Studies of Pneumonia in Childhood: V. Empyema

McNeil, Christopher J.; MacGregor, A; Wa, Alexander

doi:10.1136/adc.4.23.270

Cited by 5 publications

(4 citation statements)

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“…Mortality in those with empyema was reported at 40.5%. Most deaths in this era were in the very young and those in later life (3,24). In another study, considering the impact of weather on deaths under 5 years of age, it was noted that death rates due to 'bronchitis' were significantly higher than those due to pneumonia (25).…”

Section: Germ Theory Pneumonia and Outcomesmentioning

confidence: 97%

“…It is of note that studies from the early 20th century, which is in the pre-antibiotic period, reported that 'bronchopneumonia' was significantly more common than alveolar pneumonia and had a significantly greater mortality. In a large paediatric study, the mortality from bronchopneumonia was 54% vs. 7% in those with an 'alveolar' pneumonia (24). The term alveolar pneumonia was used rather than lobar pneumonia as it frequently did not (and still does not) affect the whole lobe.…”

Section: Germ Theory Pneumonia and Outcomesmentioning

confidence: 99%

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Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology

Everard,

Priftis,

Koumbourlis

et al. 2024

Front. Pediatr.

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In contrast to significant declines in deaths due to lung cancer and cardiac disease in Westernised countries, the mortality due to ‘chronic obstructive pulmonary disease’ (COPD) has minimally changed in recent decades while ‘the incidence of bronchiectasis’ is on the rise. The current focus on producing guidelines for these two airway ‘diseases’ has hindered progress in both treatment and prevention. The elephant in the room is that neither COPD nor bronchiectasis is a disease but rather a consequence of progressive untreated airway inflammation. To make this case, it is important to review the evolution of our understanding of airway disease and how a pathological appearance (bronchiectasis) and an arbitrary physiological marker of impaired airways (COPD) came to be labelled as ‘diseases’. Valuable insights into the natural history of airway disease can be obtained from the pre-antibiotic era. The dramatic impacts of antibiotics on the prevalence of significant airway disease, especially in childhood and early adult life, have largely been forgotten and will be revisited as will the misinterpretation of trials undertaken in those with chronic (bacterial) bronchitis. In the past decades, paediatricians have observed a progressive increase in what is termed ‘persistent bacterial bronchitis’ (PBB). This condition shares all the same characteristics as ‘chronic bronchitis’, which is prevalent in young children during the pre-antibiotic era. Additionally, the radiological appearance of bronchiectasis is once again becoming more common in children and, more recently, in adults. Adult physicians remain sceptical about the existence of PBB; however, in one study aimed at assessing the efficacy of antibiotics in adults with persistent symptoms, researchers discovered that the majority of patients exhibiting symptoms of PBB were already on long-term macrolides. In recent decades, there has been a growing recognition of the importance of the respiratory microbiome and an understanding of the ability of bacteria to persist in potentially hostile environments through strategies such as biofilms, intracellular communities, and persister bacteria. This is a challenging field that will likely require new approaches to diagnosis and treatment; however, it needs to be embraced if real progress is to be made.

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Section: Germ Theory Pneumonia and Outcomesmentioning

confidence: 97%

Section: Germ Theory Pneumonia and Outcomesmentioning

confidence: 99%

Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology

Everard,

Priftis,

Koumbourlis

et al. 2024

Front. Pediatr.

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show abstract

“…The present series comprises all the cases of acute pneumonia admitted to the three medical wards of the Royal Edinburgh Hospital for Sick Children from April, 1947, to March, 1949, inclusive Macgregor and Alexander (1929) that in bronchopneumonia ' as a rule there is a generalized acute bronchitis affecting bronchi of all sizes throughout both lungs', whereas ' in typical alveolar pneumonia the bronchial walls and the whole framework of the lungs are remarkably free from inflammatory infiltration'. No criterion will meet all possible objections, but this one appears to be, apart from post-mortem examination, the least objectionable.…”

mentioning

confidence: 99%

“…Since the distinction must be attempted, however, in order to compare the different series, the principle has been adopted in dealing with the present material of regarding those cases ofpneumonia which showed signs of a concomitant generalized bronchitis as being instances of bronchopneumonia, and those without such signs as cases of lobar pneumonia. This method of differentiation is based on the observation of McNeil, Macgregor and Alexander (1929) that in bronchopneumonia ' as a rule there is a generalized acute bronchitis affecting bronchi of all sizes throughout both lungs', whereas ' in typical alveolar pneumonia the bronchial walls and the whole framework of the lungs are remarkably free from inflammatory infiltration'. No criterion will meet all possible objections, but this one appears to be, apart from post-mortem examination, the least objectionable.…”

mentioning

confidence: 99%