TABLE 1

Respiratory complications of Down syndrome

Common
Pneumonia/recurrent respiratory infection	Immune evaluation Consider bronchoscopy to evaluate for anatomical abnormalities (e.g. tracheal bronchus) Evaluate swallowing function for dysphagia
Sleep-disordered breathing	Polysomnogram if any evidence of snoring, adenoidal or tonsillar hypertrophy, poor sleep pattern, obesity or pulmonary hypertension
Laryngomalacia	Consider 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
Tracheobronchomalacia	Consider in patient with noisy breathing, chronic cough, persistent or atypical wheezing Refer for flexible bronchoscopy
Tracheal bronchus	Consider in patients with recurrent or persistent right upper lobe pneumonia
Pulmonary hypertension	Consider in all patients with upper airway obstruction or unexplained hypoxia Echocardiogram and cardiology consultation
Subpleural cysts	Usually incidental finding on chest contrast tomography Can usually be managed with close observation
Subglottic stenosis	Refer for bronchoscopy
Less common
Post-obstructive pulmonary oedema	Anticipate in patients who require upper airway surgery
High-altitude pulmonary oedema
Persistent pulmonary hypertension of the newborn
Complete tracheal rings	Diagnosed by bronchoscopy
Pulmonary haemorrhage	Consider in patients with recurrent abnormal chest radiographs, unexplained hypoxia or anaemia Refer for bronchoscopy
Interstitial lung disease	Consider in patients with unexplained hypoxia