Lung Tissue Disease and Disordered Control of Breathing in PALS

Two of the four PALS respiratory types are easy to miss because the airway itself is clear. The PALS course teaches them alongside upper and lower airway obstruction.

Lung tissue disease

Pneumonia is the commonest cause; others include pulmonary oedema and lung injury. Look for fast breathing, grunting, crackles and low oxygen saturation that improves only partly with oxygen. Treatment includes oxygen, treating the cause (for example antibiotics for bacterial pneumonia) and, when needed, support with positive pressure.

Disordered control of breathing

Here the airway and lungs may be normal, but the brain’s drive to breathe is reduced or irregular. Causes include prolonged seizures, raised intracranial pressure, head injury, poisoning and some neuromuscular conditions. Breathing may be slow, shallow or irregular without obvious effort — which is why it is missed.

Treatment principles

• Support ventilation early if breathing is inadequate — see bag-mask ventilation.
• Treat the cause: stop seizures, manage raised pressure, consider antidotes.
• Check glucose.
• Watch for respiratory failure, which may appear without distress.

Why categorising matters

A child with pneumonia needs different treatment from one with asthma or croup, even though all three are breathless. See lower and upper airway obstruction and the systematic approach.

This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.

More PALS guides: PALS assessment, algorithms and skills

• PALS Course in Abu Dhabi — dates, format and booking
• The PALS Systematic Approach: Assess, Categorise and Treat a Sick Child
• Respiratory Distress vs Respiratory Failure in Children
• Upper Airway Obstruction in Children: Croup, Foreign Bodies and Anaphylaxis
• Lower Airway Obstruction in Children: Asthma and Bronchiolitis
• Shock in Children: The Four Types Taught in PALS
• Septic Shock in Children: Recognition and the First Hour
• Fluid Resuscitation in Children: Boluses and Reassessment
• PALS Bradycardia Algorithm: Oxygen First, Then CPR and Drugs
• PALS Tachycardia: Sinus Tachycardia vs SVT in Children
• PALS Cardiac Arrest Algorithm: Shockable and Non-Shockable Rhythms
• PALS Post-Cardiac Arrest Care: After ROSC in Children
• PALS Drugs: Adrenaline, Adenosine, Amiodarone, Atropine and More
• Weight-Based Dosing in PALS: Estimating Weight and Avoiding Errors
• Intraosseous (IO) Access in PALS: When and How It Is Used
• Paediatric Vital Signs by Age: Heart Rate, Breathing and Blood Pressure
• PALS Defibrillation and Cardioversion: Energies per Kilogram
• All PALS guides, by topic

Other life support and first aid courses: BLS Course · ACLS Course · First Aid Course · Training calendar

Frequently asked questions

What are the four PALS respiratory types?

Upper airway obstruction, lower airway obstruction, lung tissue disease and disordered control of breathing.

What is an example of lung tissue disease?

Pneumonia.

What causes disordered control of breathing?

Seizures, raised intracranial pressure, head injury, poisoning and some neuromuscular conditions.

Why is disordered control of breathing easy to miss?

The child may not look as if they are working hard to breathe.

What is the first priority?

Support oxygenation and ventilation, then treat the cause.

Sources and further reading

What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.

• CPR and ECC Guidelines — American Heart Association
• PALS course options — American Heart Association

Last reviewed 21 September 2026 by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.