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Podcast: Play in new window | Download | EmbedSubscribe: Apple Podcasts | Android | Email | Google Play | Stitcher | TuneIn | RSS | MoreThank you so much to our guest host, Jack, for sharing the book for this …

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Recurrent chest infections are a common reason for children to be seen by their general practitioner (GP) or a paediatrician. Recurrent or persistent cough may be the only symptom, but often there is also a history of wheeze, breathlessness, sputum production or general ill-health. A number of disorders can present with these features ( Table 1 ). Many of these children are simply having the repeated viral upper respiratory tract infections that are a normal part of growing up. In others, the symptoms are the first manifestations of asthma. But, in an important minority there is a clear history of persistent or recurrent episodes of pneumonia, or of chronic sputum production, indicating more severe pathology.

Table 1.

Causes of recurrent or persistent cough

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Table 1.

Causes of recurrent or persistent cough

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The challenge for the clinician is to distinguish between the child with self-limiting or minor problems and the child with serious, perhaps progressive, lung disease. To do this, it is necessary to assess the severity and to diagnose the cause of the symptoms. This depends very much on taking a detailed history, on detecting any abnormal physical signs, and in selected cases, on the use of appropriate investigations. There needs to be a high index of suspicion about uncommon disorders, such as immunodeficiencies, ciliary abnormalities, or congenital anomalies of the respiratory tract. My aim is to describe how these children should be assessed.

Acute respiratory infections are the commonest illnesses of childhood. In Britain, they account for a third of all consultations between GPs and children and 8–18% of acute hospital admissions 1 ,2 . Most involve only the upper respiratory tract, but in 10–30% the lower respiratory tract is also affected. It is common for children to have 6–10 upper respiratory tract infections (URTIs) in a year 3 ,4 . The peak incidence is at 6–12 months of age, with an increase when the child first mixes with large numbers of children at nursery or school.

Most respiratory infections are mild, self-limiting and caused by viruses. The commonest viral pathogens are rhinoviruses, coronaviruses, the respiratory syncytial virus (RSV), influenza and parainfluenza, and adenoviruses. Streptococcus pneumoniae (pneumococcus) and other streptococci, Haemophilus influenzae , Mycoplasma pneumoniae , Chlamydia pneumoniae and Moraxella catarrhalis are the commonest non-viral pathogens for lower respiratory infections 3 ,5 . Co-infection with more than one type of bacteria or virus is present in 8–30% of pneumonia 3 ,5 . In many cases, no pathogen can be identified.

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