{{short description|Medical term}} {{cs1 config|name-list-style=vanc}} {{Infobox medical condition |name = Lower respiratory tract infection |image = Depiction of a person with a lung or lower respiratory tract infection.png |caption = Depiction of a person with LRTI |symptoms = |onset = |duration = |causes = |risks = |diagnosis = |differential = |prevention = |treatment = |medication = |frequency = 291 million (2015)<ref name="pmid27733282">{{cite journal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | display-authors = 1 | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L }}</ref> |deaths = 2.74 million (2015)<ref name=pmid27733281>{{cite journal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 | display-authors = 1 | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR }}</ref> }}
'''Lower respiratory tract infection''' ('''LRTI''') is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue.<ref name="TGAntibiotic133">{{Cite book | author=Antibiotic Expert Group | title=Therapeutic Guidelines: Antibiotic | edition=15th | date=2014 | publisher=Therapeutic Guidelines Limited | isbn=978-0-9925272-1-1}}</ref> A routine chest X-ray is not always necessary for people who have symptoms of a lower respiratory tract infection.<ref>{{Cite journal|last1=Cao|first1=Amy Millicent Y.|last2=Choy|first2=Joleen P.|last3=Mohanakrishnan|first3=Lakshmi Narayana|last4=Bain|first4=Roger F.|last5=van Driel|first5=Mieke L.|date=2013-12-26|title=Chest radiographs for acute lower respiratory tract infections|journal= Cochrane Database of Systematic Reviews|volume=2013 |issue=12|article-number=CD009119|doi=10.1002/14651858.CD009119.pub2|issn=1469-493X|pmc=6464822|pmid=24369343}}</ref>
<!-- Cause and diagnosis --> Influenza affects both the upper and lower respiratory tracts.{{Citation needed|date=October 2019}}
<!-- Prevention and treatment --> Antibiotics are the first line treatment for pneumonia; however, they are neither effective nor indicated for parasitic or viral infections. Acute bronchitis typically resolves on its own with time.{{cn|date=June 2022}}
<!-- Epidemiology --> In 2015 there were about 291 million cases.<ref name=pmid27733282/> These resulted in 2.74 million deaths down from 3.4 million deaths in 1990.<ref name=pmid25530442/><ref name=pmid27733281/> This was 4.8% of all deaths in 2013.<ref name=pmid25530442>{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–71 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 | url = http://discovery.ucl.ac.uk/1462383/1/Abubakar_Global_regional_and_national_age-sex_specific.pdf| hdl = 10379/13075 }}</ref>
The World Health Organization has reported that, in 2021, "Lower respiratory infections remained the world's most deadly communicable disease other than COVID-19, ranked as the fifth leading cause of death." However, the number of deaths caused has decreased by around 13% from 2000 to 2021.<ref>{{Cite web |title=The top 10 causes of death |url=https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death |access-date=2024-08-12 |website=www.who.int |language=en}}</ref>
== Bronchitis ==
{{main|Bronchitis}} Bronchitis describes the swelling or inflammation of the<ref name=pmid26333656>{{cite journal | vauthors = Becker LA, Hom J, Villasis-Keever M, van der Wouden JC | title = Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis | journal = The Cochrane Database of Systematic Reviews | issue = 9 | article-number = CD001726 | date = September 2015 | volume = 2015 | pmid = 26333656 | doi = 10.1002/14651858.CD001726.pub5 | pmc = 7078572 }}</ref> bronchial tubes. Additionally, bronchitis is described as either acute or chronic depending on its presentation and is also further described by the causative agent. Acute bronchitis can be defined as acute bacterial or viral infection of the larger airways in healthy patients with no history of recurrent disease.<ref name="TGAntibiotic13">Antibiotic Expert Group. Therapeutic guidelines: Antibiotic. 13th ed. North Melbourne: Therapeutic Guidelines; 2006.</ref> It affects over 40 adults per 1000 each year and consists of transient inflammation of the major bronchi and trachea.