Lower respiratory tract infections in early childhood

The Article by James Peter Allinson and colleagues1Allinson JP Chaturvedi N Wong A et al.Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study.Lancet. 2023; 401: 1183-1193Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar has aroused special interest from paediatric and respiratory physicians and researchers. This birth cohort study, which spans about eight decades, has highlighted the close relationship between lung health during early childhood and the survival rate from respiratory disease during adulthood. The authors claim that impaired lung function is a mediator linking early childhood lower respiratory tract infections (LRTIs) to respiratory-cause adult mortality, independent of socioeconomic circumstances and adult smoking.1Allinson JP Chaturvedi N Wong A et al.Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study.Lancet. 2023; 401: 1183-1193Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar We are excited that the authors have obtained such complete and valuable clinical research data and feel the study adds to the strong call for lifelong respiratory health. This study showed that children who have LRTIs before the age of 2 years are at increased risk of premature death in adulthood. However, LRTIs are the most common diseases in paediatrics, and include bronchitis, bronchopneumonia, and pneumonia.2Kyu HH Vongpradith A Sirota SB et al.Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019.Lancet Infect Dis. 2022; 22: 1626-1647Summary Full Text Full Text PDF PubMed Scopus (41) Google Scholar Subsidiary exploration is recommended to compare the outcomes of different infections or combined infections on sequelae and lifelong lung function. The severity of LRTIs caused by Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae type b, and other bacterial pneumonias differs and is probably related to the use of antibiotics and the types of pathogenic infections in different regions. Those in early childhood who have recurrent LRTIs or recurrent infectious pneumonia (ie, more than two or three LRTIs per year) have an increased risk of death from respiratory disease in adulthood.3de Benedictis FM Bush A Recurrent lower respiratory tract infections in children.BMJ. 2018; 362k2698Google Scholar Globally, pneumonia is the most common cause of death and admission to hospital in children. Children with LRTIs (especially severe pneumonia and recurrent pulmonary infection) often develop long-term coughs, expectoration, and lung dysfunction, which all affect lung development and increase the risk of asthma, pulmonary fibrosis, and bronchiolitis obliterans.4van Meel ER Mensink-Bout SM den Dekker HT et al.Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children.Eur Respir J. 2022; 602102395Crossref Scopus (16) Google Scholar Chronic or repeated pulmonary inflammation also damages the airway mucosa and alveolar epithelium. Generally, lung damage cannot be repaired easily and the child's susceptibility to reinfection, multipathogen invasion, cumulative damage, and more severe lung injury increases, which can further affect lung development and function in adulthood.5Planer JD Morrisey EE After the storm: Regeneration, repair, and reestablishment of homeostasis between the alveolar epithelium and innate immune system following viral lung injury.Annu Rev Pathol. 2023; 18: 337-359Crossref Scopus (1) Google Scholar Children with severe infectious pneumonia and recurrent pulmonary infection are at increased risk of chronic obstructive pulmonary disease, chronic inflammatory injury, and other respiratory disease in adulthood, which all increase the risk of premature death.6Bui DS Lodge CJ Burgess JA et al.Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life.Lancet Resp Med. 2018; 6: 535-544Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Therefore, infectious pneumonia could be the culprit behind LRTI in early childhood. Many parents ignore the severity of LRTIs in their child's early life. However, outpatient treatment alone might be inadequate, which leads to LRTI aggravation or recurrence. Although children with respiratory syncytial virus might meet the clinical recovery and discharge criteria, they could still have abnormal lung function or recurrent infections after follow-up appointments.7Zar HJ Nduru P Stadler JAM et al.Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health.Lancet Glob Health. 2020; 8: e1316-e1325Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar From a clinical perspective, LRTIs frequently occur during early childhood and should be given prompt treatment and care to promote lung injury repair, reduce infection recurrence, and prevent the worsening of LRTIs. More emphasis should therefore be placed on early preventive measures and the avoidance of adverse risk factors. Few intervention measures exist to promote lung injury repair, and non-invasive and safe complementary alternative therapies for children are often the treatment of choice, such as massage, cupping, acupuncture, and physical therapy. As society develops, so does the spectrum of human disease. Enhanced vigilance and attention of health management institutions, physicians, and parents is essential to prevent and treat early LRTIs in children. Moreover, efforts to develop vaccines and new drugs should be increased, antibiotics should only be used under the safe guidance of specialists, and complementary and alternative medicine treatments should be considered. Allinson and colleagues’ study on early childhood LRTIs, adult respiratory diseases, and mortality highlights the importance of respiratory health in early childhood and establishes the concept that a healthy childhood is the cornerstone of a healthy adulthood. We declare no competing interests. Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort studyIn this prospective, life-spanning, nationally representative cohort study, LRTI during early childhood was associated with almost a two times increased risk of premature adult death from respiratory disease, and accounted for one-fifth of these deaths. Full-Text PDF Open AccessLower respiratory tract infections in early childhood – Authors' replyWe thank Xiaoqian Zhang and colleagues, Jianning Guo and colleagues, and Seif Shaheen for their thoughtful correspondence regarding our Article.1 Full-Text PDF