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Worldwide, respiratory viral infections remain a major cause of death. Of these RSV, human metapneumovirus, adenovirus and influenza appear of most important ( 8, 9). It is now recognized that a large proportion of children acquiring a virus such as rhinovirus have no symptoms at all while ( 5– 9) at the other end of the severity spectrum infants with viral lower respiratory infections may require mechanical ventilation and even die. Respiratory viral infections are very common in the preschool years ( 1– 4). Through the Looking Glass Lewis Carroll 1871 Introduction “ When I use a word,” Humpty Dumpty said in a rather scornful tone, “ it means just what I choose it to mean–neither more nor less.” A proposed simplified approach to the nomenclature used to categorize virus associated LRTIs is presented based on an understanding of the underlying pathological processes and how these contribute to the physical signs. The difficulty is identifying which group a particular patient falls into. For those with a viral exacerbation of asthma, characterized by bronchoconstriction combined with impaired b-agonist responsiveness, standard management of an exacerbation of asthma (including the use of steroids to re-establish bronchodilator responsiveness) represents optimal treatment. These patients benefit from good supportive care including supplemental oxygen if required (though those with a pre-existing bacterial bronchitis will also benefit from antibiotics). The airways obstruction in the former group is predominantly caused by airways secretions and to some extent mucosal oedema (a “snotty lung”). In the former group, a neutrophil dominated inflammation response is responsible for the airways' obstruction whilst amongst asthmatics much of the obstruction is attributable to bronchoconstriction.

As was noted almost 60 years ago, amongst pre-school children with a viral LRTI and airways obstruction there are those with a “viral bronchitis” and those with asthma. The consequence is that terminology and fashions in treatment have tended to go around in circles. Moreover, there is a lack of insight into the fact that the same pathology can produce different clinical signs at different ages. This lack of clarity is due, in large part, to a failure to understand the basic underlying inflammatory and associated processes and, in part, due to the lack of a simple test to identify a condition such as asthma. Terms such as “bronchiolitis,” “reactive airways disease,” “viral wheeze,” and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. 2Division of Paediatrics and Child Health, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia.1Third Department of Paediatrics, Attikon Hospital, University of Athens School of Medicine, Athens, Greece.Lung sounds.Konstantinos Douros 1 Mark L. Physical signs in patients with chronic obstructive pulmonary disease. Inspiratory crackles - early and late - revisited: Identifying COPD by crackle characteristics. The relationship between crackle characteristics and airway morphology in COPD. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. We link primary sources - including studies, scientific references, and statistics - within each article and also list them in the resources section at the bottom of our articles. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.