treatment for pneumonia; however, they are not effective or indicated for parasitic or viral infections Acute bronchitis typically resolves on its own with time

In 2015 there were about 291 million cases1 These resulted in 274 million deaths down from 34 million deaths in 199042 This was 48% of all deaths in 20134

Contents

  • 1 Causes
    • 11 Bronchitis
    • 12 Pneumonia
    • 13 Other causes
  • 2 Treatment
  • 3 Prevention
  • 4 Epidemiology
  • 5 Society and culture
  • 6 References
  • 7 External links

Causesedit

Bronchitisedit

Main article: Bronchitis

Bronchitis describes the swelling or inflammation of the5 bronchial tubes Additionally, bronchitis is described as either acute or chronic depending on its presentation and is also further described by the causative agent Acute bronchitis can be defined as acute bacterial or viral infection of the larger airways in healthy patients with no history of recurrent disease3 It affects over 40 adults per 1000 each year and consists of transient inflammation of the major bronchi and trachea6 Most often it is caused by viral infection and hence antibiotic therapy is not indicated in immunocompetent individuals75 Viral bronchitis can sometimes be treated using antiviral medications depending on the virus causing the infection, and medications such as anti-inflammatory drugs and expectorants can help mitigate the symptoms85 Treatment of acute bronchitis with antibiotics is common but controversial as their use has only moderate benefit weighted against potential side effects nausea and vomiting, increased resistance, and cost of treatment in a self-limiting condition69 Beta2 agonists are sometimes used to relieve the cough associated with acute bronchitis In a recent systematic review it was found there was no evidence to support their use5

5Acute Exacerbations of Chronic Bronchitis AECB are frequently due to non-infective causes along with viral ones 50% of patients are colonised with Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis3 Antibiotics have only been shown to be effective if all three of the following symptoms are present: increased dyspnoea, increased sputum volume and purulence In these cases 500 mg of Amoxycillin orally, every 8 hours for 5 days or 100 mg doxycycline orally for 5 days should be used3

Pneumoniaedit

Main article: Pneumonia

Pneumonia occurs in a variety of situations and treatment must vary according to the situation8 It is classified as either community or hospital acquired depending on where the patient contracted the infection It is life-threatening in the elderly or those who are immunocompromised1011 The most common treatment is antibiotics and these vary in their adverse effects and their effectiveness1012 Pneumonia is also the leading cause of death in children less than five years of age in low income countries12 The most common cause of pneumonia is pneumococcal bacteria, Streptococcus pneumoniae accounts for 2/3 of bacteremic pneumonias13 This is a dangerous type of lung infection with a mortality rate of around 25%11 For optimal management of a pneumonia patient, the following must be assessed: pneumonia severity including treatment location, eg, home, hospital or intensive care, identification of causative organism, analgesia of chest pain, the need for supplemental oxygen, physiotherapy, hydration, bronchodilators and possible complications of emphysema or lung abscess14

Other causesedit

This list is incomplete; you can help by expanding it

Parasitic infections:

  • Respiratory cryptosporidiosis

Viral infections:

  • Adenovirus
  • Influenza
  • Human parainfluenza viruses
  • Human respiratory syncytial virus

Aspiration pneumonia

Treatmentedit

Antibiotics do not help the many lower respiratory infections which are caused by parasites or viruses While acute bronchitis often does not require antibiotic therapy, antibiotics can be given to patients with acute exacerbations of chronic bronchitis The indications for treatment are increased dyspnoea, and an increase in the volume or purulence of the sputum The treatment of bacterial pneumonia is selected by considering the age of the patient, the severity of the illness and the presence of underlying disease Amoxicillin and doxycycline are suitable for many of the lower respiratory tract infections seen in general practice

Preventionedit

Vaccination helps prevent bronchopneumonia, mostly against influenza viruses, adenoviruses, measles, rubella, streptococcus pneumoniae, haemophilus influenzae, diphtheria, bacillus anthracis, chickenpox, and bordetella pertussis

Epidemiologyedit

Deaths from lower respiratory infections per million persons in 2012   24-120   121-151   152-200   201-241   242-345   346-436   437-673   674-864   865-1,209   1,210-2,085 Disability-adjusted life year for lower respiratory infections per 100,000 inhabitants in 200415   no data   less than 100   100–700   700–1,400   1,400–2,100   2,100–2,800   2,800–3,500   3,500–4,200   4,200–4,900   4,900–5,600   5,600–6,300   6,300–7,000   more than 7,000

