Wheezing in infancy, croup, and epiglottitis

Laryngotracheobronchitis as a complication of measles during an urban epidemic

OBJECTIVE

To evaluate demographic and clinical correlates of laryngotracheobronchitis (LTB) as a complication of measles during a community-wide epidemic.

DESIGN

Retrospective review of medical records.

SETTING

Childrens Hospital Los Angeles, a large urban pediatric facility, during a regional epidemic of measles studied January through June 1990.

PATIENTS

All patients identified at our hospital who met Centers for Disease Control criteria for measles.

MEASUREMENTS AND RESULTS

Of 440 patients with measles, 82 also had LTB (18.6%). Patients in whom LTB developed were significantly younger (mean +/- SD: 14.7 +/- 8.2 months) than the cohort (24.8 +/- 30.1 months) (p less than 0.001) and more likely to require hospitalization (91.5%) than the cohort (44.3%) (p less than 0.001). Thirteen patients (17.3%) required intensive care, including 9 (11%) who required endotracheal intubation for a mean of 8.3 +/- 7.1 days. Pulmonary function testing of five patients with an endotracheal tube in place, including three not clinically assessed as having pneumonia, indicated the presence of concomitant lower respiratory tract disease.

CONCLUSION

Laryngotracheobronchitis was a frequent and often severe complication of measles. The likelihood that LTB would develop was inversely related to age, generally required inpatient care, and necessitated endotracheal intubation in severely affected patients.

Parental smoking and asthma in childhood

The effect of parental smoking on childhood asthma was investigated in which data from 302 asthmatic and 433 healthy children aged 1 to 12 years, were studied. All asthmatic patients received prick tests for common allergens. A significantly higher number of heavy parental smokers was found in asthmatic children under 6 years of age with negative prick tests (P = 0.02). A stepwise logistic regression was performed in order to verify interactions between parental smoking and other variables. It is concluded that parental smoking is an important risk factor for "prick test negative" asthmatic children aged 6 years or less.