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Kim H, Shin JY, Chen J, Kim JH, Noh Y, Cheong HJ, Oh YM, Guignard A, Shantakumar S. Risk Factors of Pertussis Among Older Adults in South Korea: A Nationwide Health Data-Based Case-Control Study. Infect Dis Ther 2023; 12:545-561. [PMID: 36588139 PMCID: PMC9925654 DOI: 10.1007/s40121-022-00747-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/12/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION To better understand the conditions associated with pertussis diagnosis among older adults in South Korea, a matched case-control study was conducted of individuals ≥ 50 years diagnosed with pertussis between 2009 and 2018. METHODS Pertussis cases were identified using the nationwide Health Insurance Review and Assessment service (HIRA) database. Each case was then matched to up to 10 controls identified using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) by age, sex, and geographic region at index date. In the 12 months and 30 days prior to index date, the presence of clinical characteristics previously reported to be related to pertussis and pertussis-like conditions were assessed, respectively. A conditional multivariate logistic regression model was then used to calculate odds ratios (ORs) of pertussis diagnosis, adjusted for each of the characteristics. RESULTS Pertussis cases (n = 1004) generally demonstrated a higher prevalence of comorbidities compared to controls (n = 9710). Pre-existing asthma and chronic obstructive pulmonary disease (COPD) within 12 months of index date were associated with a two-fold increased risk of pertussis with adjusted ORs (95% confidence interval) of 2.08 (1.68-2.58) and 2.32 (1.59-3.39), respectively. Gastroesophageal reflux disease [GERD; 2.67 (2.23-3.19)], cancer [1.68 (1.23-2.31)], cardiovascular disease [1.62 (1.31-2.00)], renal disease [1.56 (1.12-2.16)], autoimmune disease [1.50 (1.25-1.79)], and hyperlipidemia [1.43 (1.16-1.77)] were also associated with pertussis diagnosis. Finally, acute respiratory events within 30 days prior to index date, such as pneumonia, acute bronchitis, and upper respiratory tract infection (URTI), were highly associated with increased odds of pertussis diagnosis [adjusted ORs of 8.28 (5.10-13.44), 4.86 (3.84-6.14), and 2.90 (2.30-3.67), respectively]. CONCLUSIONS This study's findings complement and expand upon previous studies on the adult pertussis population, generating real-world data to describe underlying clinical characteristics of those diagnosed with pertussis in South Korea.
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Affiliation(s)
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Seobu-ro 2066, Jangan-gu, Suwon, Gyeonggi-do, 440-746, South Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea.
| | | | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Seobu-ro 2066, Jangan-gu, Suwon, Gyeonggi-do, 440-746, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Seobu-ro 2066, Jangan-gu, Suwon, Gyeonggi-do, 440-746, South Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeon-Mok Oh
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Muralitharan P, Carlsen P, Hilland M, Delestre-Levai I, Vollsæter M, Hufthammer KO, Engan M, Røksund OD, Halvorsen T, Clemm HH. Use of inhaled ipratropium bromide to improve exercise-induced laryngeal obstruction cannot be recommended. ERJ Open Res 2023; 9:00308-2022. [PMID: 36699648 PMCID: PMC9868967 DOI: 10.1183/23120541.00308-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young adults. Current management generally consists of breathing advice, speech therapy, inspiratory muscle training or supraglottoplasty in highly motivated subjects with supraglottic collapse. Inhaled ipratropium bromide (IB) is a muscarinic receptor antagonist used to treat asthma that is suggested in a few reports to improve EILO symptoms. The aim of the present study was to investigate effects of inhaled IB in EILO diagnosed by continuous laryngoscopy exercise (CLE) test and classified by CLE scores. Methods A randomised crossover trial was conducted at Haukeland University Hospital, Bergen, Norway, enrolling participants diagnosed with EILO defined by characteristic symptoms and CLE score ≥3 (range 0-12). Two consecutive CLE tests were performed within 2 weeks, one test with and one test without prior administration of inhaled IB in a randomised order. Main outcomes were the CLE score, dyspnoea measured using a modified BORG scale (range 0-10) and cardiopulmonary exercise data provided by the CLE test. Results 20 participants (14 females) aged 12-25 years participated, and all ran to exhaustion on both tests. Mean CLE score, BORG score and peak oxygen consumption were similar in tests performed with and without IB; mean differences (95% confidence interval) were 0.08 (-0.28-0.43), 0.35 (-0.29-0.99) and -0.4 (-1.9-1.1) mL·kg-1·min-1, respectively. Conclusion Inhaled IB did not improve CLE score, dyspnoea or exercise capacity in subjects with EILO. The study does not support the use of inhaled IB to treat EILO.
