The prevalence of wheeze in children with clinical presentation of severe/very severe pneumonia and response to bronchodilator therapy at Kenyatta National Hospital, Nairobi.

Abstract

Background: Wheeze is a common presentation of respiratory disease in children. In developing countries, there is a high morbidity and mortality associated with bacterial pneumonia in young children and empiric antibiotic treatment is recommended. However in the presence of wheeze and signs of pneumonia, possibility of a reversible airways disease should be considered. The objectives of this study were to determine the prevalence of wheeze in children less than five years with a clinical presentation suggestive of severe/very severe pneumonia, to determine the proportion of the children with wheeze who improved following bronchodilator therapy and the factors associated with positive response to bronchodilator therapy. Method: This cross-sectional study was carried out at the Paediatric Emergency Unit, KNH, from June to September 2009. A total of 459 children met the eligibility criteria and were enrolled into the study. 169 of them had wheeze and were commenced on inhaled salbutamol. GoK guidelines were adhered to during the study. Results: The prevalence of wheeze in children with signs of severe/very severe pneumonia was found to be 36.8%. The median age of children with wheeze was 11.4 months (IQR 6.6-23.7 months), with a male to female ratio of 1.1:1 .The proportion of children with wheeze who responded to inhaled salbutamol was 43.8%. Absence of fever ,OR 0.41 [(95%CI 0.18-0.98), p=0.04] was the only factor that was independently associated with a positive response to inhaled bronchodilators in these children. Conclusion: A third of the children with features suggestive of severe/very severe pneumonia had wheeze/rhonchi. Two out of every 5 children with wheeze responded to immediate use of inhaled salbutamol at the Paediatric Emergency Unit, leading to a 16% reduction of the overall number of potential pneumonia admissions. Recommendation: Bronchodilator challenge is recommended for children with wheeze and signs of severe/very severe pneumonia