Rethink Respiratory Rate for Diagnosing Childhood Pneumonia

By Israel Amirav and Moran Lavie

The Lancet, July 1, 2019

 

One in six childhood deaths is caused by pneumonia, making it the largest infectious cause of death for children worldwide [1], particularly in low and middle-income countries (LMIC) where timely pneumonia diagnosis is a much greater challenge because of limited resources [2]. The World Health Organization (WHO) defines pneumonia as the presence of fast breathing and/or chest indrawing in children who present with cough or cold and/or difficulty breathing. If diagnosed early, antibiotic therapy can be initiated to effectively treat pneumonia [3]. Fast breathing had long been considered a sensitive clinical sign of pneumonia in a child with cough or difficulty breathing [4], particularly in LMIC. The WHO has recommended that community health workers (CHWs) use the respiratory rate (RR) for diagnosis and that they treat pneumonia in children according to specific case-management algorithms [5]. There are numerous technologies for measuring RR by detecting changes in selected parameters, such as exhaled carbon dioxide, air temperature, humidity and chest wall movement [6, 7]. Each method has strengths and limitations, and most of them are not suitable for LMIC [8].

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Monday, 16 December 2019