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Affiliation(s)
- Praveen Muralitharan
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Corresponding author: Praveen Muralitharan ()
| | - Petter Carlsen
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Magnus Hilland
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Irisz Delestre-Levai
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Mette Engan
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege H. Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
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Yusuf RA, Rathebe PC, Mbonane TP. Association between Environmental Exposures and Asthma among Children in King Williams Town, South Africa. Diseases 2022; 10:diseases10040123. [PMID: 36547209 PMCID: PMC9777677 DOI: 10.3390/diseases10040123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
The study aimed to assess the association between environmental exposure and asthma among children between 3 and 12 years old in King Williams Town, South Africa. A quantitative case-control study was conducted at Grey Hospital to assess the association between environmental exposure and asthma among children who reside in King Williams Town. Of the total 566 study participants, 50.5% (286) had asthma while 49.5% did not. Socio-demographic factors associated with asthma in children were being within the age group 9-12 years (OR 1.74, CI 95% 1.09-2.78) and India ethnicity (OR 0.20, CI 95% 0.08-0.48). Factors associated with asthma were weight within 25-35 kg (OR 1.64, CI 95% 1.11-2.42) and BMI within 15-20 (OR 4.80, CI 95% 2.80-8.22). Environmental risk factors associated with asthma were indoor exposure to tobacco smoke from mothers of the participants (OR 5.45, CI 95% 3.08-9.65) and from fathers (OR 4.37; CI 95% 2.77-6.90). Abstaining from eating seafood appeared to be protective from developing asthma (OR 0.01; CI 95% 0.00-0.05). The study found no significant association between outdoor environmental exposures and childhood asthma. The age of participant, weight, BMI, exposure to environmental tobacco smoke (ETS), and eating seafood had significant correlations with childhood asthma. Strengthening the evaluation of children healthcare and encouraging smoking cessation among parents could reduce exposure to environmental asthma triggers among children.
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Chou EY, Pelz BJ, Chiu AM, Soung PJ. All that Wheezes is not Asthma or Bronchiolitis. Crit Care Clin 2022; 38:213-229. [DOI: 10.1016/j.ccc.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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5
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Lupu VV, Miron IC, Lupu A, Moscalu M, Mitrofan EC, Munteanu D, Luca AC. The relationship between gastroesophageal reflux disease and recurrent wheezing in children. Medicine (Baltimore) 2021; 100:e27660. [PMID: 34964728 PMCID: PMC8615307 DOI: 10.1097/md.0000000000027660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/09/2021] [Indexed: 11/25/2022] Open
Abstract
Gastroesophageal reflux disease occurs when gastric contents flow back into the esophagus and produce symptoms. Recurrent wheezing affects the quality of life for the patient and family. The association of gastroesophageal reflux with recurrent wheezing is suggested by different studies. The purpose of this study was to explore this relationship and to evaluate the outcome after appropriate treatment.A retrospective study on 85 children with recurrent wheezing, admitted in a pediatric gastroenterology regional center in Romania was performed. 24-hour continuous esophageal pH monitoring was used to evaluate the presence of gastroesophageal reflux and the results were interpreted using the Boix Ochoa score. All patients with positive score received treatment with proton pump inhibitors and they were evaluated again after 2 months.Gastroesophageal reflux was present in 71 children (83.5%), while 14 (16.5%) had a negative score, with a statistic significance (χ2 = 6.88, P = .0086, 95% confidence interval). After 2 months treatment with proton pump inhibitors, the Boix Ochoa score was still positive in 15 patients (21.13%).Recurrent wheezing is a solid reason for evaluating the presence of gastroesophageal reflux by 24-hour continuous esophageal pH-metry. Adequate treatment of gastroesophageal reflux solves also the recurrent wheezing in the majority of patients.
