Respiratory complications of Down syndrome

 Pneumonia/recurrent respiratory infection
  • Immune evaluation

  • Consider bronchoscopy to evaluate for anatomical abnormalities (e.g. tracheal bronchus)

  • Evaluate swallowing function for dysphagia

 Sleep-disordered breathingPolysomnogram if any evidence of snoring, adenoidal or tonsillar hypertrophy, poor sleep pattern, obesity or pulmonary hypertension
 LaryngomalaciaConsider flexible bronchoscopy to evaluate severity, even in clinically mild cases
If moderate to severe, consider polysomnogram to evaluate for obstructive sleep apnoea
Evaluate swallowing function
 TracheobronchomalaciaConsider in patient with noisy breathing, chronic cough, persistent or atypical wheezing
Refer for flexible bronchoscopy
 Tracheal bronchusConsider in patients with recurrent or persistent right upper lobe pneumonia
 Pulmonary hypertensionConsider in all patients with upper airway obstruction or unexplained hypoxia
Echocardiogram and cardiology consultation
 Subpleural cystsUsually incidental finding on chest contrast tomography
Can usually be managed with close observation
 Subglottic stenosisRefer for bronchoscopy
Less common
 Post-obstructive pulmonary oedemaAnticipate in patients who require upper airway surgery
 High-altitude pulmonary oedema
 Persistent pulmonary hypertension of the newborn
 Complete tracheal ringsDiagnosed by bronchoscopy
 Pulmonary haemorrhageConsider in patients with recurrent abnormal chest radiographs, unexplained hypoxia or anaemia
Refer for bronchoscopy
 Interstitial lung diseaseConsider in patients with unexplained hypoxia