Understanding and managing respiratory infections in children and young adults with neurological impairment

ABSTRACT

Introduction

Patients with neurocognitive impairment (NI) have multiple medical needs, with respiratory problems leading to an important reduction in quality of life and life expectancy. We aimed to explain that the origin of chronic respiratory symptoms in patients with NI is multifactorial.

Areas covered

In people with NI there is a high prevalence of swallowing dysfunction and hypersalivation inducing aspiration; cough efficacy is decreased resulting in chronic lung infection; sleep-disordered breathing is frequent and muscle mass is abnormal due to malnutrition. Technical investigations are not always specific and sensitive enough to better diagnose the causes of the respiratory symptoms; moreover, they can sometimes be difficult to perform in this vulnerable patient population. We provide a clinical pathway to adopt to identify, prevent, and treat respiratory complications in children and young adults with NI. A holistic approach in discussion with all care providers and the parents is highly recommended.

Expert opinion

The care for people with NI and chronic respiratory problems is challenging. The interplay between several causative factors may be difficult to entangle. Well-performed clinical research in this field is largely missing and should be encouraged. Only then, evidence-based clinical care will become possible for this vulnerable patient group.

KEYWORDS:

• Neurocognitive impairment
• child
• chronic infection
• sleep disordered breathing
• cerebral palsy

Article highlights

• There is an interplay between several causative factors leading to chronic respiratory problems in children and young adults with neurological impairment

• Clinical evaluation is still the basis of good clinical care, but technical investigations may help in decision making

• Therapeutic options are available, however often with limited evidence on their effectiveness.

• More research in this field is needed

• Patient care should involve a multidisciplinary team

• Advanced care management should be discussed early in the disease course

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.