<ref name=pmid26186368>{{cite journal | vauthors = Wark P | title = Bronchitis (acute) | journal = BMJ Clinical Evidence | volume = 2015 | date = July 2015 | pmid = 26186368 | pmc = 4505629 }}</ref> Most often it is caused by viral infection and hence antibiotic therapy is not indicated in immunocompetent individuals.<ref name="oldRef7">Therapeutic guidelines : respiratory. 2nd ed: North Melbourne : Therapeutic Guidelines Limited, 2000.{{page needed|date=August 2018}}</ref><ref name=pmid26333656/> Viral bronchitis can sometimes be treated using antiviral medications depending on the virus causing the infection, and medications such as anti-inflammatory drugs and expectorants can help mitigate the symptoms.<ref name="oldRef10"/><ref name=pmid26333656/> Treatment of acute bronchitis with antibiotics is common but controversial as their use has only moderate benefit weighted against potential side effects (nausea and vomiting), increased resistance, and cost of treatment in a self-limiting condition.<ref name=pmid26186368/><ref>{{cite journal |last1=Smith |first1=SM |last2=Fahey |first2=T |last3=Smucny |first3=J |last4=Becker |first4=LA |title=Antibiotics for acute bronchitis. |journal=The Cochrane Database of Systematic Reviews |date=19 June 2017 |volume=2017 |issue=6 |article-number=CD000245 |doi=10.1002/14651858.CD000245.pub4 |pmid=28626858 |pmc=6481481 }}</ref> Beta2 agonists are sometimes used to relieve the cough associated with acute bronchitis. In a recent systematic review it was found there was no evidence to support their use.<ref name=pmid26333656/>
Acute exacerbations of chronic bronchitis (AECB) are frequently due to non-infective causes along with viral ones. 50% of patients are colonised with ''Haemophilus influenzae'', ''Streptococcus pneumoniae'', or ''Moraxella catarrhalis''.<ref name="TGAntibiotic13"/> Antibiotics have only been shown to be effective if all three of the following symptoms are present: increased dyspnea, increased sputum volume, and purulence. In these cases, 500 mg of amoxicillin orally, every 8 hours for 5 days or 100 mg doxycycline orally for 5 days should be used.<ref name="TGAntibiotic13"/>
== Pneumonia ==
{{main|Pneumonia}} Pneumonia occurs in a variety of situations and treatment must vary according to the situation.<ref name="oldRef10">Integrated pharmacology / Clive Page ... [et al.]. 2nd ed: Edinburgh : Mosby, 2002.{{page needed|date=August 2018}}</ref> It is classified as either community or hospital acquired depending on where the patient contracted the infection. It is life-threatening in the elderly or those who are immunocompromised.<ref name=pmid25300166>{{cite journal | vauthors = Pakhale S, Mulpuru S, Verheij TJ, Kochen MM, Rohde GG, Bjerre LM | title = Antibiotics for community-acquired pneumonia in adult outpatients | journal = The Cochrane Database of Systematic Reviews | issue = 10 | article-number = CD002109 | date = October 2014 | volume = 2014 | pmid = 25300166 | doi = 10.1002/14651858.CD002109.pub4 | pmc = 7078574 }}</ref><ref name=pmid23440780/> The most common treatment is antibiotics and these vary in their adverse effects and their effectiveness.<ref name=pmid25300166/><ref name=pmid23733365>{{cite journal | vauthors = Lodha R, Kabra SK, Pandey RM | title = Antibiotics for community-acquired pneumonia in children | journal = The Cochrane Database of Systematic Reviews | issue = 6 | article-number = CD004874 | date = June 2013 | volume = 2013 | pmid = 23733365 | doi = 10.1002/14651858.CD004874.pub4 | pmc = 7017636 }}</ref> Pneumonia is also the leading cause of death in children less than five years of age in low income countries.<ref name=pmid23733365/> The most common cause of pneumonia is pneumococcal bacteria, ''Streptococcus pneumoniae'' accounts for 2/3 of bacteremic pneumonias.<ref name="oldRef15">The Merck manual of diagnosis and therapy. 17th ed / Mark H. Beers and Robert Berkow ed: Whitehouse Station, N.J. : Merck Research Laboratories, 1999.{{page needed|date=August 2018}}</ref> Invasive pneumococcal pneumonia has a mortality rate of around 20%.