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Affiliation(s)
| | | | - Ancuta Lupu
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Mihaela Moscalu
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | | | - Dragos Munteanu
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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6
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Keeping Pace with Adolescent Asthma: A Practical Approach to Optimizing Care. Pulm Ther 2021; 8:123-137. [PMID: 34743311 PMCID: PMC8571974 DOI: 10.1007/s41030-021-00177-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/25/2021] [Indexed: 10/30/2022] Open
Abstract
Known for their pre-occupation with body image, self-identity creation, peer acceptance, and risk-taking behaviors, adolescents with asthma face unique challenges. Asthma is a heterogeneous disease and accurate diagnosis requires assessment through detailed clinical history, examination, and objective tests. Diagnostic challenges exist as many adolescents can present with asthma-like symptoms but do not respond to asthma treatment and risk being mis-diagnosed. Under-recognition of asthma symptoms and denial of disease severity must also be addressed. The over-reliance on short-acting beta-agonists in the absence of anti-inflammatory therapy for asthma is now deemed unsafe. Adolescents with mild asthma benefit from symptom-driven treatment with combination inhaled corticosteroids (ICS) and long-acting beta-agonist (LABA) on an as-required basis. For those with moderate-to-persistent asthma requiring daily controller therapy, maintenance and reliever therapy using the same ICS-LABA controller simplifies treatment regimes, while serving to reduce exacerbation risk. A developmentally staged approach based on factors affecting asthma control in early, middle, and late adolescence enables better understanding of the individual's therapeutic needs. Biological, psychological, and social factors help formulate a risk assessment profile in adolescents with difficult-to-treat and severe asthma. Smoking increases risks of developing asthma symptoms, lung function deterioration, and asthma exacerbations. Morbidity associated with e-cigarettes or vaping calls for robust efforts towards smoking and vaping cessation and abstinence. As adolescents progress from child-centered to adult-oriented care, coordination and planning are required to improve their self-efficacy to ready them for transition. Frequent flare-ups of asthma can delay academic attainment and adversely affect social and physical development. In tandem with healthcare providers, community and schools can link up to help shoulder this burden, optimizing care for adolescents with asthma.
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7
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Welsh L, Giannini A, Massie J. Exercise-induced laryngeal obstruction in children and adolescents: are we listening? Arch Dis Child Educ Pract Ed 2021; 106:66-70. [PMID: 33077532 DOI: 10.1136/archdischild-2020-319454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/17/2020] [Accepted: 09/06/2020] [Indexed: 11/03/2022]
Abstract
Exertional dyspnoea among children and adolescents is a common presenting complaint to general practitioners. Exertional dyspnoea is most commonly attributed to exercise-induced bronchoconstriction (EIB), but there are several other causes including hyperventilation syndrome, breathlessness associated with normal exercise limitation and exercise-induced laryngeal obstruction (EILO). The symptoms of EILO include stridor, throat tightness and difficulty on inspiration. If these are mistaken for EIB, children will receive asthma therapy. The underlying mechanism of EILO includes closure of the larynx during high-intensity exercise, which causes a reduction in airflow and breathlessness. This phenomenon is often associated with a background of psychological stress. Historically, a diagnosis of EILO has been considered 'rare' though this may be a reflection of under-recognition. Direct visual observation via laryngoscopy is the gold standard for diagnosis of EILO; however, this is rarely available even in specialised centres. Nevertheless, the diagnosis can usually be made by recognising the characteristic clinical pattern. Here we provide recommendations for appropriate investigations for the determination of EILO, together with suggested treatment.
