Airways chronic/persistent inflammation

Chronic bronchitis is a persistent inflammation of the bronchi because of excess mucous production that irritates the bronchial and results in a persistent productive cough. Smoking is a common cause of chronic bronchitis and is aggravated by air pollution, infection, and allergies. Patients with chronic bronchitis have rhonchi (a gurgling sound) on inspiration and expiration, caused by airway blockage from excess mucus. This excess results in hypercapnia (buildup of carbon dioxide in the blood) and hypoxemia (decreased oxygen in the blood). The patient experiences respiratory acidosis. 

Glucocorticoids are widely used to treat a variety of inflammatory and immune diseases. With the recognition that airway inflammation is present even in patients with mild asthma, treatment with glucocorticoids is now the mainstay of asthma therapy. Consequently, by far the most common use of glucocorticoids today is in the treatment of asthma and inhaled glucocorticoids have now become established as first-line treatment in adults and children with persistent asthma, the commonest chronic airway inflammatory disease. 

Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000 343 269-280. Vignola AM, Chanez P, Campbell AM, Souques F, Lebel B, Enander I, Bousquet J. Airway inflammation in mild intermittent and in persistent asthma. Am J Respir Crit Care Med 1998 157 403-409. 

Most children are managed with NPPV (1,50). However, some require invasive ventilation through a tracheostomy. The main indications for a tracheostomy in children are airway abnormalities such as tracheobronchomalacia or tracheal stenosis, chronic disease of prematurity, and NMD (1,51,52). The indications for a tracheostomy are comparable to those of the adult population. They include the persistence of hypercapnia despite NPPV and additional measures such as daytime mouthpiece ventilation, aspiration, and bulbar dysfunction (53). In children, NPPV is more difficult to perform in those who might be 24-hour dependent, than in adults. Infants with primaiy alveolar hypoventilation (Ondine s curse) are preferentially ventilated by means of a tracheostomy (18). Tracheostomy ventilation favors airway inflammation (54) and may affect speech and language development (55). In children with progressive NMD, the decision of a tracheostomy has to be discussed on an individual basis, taking into account the familial environment and the parent s and child s perspective (52,56). In any case, sending children home with invasive ventilation is more difficult than when noninvasive ventilation is used (52). 

---