<ref name=pmid23440780>{{cite journal | vauthors = Moberley S, Holden J, Tatham DP, Andrews RM | title = Vaccines for preventing pneumococcal infection in adults | journal = The Cochrane Database of Systematic Reviews | issue = 1 | article-number = CD000422 | date = January 2013 | volume = 2013 | pmid = 23440780 | doi = 10.1002/14651858.CD000422.pub3 | pmc = 7045867 }}</ref> For optimal management of a pneumonia patient, the following must be assessed: pneumonia severity (including treatment location, e.g., home, hospital or intensive care), identification of causative organism, analgesia of chest pain, the need for supplemental oxygen, physiotherapy, hydration, bronchodilators and possible complications of emphysema or lung abscess.<ref>{{cite journal |doi=10.18410/jebmh/2017/33 |title=Diagnosis of Sputum Culture Positive Organisms and Their Antimicrobial Sensitivity Profile in a Tertiary Care Centre- Kanyakumari |journal=Journal of Evidence Based Medicine and Healthcare |volume=4 |issue=4 |pages=168–171 |year=2017 |last1=Kumar Pius |first1=Prince Sree |last2=Alexis |first2=Anitha |last3=P |first3=Suresh Kumar |last4=Ganesan |first4=Manivel |doi-access=free }}</ref>
==Causes== thumb|upright=1.3|Deaths from lower respiratory infections per million persons in 2012: {{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|24-120}}{{legend|#ffe820|121-151}}{{legend|#ffd820|152-200}}{{legend|#ffc020|201-241}}{{legend|#ffa020|242-345}}{{legend|#ff9a20|346-436}}{{legend|#f08015|437-673}}{{legend|#e06815|674-864}}{{legend|#d85010|865-1,209}}{{legend|#d02010|1,210-2,085}}{{div col end}} [[File:Lower respiratory infections world map - DALY - WHO2004.svg|thumb|upright=1.3|Disability-adjusted life year for lower respiratory infections per 100,000 inhabitants in 2004:<ref>{{cite web|url=https://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls |title=Mortality and Burden of Disease Estimates for WHO Member States in 2002|format=xls |work=World Health Organization|year=2002 }}</ref>{{Div col|small=yes|colwidth=10em}} {{legend|#b3b3b3|no data}} {{legend|#ffff65|less than 100}} {{legend|#fff200|100–700}} {{legend|#ffdc00|700–1,400}} {{legend|#ffc600|1,400–2,100}} {{legend|#ffb000|2,100–2,800}} {{legend|#ff9a00|2,800–3,500}} {{legend|#ff8400|3,500–4,200}} {{legend|#ff6e00|4,200–4,900}} {{legend|#ff5800|4,900–5,600}} {{legend|#ff4200|5,600–6,300}} {{legend|#ff2c00|6,300–7,000}} {{legend|#cb0000|more than 7,000}} {{div col end}}]]
Typical bacterial Infections: * ''Haemophilus influenzae'' * ''Staphylococcus aureus'' * ''Klebsiella pneumoniae''
Atypical bacterial Infections: * ''Legionella pneumophila'' * ''Mycoplasma pneumoniae'' * ''Chlamydophila pneumoniae'' * ''Chlamydia psittaci''
Parasitic infections: * Respiratory cryptosporidiosis
Viral infections: * Adenovirus * Influenza A virus * Influenza B virus * Human parainfluenza viruses * Human respiratory syncytial virus * Severe acute respiratory syndrome coronavirus (SARS-CoV) * Middle East respiratory syndrome coronavirus (MERS-CoV) * Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Aspiration pneumonia
==Prevention==
Vaccination helps prevent bronchopneumonia, mostly against influenza viruses, adenoviruses, measles, rubella, streptococcus pneumoniae, haemophilus influenzae, diphtheria, bacillus anthracis, chickenpox, and bordetella pertussis.<ref name=pmid21951385>{{cite journal | vauthors = Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJ | title = Guidelines for the management of adult lower respiratory tract infections--full version | journal = Clinical Microbiology and Infection | volume = 17 | pages = E1–59 | date = November 2011 | issue = Suppl 6 | pmid = 21951385 | doi = 10.1111/j.1469-0691.2011.03672.x | pmc = 7128977 | doi-access = free }}</ref> Specifically for the children with low serum retinol or who are suffering from malnutrition, vitamin A supplements are recommended as a preventive measure against acute LRTI.<ref>{{cite journal |last1=Chen |first1=Hengxi |last2=Zhuo |first2=Qi |last3=Yuan |first3=Wei |last4=Wang |first4=Juan |last5=Wu |first5=Taixiang |title=Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age |journal=Cochrane Database of Systematic Reviews |issue=1 |article-number=CD006090 |date=23 January 2008 |doi=10.1002/14651858.CD006090.pub2 |pmid=18254093|pmc=11842301 }}</ref> ==Treatment== Antibiotics do not help the many lower respiratory infections which are caused by parasites or viruses. While acute bronchitis often does not require antibiotic therapy, antibiotics can be given to patients with acute exacerbations of chronic bronchitis.