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Affiliation(s)
- Liam Welsh
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Alessandra Giannini
- Melbourne Allergy Centre and Children's Specialists, Melbourne, Victoria, Australia
| | - John Massie
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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8
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Ashmawy NS, Gad HA, Ashour ML, El-Ahmady SH, Singab ANB. The genus Polyscias (Araliaceae): A phytochemical and biological review. J Herb Med 2020. [DOI: 10.1016/j.hermed.2020.100377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ramphul M, Bush A, Chang A, Prifits KN, Wallis C, Bhatt JM. The role of the pediatrician in caring for children with tracheobronchomalacia. Expert Rev Respir Med 2020; 14:679-689. [DOI: 10.1080/17476348.2020.1750374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Manisha Ramphul
- Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - Andrew Bush
- Imperial College, London, UK
- Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, London, UK
| | - Anne Chang
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Children Centre for Health Research, Queensland University of Technology, Brisbane, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kostas N Prifits
- Allergy - Pulmonology Unit, 3rd Dept Paediatrics, Athens University Medical School, Chaidari, Greece
| | - Colin Wallis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham Children’s Hospital, Nottingham University Hospitals, Queens Medical Centre, Nottingham, UK
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10
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Lascano-Vaca Y, Ortiz-Prado E, Gomez-Barreno L, Simbaña-Rivera K, Vasconez E, Lister A, Arteaga-Espinosa ME, Perez GF. Clinical, genetic and microbiological characterization of pediatric patients with cystic fibrosis in a public Hospital in Ecuador. BMC Pediatr 2020; 20:111. [PMID: 32143663 PMCID: PMC7060626 DOI: 10.1186/s12887-020-2013-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 02/27/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To carry out a complete clinical, pathological, genetic and microbiological characterization of pediatric patients with molecular confirmed cystic fibrosis (CF) attending the Carlos Andrade Marín Hospital (HCAM) within the study period. METHODS A cross-sectional analysis of the pediatric population with a confirmed diagnosis of CF disease who attended HCAM, one of the largest tertiary-level hospitals in Ecuador, between 2017 and 2018 was performed. All demographic, clinical and genetic variables were obtained from the electronic medical records (EMR) stored by the hospital. RESULTS Forty seven patients with CF were included in the study. Gender distribution was similar between male (48.9%, n = 23) and female patients (51.1%, n = 24). The Tiffeneau-Pinelli index (FEV1/FVC) changed significantly after nine months post-diagnosis (85.55 ± 13.26; p < 0.05). The most common pathogenic genetic variants were F508del, found in 52.78% of the cohort (n = 19); H609R, found in 36.11% (n = 13); g.204099A > C, found in 14.1% (n = 7), followed by G85E and the N1303K with 11.11% (n = 3) each. CONCLUSIONS To our best knowledge, this is the first study exploring the clinical, genetic and bacteriological profile of CF's patients in Ecuador. Within the cohort of patients, an important and unique genetic feature was characterized by the presence of the g.204099A > C and the c.206359C > A homozygous polymorphism as well as the presence of the H609R variant, a mutation only reported among Ecuadorians.