In 2010, lower respiratory infections caused about 28 million deaths, down from 34 million in 199016

Society and cultureedit

Lower respiratory tract infections place a considerable strain on the health budget and are generally more serious than upper respiratory infections

Referencesedit

  1. ^ a b GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators 8 October 2016 "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015" Lancet London, England 388 10053: 1545–1602 PMC 5055577  PMID 27733282 doi:101016/S0140-67361631678-6 
  2. ^ a b GBD 2015 Mortality and Causes of Death, Collaborators 8 October 2016 "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015" Lancet London, England 388 10053: 1459–1544 PMC 5388903  PMID 27733281 doi:101016/s0140-67361631012-1 
  3. ^ a b c d Antibiotic Expert Group Therapeutic guidelines: Antibiotic 13th ed North Melbourne: Therapeutic Guidelines; 2006
  4. ^ a b GBD 2013 Mortality and Causes of Death, Collaborators 17 December 2014 "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013" Lancet 385: 117–71 PMC 4340604  PMID 25530442 doi:101016/S0140-67361461682-2 
  5. ^ a b c d e Becker, Lorne A; Hom, Jeffrey; Villasis-Keever, Miguel; van der Wouden, Johannes C 2015-09-03 "Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis" The Cochrane Database of Systematic Reviews 9: CD001726 ISSN 1469-493X PMID 26333656 doi:101002/14651858CD001726pub5 
  6. ^ a b BJM Clinical evidence: London, United Kingdom: BMJ, 1999-2007 : Accessed 29/3/7 at : http://0-wwwclinicalevidencecomlibrarynewcastleeduau/ceweb/indexjsp
  7. ^ Therapeutic guidelines : respiratory 2nd ed: North Melbourne : Therapeutic Guidelines Limited, 2000
  8. ^ a b Integrated pharmacology / Clive Page et al 2nd ed: Edinburgh : Mosby, 2002
  9. ^ Fahey T SJ, Becker L, Glazier R 2004 "Antibiotics for acute bronchitis" Cochrane Database of Systematic Reviews 4: CD000245 doi:101002/14651858CD000245pub2 
  10. ^ a b Pakhale, Smita; Mulpuru, Sunita; Verheij, Theo J M; Kochen, Michael M; Rohde, Gernot G U; Bjerre, Lise M 2014-10-09 "Antibiotics for community-acquired pneumonia in adult outpatients" The Cochrane Database of Systematic Reviews 10: CD002109 ISSN 1469-493X PMID 25300166 doi:101002/14651858CD002109pub4 
  11. ^ a b Moberley S, Holden J, Tatham DP, Andrews RM 2013 Moberley S, ed "Vaccines for preventing pneumococcal infection in adults" Cochrane Database Syst Rev 1: CD000422 PMID 23440780 doi:101002/14651858CD000422pub3 
  12. ^ a b Lodha, Rakesh; Kabra, Sushil K; Pandey, Ravindra M 2013-06-04 "Antibiotics for community-acquired pneumonia in children" The Cochrane Database of Systematic Reviews 6: CD004874 ISSN 1469-493X PMID 23733365 doi:101002/14651858CD004874pub4 
  13. ^ The Merck manual of diagnosis and therapy 17th ed / Mark H Beers and Robert Berkow ed: Whitehouse Station, NJ : Merck Research Laboratories, 1999
  14. ^ eTG complete electronic resource "" 
  15. ^ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" xls World Health Organization 2002 
  16. ^ Lozano, R; Naghavi, M; Foreman, K; Lim, S; Shibuya, K; Aboyans, V; Abraham, J; Adair, T; Aggarwal, R; Ahn, SY; Alvarado, M; Anderson, HR; Anderson, LM; Andrews, KG; Atkinson, C; Baddour, LM; Barker-Collo, S; Bartels, DH; Bell, ML; Benjamin, EJ; Bennett, D; Bhalla, K; Bikbov, B; Bin Abdulhak, A; Birbeck, G; Blyth, F; Bolliger, I; Boufous, S; Bucello, C; et al Dec 15, 2012 "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010" Lancet 380 9859: 2095–128 PMID 23245604 doi:101016/S0140-67361261728-0 

External linksedit

Classification
  • ICD-10: J10-J22, J40-J47


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