The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
The Global Health Unit, Department of Paediatrics and Adolescent Medicine, Danish National Hospital "Rigshospitalet", Copenhagen, Denmark.
NPJ Prim Care Respir Med. 2018 Apr 10;28(1):13. doi: 10.1038/s41533-018-0081-y.
Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers' U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children's recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication.
5 岁以下儿童（U5）下呼吸道疾病（LRT-疾病）是全球发病率、住院率和死亡率的主要原因，尤其是在低收入国家。了解可能存在的不一致管理方法是很重要的。本研究探讨了 U5 反复出现 LRT 疾病的照顾者和卫生专业人员的看法和做法。在吉尔吉斯斯坦的两个农村省份，对 13 名患有反复 LRT 疾病的 U5 照顾者和 22 名初级保健卫生专业人员进行了半结构化访谈，并进行了三角分析。对数据进行了主题分析。大多数（8/13）照顾者描述他们的幼儿反复咳嗽、呼吸嘈杂和呼吸困难，其中一些对急性沙丁胺醇反应良好，或因 LRT 疾病多次住院。家庭压力和经济负担是巨大的。卫生专业人员将反复出现 LRT 疾病的幼儿主要诊断为肺炎和/或多种支气管炎。广谱抗生素和支持性药物被反复使用，由卫生专业人员开具处方或由照顾者在药房未经处方购买。卫生专业人员从未将哮喘诊断应用于 U5，也没有开具吸入性类固醇，也没有接受采访的照顾者的 U5 被诊断为哮喘。卫生专业人员和照顾者对儿童反复发生的呼吸道疾病发展为严重慢性肺部疾病（包括哮喘）有共同的关注。总之，该研究发现，对 U5 反复出现的 LRT 疾病的管理不一致，抗生素的使用过高，哮喘/喘息的诊断明显不足。当不使用哮喘诊断时，这种疾病就不会被认为是一种长期疾病，需要预防/控制药物。
