Abstract

Background: The clinical presentation of lower respiratory tract illness in children frequently resembles more than one disease entities of those described in textbooks. Not uncommonly, terms like “bronchiolitis”, “bronchitis”, “asthma exacerbation”, “bronchopneumonia” and “pneumonia” are used interchangeably.

Methods: In this article, a didactic simplified algorithm for the management of the child from the community presenting with cough and fever is described after systematic review of the literature.

Results: In step 1 of the algorithm, findings from the physical examination are used to localize the diseased anatomic part(s) of the lower respiratory tract i.e. trachea, bronchi, bronchioles or alveoli. In step 2, speculations are made regarding the infectious agent most likely affecting the lower respiratory tract based on the patient's symptoms and past medical history and the known epidemiology of respiratory disorders. In step 3, the appropriate treatment plan is selected taking under consideration the affected anatomic part(s) and the speculated pathogen. Finally, in step 4, clinical response is evaluated and the diagnostic assumptions and treatment strategy are modified accordingly.

Conclusion: When findings from the physical examination are matched with information from the current and past medical history and the known epidemiology of respiratory disorders, speculations regarding the most likely etiologic agents can be made and appropriate treatment interventions can be selected.

Keywords: Bronchiolitis, bronchitis, bronchopneumonia, bronchospasm, chest auscultation, chest percussion, lower respiratory tract infection.

Graphical Abstract