‘Recurrent lower respiratory tract infections’ – going around in circles, respiratory medicine style

SummaryRecurrent lower respiratory tract infections are very common in childhood, particularly the pre-school years. The term lower respiratory tract infection [LTRI] is, as with many terms used in respiratory medicine, used very loosely and carries little more information than the often decried term ‘chest infections’. LRTIs should more accurately be characterised by
• the type of infection [viral or bacterial]
• the site of infection [conducting airways, or respiratory compartment or both - bronchitis/pneumonia/bronchopneumonia]
• the nature of the episode [acute or acute on chronic (exacerbation)]
• the interaction with co-morbidities such as asthmaThe limited nature of the responses of the lower airways to any insult whether it is infective or irritation due to inhaled or aspirated chemicals means that almost any aetiology can lead to cough, shortness of breath and noisy breathing. We lack good non-invasive techniques to study the nature of the inflammation in the lower airways and hence the cause of chronic and recurrent symptoms in patients is frequently mis-diagnosed.