Take a deep Breath

asthmaRespiratory diseases can greatly impair a child’s ability to function normally and are an important cause of missed school days and limitations to activities and normal child’s play. And unfortunately, respiratory disease is on the rise – HEALTH speaks to Dr. Jenny John Cheriathu, Specialist in Pediatrics who sheds light on this problem.

Different Types

According to Dr. Cheriathu, the most common respiratory disorders noted in younger children aged years 5 to 10 include: upper respiratory infections such as tonsillitis, pharyngitis, rhinitis, and sinusitis. Others include otitis media with or without effusion, laryngotracheo bronchitis, tuberculosis, pneumonia, bronchiectasis, changes in lung function as well as asthma or bronchospasm allergies.

Possible Causes

According to the World Health Report, the biggest contributors to poor health in the world’s children include being underweight, poor sanitation and hygiene, and indoor pollution, indicates Dr. Cheriathu. “Young children spend most of their time indoors where levels of air pollution can be much higher than levels outdoors,” he says. “Also tobacco smoke is linked to acute otitis media.” Outdoor exposure to ozone is linked to bronchospasm and asthma attacks in some children. “Even exposure to indoor molds is associated with acute pulmonary hemorrhage among infants,” he explains and also high exposure to particulate and secondhand smoke is associated with sudden infant death syndrome (SIDS).

Children’s Susceptibility

Children, tells Dr. Cheriathu, may be more vulnerable to the effects of air pollution than adults. “Children’s lung development proceeds through proliferation of pulmonary alveoli and capillaries until age two, following which alveolar expansion occurs until ages five to eight,” he says. “The lungs do not complete their growth until full adult stature is achieved in adolescence.”

Also Dr. Cheriathu explains that young children have a higher resting metabolic rate and rate of oxygen consumption per unit body weight than adults because they have a larger surface per unit body weight and because they are growing rapidly. “In addition, children have narrower airways than those of adults,” he tells, therefore
irritation caused by air pollution that would produce only a slight response in an adult can result in potentially significant obstruction in the airways of a young child. Also children have shorter stature, so they breathe closer to the ground.

Risk Factors

Upper respiratory infections are the most frequently occurring illness in childhood, points out Dr. Cheriathu. “Environmental factors that increase the likelihood of acquiring colds include attendance at child care facilities, smoking, passive exposure to tobacco smoke, low income, and crowding,” he notes. “Since upper respiratory
infections are transmitted by contaminated hands or by sneezing, frequent hand washing after contact with an infected person reduces the risk of secondary infection.”

Specific Problems

Middle ear infections These, says Dr. Cheriathu, are greatly increased by exposure to passive tobacco exposure. “In addition, there is synergy between viral infections and particulate exposures such as tobacco smoke which contains large amounts of particulate matter,” says Dr. Cheriathu.


Passive or active exposure to tobacco smoke is significantly associated with tuberculous infection and tuberculosis disease, indicates Dr. Cheriathu. “These effects appear to be independent of the effects of alcohol use, socioeconomic status and a large number of other potential confounders,” he details.


This is a leading cause of illness and death worldwide in children. According to Dr. Cheriathu, a synergy has been established between bacterial and viral pneumonia and air pollution. “Zinc helps in preventing pneumonia and accelerating recovery from severe pneumonia,” he explains.


Asthma is a major public health problem for children. Dr. Cheriathu points out that rates have risen in many industrialized nations in the past 20 years, and some clinicians in less industrialized countries are beginning to diagnose more cases of wheezing than previously. “Asthma is the most common chronic disease in childhood,” he says.

Reasons Asthma is On the Rise

Some reasons asthma is increasing, says Dr. Cheriathu include dietary changes, increased use of antibiotics, more use of processed foods which means an alteration in bowel flora with more Clostridial bacteria, less lactobacillus.

Major Indoor Causes of Asthma

  1. Allergens: dust mites
  2. Animal allergens: cockroaches or molds
  3. Irritants: tobacco smoke, perfumes, cleaning agents, and/or nitrogen oxides

Interventions and Prevention at the Population-level

  1. Smoke-free policies including protect children from second-hand smoke, create non-smoking social norm, and reduce tobacco consumption.
  2. Air Quality Standards: WHO has generated air quality standards for the major “criteria” airpollutants. Reductions to these levels offer significant health benefits.
  3. Mass transportation initiatives
  4. Indoor Air Regulations for public buildings
  5. Smoke-free schools/ workplaces

Prevention At the Individual-level

  1. Zinc supplements accelerate recovery from severe pneumonia.
  2. Vitamins C and E may blunt the effects of ozone on lung function but do not seem to prevent symptoms.
  3. Yearly influenza vaccination among school going and day-care attending children.


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