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Clinical investigations from the RACP

Investigation of the child with recurrent pneumonia

Yvonne Belessis, Katrina Doyle, Adam Jaffe

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Abstract

An underlying cause is found in most children with recurrent pneumonia. Children with focal pneumonia, failure to thrive, comorbidities or chronic suppurative symptoms are most likely to have a significant predisposing condition and require specialist assessment.

Key Points

  • Recurrent pneumonia is defined as two or more episodes in a year or three or more episodes ever, with radiographic clearing between episodes.
  • A systematic approach to recurrent pneumonia will identify those children with potentially more serious conditions while not over-investigating those with recurrent viral illnesses or unrecognised asthma.
  • A persistent wet cough is abnormal in childhood (a recurrent wet cough is, however, common in children under the age of about 5 years, who have frequent viral lower respiratory tract infections and/or asthma).
  • An estimated 6 to 9% of children hospitalised with pneumonia have had a previous episode: most of these children have an identifiable predisposing condition.
  • A delay in diagnosis of the underlying cause of recurrent pneumonia may be associated with a significant decline in lung function and bronchiectasis.
  • Children with focal disease, failure to thrive, comorbidities or chronic suppurative symptoms require specialist assessment.

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