Paediatric respiratory mortality - past triumphs, future challenges

George Russell ^1*

¹ University of Aberdeen, United Kingdom

^* To whom correspondence should be addressed. E-mail: libra{at}ifb.co.uk.

Accepted 30 August 2005

Abstract

To invite me to comment on a paper that reports changes occurring during a period that coincided to within a year or two with my career as a consultant paediatrician presents me with an irresistible temptation to reminisce. At medical school in the late 1950's I learned that pneumonia, one-time captain of the men of death, had responded dramatically first to sulphonamides and then to penicillin, but that some deaths were still "inevitable" - a phrase much used at that time to excuse our inability to manage conditions that we did not fully understand. Asthma was common in children, but was considered to be an unusual cause of death, despite which it was responsible for the first death I encountered as a paediatric senior house officer. In the minds of my teachers asthma was readily distinguished from bronchitis, and to this day I can replicate a table listing the differences between asthma and wheezy bronchitis, most of which has to my surprise turned out to be accurate.[1] In those far off days most children with cystic fibrosis (CF) died in the pre- school years - pseudomonads were not the problem they are now, and most children died while still colonised with Staph aureus or H influenzae. Bronchiolitis was considered to be rather an esoteric diagnosis for which there was no diagnostic test - it would be a few years before its association with the respiratory syncytial virus (RSV) was appreciated.[2] It was thought safer to diagnose pneumonia if crackles were prominent, and to treat the child with antibiotics, whilst those with predominant wheeze were labelled "bronchitis" and given ephedrine.

Keywords: acute bronchiolitis, asthma, cystic fibrosis, mortality, pneumonia

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