P ND X RESP DIFFY

Box 1 

Why do children with neurodisability (ND) have respiratory difficulties?

• Children with cerebral palsy have a variable amount of respiratory muscle weakness leading to ineffective cough and poor clearance of secretions.
• Varying degrees of kyphoscoliosis can cause a restrictive respiratory defect with diminished respiratory reserve and poor ventilation.
• Upper airway muscle dysfunction can cause obstructed breathing during sleep. There may also be problems with central respiratory control.
• Aspiration from gastro-oesophageal reflux is a common comorbidity especially in those children with more severe ND.3
• Poor salivary control and swallowing dysfunction with pooling of secretions may expose the lungs to aspiration of food especially liquids and oropharyngeal secretions (aspiration over the top). This can be intermittent and often occurs without overt symptoms like cough when it is referred to as ‘silent’.4 ,5
• Children with ND may have been born prematurely and have chronic lung disease of prematurity. There is a higher incidence of reactive airways and relatively poor lung function throughout the lifetime.
• Limited mobility and a poor nutritional state predispose to respiratory infections.
• Build-up of secretions predisposes to bacterial colonisation with organisms like Pseudomonas and Streptococcus mitis.1
• The vicious cycle of infection, impaired mucociliary clearance and chronic inflammation can lead to an increased risk of structural damage in the form of bronchiectasis.
• Quite often, more than one of these factors is operational in the same child in addition to other comorbidities.