<ref name=pmid11751764>{{cite journal | vauthors = Ball P, Baquero F, Cars O, File T, Garau J, Klugman K, Low DE, Rubinstein E, Wise R | title = Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence | journal = The Journal of Antimicrobial Chemotherapy | volume = 49 | issue = 1 | pages = 31–40 | date = January 2002 | pmid = 11751764 | doi = 10.1093/jac/49.1.31 | author10 = Consensus Group on Resistance Prescribing in Respiratory Tract Infection | doi-access = }}</ref> The indications for treatment are increased dyspnoea, and an increase in the volume or purulence of the sputum.<ref name=pmid16319346>{{cite journal | vauthors = Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Leven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Verheij TJ | title = Guidelines for the management of adult lower respiratory tract infections | journal = The European Respiratory Journal | volume = 26 | issue = 6 | pages = 1138–80 | date = December 2005 | pmid = 16319346 | doi = 10.1183/09031936.05.00055705 | doi-access = free }}</ref> The treatment of bacterial pneumonia is selected by considering the age of the patient, the severity of the illness and the presence of underlying disease. A systematic review of 32 randomised controlled trials with 6,078 participants with acute respiratory infections compared procalcitonin (a blood marker for bacterial infections) to guide the initiation and duration of antibiotic treatment, against no use of procalcitonin. Among 3,336 people receiving procalcitonin-guided antibiotic therapy, there were 236 deaths, compared to 336 deaths out 3,372 participants who did not. Procalcitonin-guided antibiotic therapy also reduced the antibiotic use duration by 2.4 days, and there were fewer antibiotic side effects. This means that procalcitonin is useful for guiding whether to use antibiotics for acute respiratory infections and the duration of the antibiotic.<ref>{{cite journal |last1=Schuetz |first1=Philipp |last2=Wirz |first2=Yannick |last3=Sager |first3=Ramon |last4=Christ-Crain |first4=Mirjam |last5=Stolz |first5=Daiana |last6=Tamm |first6=Michael |last7=Bouadma |first7=Lila |last8=Luyt |first8=Charles E |last9=Wolff |first9=Michel |last10=Chastre |first10=Jean |last11=Tubach |first11=Florence |last12=Kristoffersen |first12=Kristina B |last13=Burkhardt |first13=Olaf |last14=Welte |first14=Tobias |last15=Schroeder |first15=Stefan |last16=Nobre |first16=Vandack |last17=Wei |first17=Long |last18=Bucher |first18=Heiner C C |last19=Bhatnagar |first19=Neera |last20=Annane |first20=Djillali |last21=Reinhart |first21=Konrad |last22=Branche |first22=Angela |last23=Damas |first23=Pierre |last24=Nijsten |first24=Maarten |last25=de Lange |first25=Dylan W |last26=Deliberato |first26=Rodrigo O |last27=Lima |first27=Stella SS |last28=Maravić-Stojković |first28=Vera |last29=Verduri |first29=Alessia |last30=Cao |first30=Bin |last31=Shehabi |first31=Yahya |last32=Beishuizen |first32=Albertus |last33=Jensen |first33=Jens-Ulrik S |last34=Corti |first34=Caspar |last35=Van Oers |first35=Jos A |last36=Falsey |first36=Ann R |last37=de Jong |first37=Evelien |last38=Oliveira |first38=Carolina F |last39=Beghe |first39=Bianca |last40=Briel |first40=Matthias |last41=Mueller |first41=Beat |title=Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections |journal=Cochrane Database of Systematic Reviews |volume=10 |article-number=CD007498 |date=12 October 2017 |issue=5 |doi=10.1002/14651858.CD007498.pub3 |pmid=29025194 |pmc=6485408 }}</ref> Amoxicillin and doxycycline are suitable for many of the lower respiratory tract infections seen in general practice.<ref name=pmid11751764/> Another cochrane review suggests that new studies are needed to confirm that azithromycin may lead to less treatment failure and lower side effects than amoxycillin.<ref>{{cite journal |last1=Laopaiboon |first1=Malinee |last2=Panpanich |first2=Ratana |last3=Swa Mya |first3=Kyaw |title=Azithromycin for acute lower respiratory tract infections |journal=Cochrane Database of Systematic Reviews |issue=3 |article-number=CD001954 |date=8 March 2015 |volume=2015 |doi=10.1002/14651858.CD001954.pub4 |pmid=25749735 |pmc=6956663 }}</ref> In the other hand, there is no sufficient evidence to consider the antibiotics as a prophylaxis for the high risk children under 12 years.<ref>{{cite journal |last1=Onakpoya |first1=Igho J |last2=Hayward |first2=Gail |last3=Heneghan |first3=Carl J |title=Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under |journal=Cochrane Database of Systematic Reviews |issue=9 |article-number=CD011530 |date=26 September 2015 |volume=2015 |doi=10.1002/14651858.CD011530.pub2|pmid=26408070 |pmc=10624245 }}</ref>
