This chapter covers various respiratory diseases in children, with particular focus on acute infections, perinatal lung disease and bronchopulmonary dysplasia, tuberculosis (TB) and congenital respiratory disorders, and immunisation against the common infections of childhood. Asthma (see chapter 12) and cystic fibrosis (see chapter 14) in children are covered elsewhere.
In cross-sectional surveys in 1987 and 2001 in the Netherlands, the most frequent reason for children consulting a general practitioner was respiratory morbidity, accounting for about 25% of all consultations by children (figure 1). About 10% of consultations are for asthma, with the other main respiratory diseases being bronchiolitis, acute bronchitis and respiratory infections. Furthermore, a recent US report showed that pneumonia, asthma and acute bronchitis are consistently the three leading diagnoses in children (excluding the newborn) admitted to hospital for any cause. Recent comparable European data are not available but it can be assumed that similar conclusions apply, at least to western European countries. It is also likely that the burden of respiratory disease is even higher in eastern European countries. The Dutch survey also demonstrates that the burden of respiratory morbidity in a western European country fluctuates with time: it depends, for example, on unpredicted epidemics such as Mexican influenza, changes in vaccination programmes, development of antibiotic resistance and variations in climate. It also implies that in children, the cost of first-line care for respiratory tract problems, together with skin conditions, represents about half of the total costs of first-line healthcare.