‘Limit diagnostic investigations’ in children with recurrent CAP

Research shows that pediatric recurrent community-acquired pneumonia (rCAP) in different lung areas (DLA) is most commonly associated with mild conditions like rhinosinusitis and asthma, and not severe underlying disease.

Study authors Susanna Esposito (University of Milan, Italy) and colleagues say that extensive diagnostic investigations are therefore likely unwarranted in the majority of patients.

The study included 146 children aged under 14 years with rCAP in DLA who had experienced two or more episodes of CAP in a single year or three or more episodes at any time between 2009 and 2012. There were also 145 age- and gender-matched controls.

The researchers found that, compared with controls, children with rCAP in DLA were on average born at a significantly lower gestational age (80.2 vs 88.3% born ≥37 weeks), had a lower birthweight (82.8 vs 95.2% >2500 g), more commonly experienced respiratory distress at birth (17.8 vs 0.0%), and started daycare attendance at a younger age (48.7 vs 29.0% <36 months).

When they examined potential predisposing factors to CAP, the team noted that, although severe diseases were rare, they did not occur at all in children without CAP. By contrast, in children with rCAP, three had heart disease, four had oromotor incoordination or swallowing dysfunction, one had primary ciliary dyskinesia, and two had primary or acquired immunodeficiency.

However, the most important predisposing factors were rhinosinusitis, recurrent wheezing, and asthma, which occurred in 71.9%, 77.4%, and 31.5% of children with rCAP in DLA compared with 4.1%, 13.8%, and 5.5% of controls, respectively. And, these conditions appeared to be related to an increased frequency of mild or moderate respiratory infections, occurring in 67.8% versus 20.0% of patients and controls.

The team says that their findings should help discourage physicians from adopting an aggressive diagnostic approach that has been advocated for rCAP by previous authors. Many of these studies were carried out some time ago and in developing countries, they note.

“Our findings show that the diagnostic approach to children with rCAP in DLAs used in the developed world is relatively easy in most cases, and the severe underlying diseases favouring rCAP are usually identified early,” comment Esposito et al in BMC Pulmonary Medicine.

Regarding the increased prevalence of respiratory conditions among patients, they suggest that the concurrence of these factors likely amplified patients’ symptoms with “no particular clinical implication.”

“Consequently, such children only need to undergo the preventive and therapeutic measures usually prescribed for recurrent respiratory infections and wheezing,” the authors conclude.

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