Oxygen supplementation is often recommended for people with severe lower respiratory tract infections.<ref name="oxygen 2014" /> Oxygen can be provided in a non-invasive manner using nasal prongs, face masks, a head box or hood, a nasal catheter, or a nasopharyngeal catheter.<ref name="oxygen 2014">{{cite journal |last1=Rojas-Reyes |first1=Maria Ximena |last2=Granados Rugeles |first2=Claudia |last3=Charry-Anzola |first3=Laura Patricia |title=Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age |journal=Cochrane Database of Systematic Reviews |issue=12 |article-number=CD005975 |date=10 December 2014 |volume=2014 |doi=10.1002/14651858.CD005975.pub3|pmid=25493690 |pmc=6464960 }}</ref> For children younger than 15 years old, nasopharyngel catheters or nasal prongs are recommended over a face mask or head box.<ref name="oxygen 2014" /> A Cochrane review in 2014 presented a summary to identify children complaining of severe LRTI, however; further research is required to determine the effectiveness of supplemental oxygen and the best delivery method.<ref name="oxygen 2014" />
==Epidemiology== Lower respiratory infectious disease is the fifth-leading cause of death and the combined leading infectious cause of death, being responsible for 2.74 million deaths worldwide.<ref name="pmid28843578">{{Cite journal |date=November 2017 |title=Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet. Infectious Diseases |volume=17 |issue=11 |pages=1133–1161 |doi=10.1016/S1473-3099(17)30396-1 |pmc=5666185 |pmid=28843578 |display-authors=1 | vauthors = Troeger C, Forouzanfar M, Rao PC, Khalil I, Brown A, Swartz S, Fullman N, Mosser J, Thompson RL, Reiner RC, Abajobir A, Alam N, Alemayohu MA, Amare AT, Antonio CA, Asayesh H, Avokpaho E, Barac A, Beshir MA, Boneya DJ, Brauer M, Dandona L, Dandona R, Fitchett JR, Gebrehiwot TT, Hailu GB, Hotez PJ, Kasaeian A, Khoja T, Kissoon N }}</ref> This is generally similar to estimates in the 2010 Global Burden of Disease study.<ref name=pmid23245604>{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | display-authors = 29 | hdl = 10536/DRO/DU:30050819 | s2cid = 1541253 | url = https://zenodo.org/record/2557786 | hdl-access = free }}</ref> This total only accounts for ''Streptococcus pneumoniae'' and ''Haemophilus influenzae'' infections and does not account for atypical or nosocomial causes of lower respiratory disease, therefore underestimating total disease burden.{{cn|date=June 2022}}
==Society and culture== Lower respiratory tract infections place a considerable strain on the health budget and are generally more serious than upper respiratory tract infections.{{cn|date=June 2022}}
Workplace burdens arise from the acquisition of a lower respiratory tract infection, with factors such as total per person expenditures and total medical service utilisation demonstrated as greater among individuals experiencing a lower respiratory tract infection.<ref name=pmid29162852>{{cite journal | vauthors = Chen Y, Shan X, Zhao J, Han X, Tian S, Chen F, Su X, Sun Y, Huang L, Grundmann H, Wang H, Han L | title = Predicting nosocomial lower respiratory tract infections by a risk index based system | journal = Scientific Reports | volume = 7 | issue = 1 | page = 15933 | date = November 2017 | pmid = 29162852 | pmc = 5698311 | doi = 10.1038/s41598-017-15765-z | bibcode = 2017NatSR...715933C }}</ref>
Pan-national data collection indicates that childhood nutrition plays a significant role in determining the acquisition of a lower respiratory tract infection, with the promotion of the implementation of nutrition program, and policy guidelines in affected countries.<ref name=pmid28843578/> {{Clear}}
== References == {{reflist|30em}}
== External links == {{Medical condition classification and resources | ICD10 = J10-J22, J40-J47 | ICD9 = }} {{Respiratory pathology}} {{DEFAULTSORT:Lower Respiratory Tract Infection}} Category:Acute lower respiratory infections Category:Infectious diseases