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Respiratory and ENT Infections

The lungs of children with Down syndrome are generally underdeveloped.
These are some of the differences that occur:

Limited growth of blood vessels throughout the lungs.
Narrowed arteries in the lungs.
Increased pressure through the lungs (Colvin & Yaeger (2017)

Respiratory infections, including pneumonia, bronchitis, and croup, are common in children with Down syndrome. ENT infections, notably sinusitis and otitis media, are also prevalent in these children. Because of the immune system disorders previously discussed, prompt evaluation for antibiotic therapy is both appropriate and essential. Working with Down syndrome children, the nurse may often be the first healthcare professional to notice signs of infection and guide the family to the primary care provider.

Colvin and Yaeger (2017) list of Down Syndrome respiratory complications with recommendations for assessments.
Common complications
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 a 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 findings on chest contrast tomography It can usually be managed with close observation
Subglottic stenosis	Refer for bronchoscopy
Less common complications
Post-obstructive pulmonary edema	Anticipate in patients who require upper airway surgery
High-altitude pulmonary edema
Persistent pulmonary hypertension of the newborn
Complete tracheal rings	Diagnosed by bronchoscopy
Pulmonary hemorrhage	Consider in patients with recurrent abnormal chest radiographs, unexplained hypoxia, or anemia Refer for bronchoscopy
Interstitial lung disease	Consider in patients with unexplained hypoxia
Source: https://err.ersjournals.com/content/26/143/160098.figures-only

According to Blake et al. (2021), respiratory illnesses significantly contribute to morbidity and mortality among persons with Down syndrome (DS). From the Retrospective chart audits of patients with DS diagnosis of respiratory disease in ten years, 18% were due to respiratory illnesses. The breakdown of their contact with the hospital was as follows:

120 were seen in the emergency department
88 were admitted (majority under the age of 5 or over the age of 45)
Admitted patients were more likely to have a history of pneumonia and chronic lung disease. Of admitted patients, 77% required supplemental oxygen, and 46% required intensive care unit admission.

References

Blake, J. M., Gomez, D.E., Skotko, B. G., Torres, A. & Santoro, S. L. (2021). Pneumonia and respiratory infection in Down syndrome: A 10-year cohort analysis of inpatient and outpatient encounters across the lifespan. American Journal of Medical Genetics, 185(10), 2878-2887.

Colvin, K.L. & Yeager, M.E. (2017). What people with Down Syndrome can teach us about cardiopulmonary disease. Eur Respir Rev. 26 (143).