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Affiliation(s)
- Yazmina Lascano-Vaca
- Pediatric Pneumology Service, Pediatric Unit of the Carlos Andrade Marin Specialties Hospital, Quito, Ecuador
| | - Esteban Ortiz-Prado
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador.
| | - Lenin Gomez-Barreno
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador
| | - Katherine Simbaña-Rivera
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador
| | - Eduardo Vasconez
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador
| | - Alexander Lister
- Faculty of Medicine, University of Southampton, Southampton, England
| | | | - Geovanny F Perez
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA
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11
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Januska MN, Goldman DL, Webley W, Teague WG, Cohen RT, Bunyavanich S, Vicencio AG. Bronchoscopy in severe childhood asthma: Irresponsible or irreplaceable? Pediatr Pulmonol 2020; 55:795-802. [PMID: 31730298 PMCID: PMC7385726 DOI: 10.1002/ppul.24569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
For children with severe asthma, guideline-based management focuses on the escalation of anti-inflammatory and bronchodilatory medications while addressing comorbid conditions. Bronchoscopy, in this context, has been relegated to ruling out asthma mimickers. More recently, however, there have been questions surrounding the clinical utility of bronchoscopy in severe childhood asthma. In this solicited lecture summary, we discuss the past, present, and potential future applications of bronchoscopy in severe childhood asthma.
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Affiliation(s)
- Megan N. Januska
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY
| | | | | | | | | | - Supinda Bunyavanich
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY
- Ichan School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY
| | - Alfin G. Vicencio
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY
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12
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Abstract
PURPOSE OF REVIEW Asthma is a common chronic disease of the airways characterized by recurrent respiratory symptoms, bronchoreactivity, and airway inflammation. The high toll on quality of life has led to sustained efforts to understand the factors leading to asthma inception and poor disease control. Obesity is another increasingly common pediatric disease, which appears to increase the risk for incident asthma and worsened disease severity. Currently, our understanding of how obesity affects asthma risk and affects its phenotypic characteristics remains incomplete. The current review describes our current understanding of the epidemiology, clinical characteristics, and management considerations of obesity-related asthma in children. RECENT FINDINGS The epidemiologic relationship between obesity in children and incident asthma remains confusing despite numerous longitudinal cohort studies, and appears to be influenced by early life exposures, patterns of somatic growth and underlying familial risks of allergic disease. Children with comorbid obesity and asthma demonstrate diverse phenotypic characteristics which are still becoming clear. SUMMARY Like any child with asthma, a child with comorbid obesity requires an individualized approach adhering to current best-practice guidelines and an understanding of how obesity and asthma may interact.
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Mikalsen IB, Dalen I, Karlstad Ø, Eide GE, Magnus M, Nystad W, Øymar K. Airway symptoms and atopy in young children prescribed asthma medications: A large-scale cohort study. Pediatr Pulmonol 2019; 54:1557-1566. [PMID: 31273956 DOI: 10.1002/ppul.24437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/15/2019] [Indexed: 11/09/2022]
Abstract
Diagnosing asthma and deciding treatment are difficult in young children. An inappropriate and too high prescription rate of inhaled corticosteroids (ICS) is suggested, but how airway symptoms are associated with prescriptions of asthma medication is less known. We studied how strongly wheeze, lower respiratory tract infections (LRTI), and atopic diseases are associated with dispensing of asthma medications during early childhood. We used data from the Norwegian Mother and Child Cohort Study and the Norwegian Prescription Database at four age-intervals (0-6, 6-18, 18-36 months, and 3-7 years). Primary outcomes were dispensed asthma medications (no medication, short-acting β-2 agonist, or ICS). Relative risks (RRs) and average attributable fractions (AAFs) were estimated. Both wheeze and LRTI were positively associated with both medication groups (0-6 months: no data on wheeze). The RRs and AAFs were higher for wheeze than LRTI. For ICS, the AAFs (95% CI) for wheeze vs LRTI were: 6 to 18 months: 69.2 (67.2, 71.2)% vs 10.4 (9.0, 11.8)%, 18 to 36 months: 33.0 (30.5, 35.5)% vs 10.0 (8.0, 12.0)%, and 3 to 7 years: 33.7 (31.0, 36.5)% vs 1.2 (0.5, 1.9)%. Except at 3 to 7 years of age, the AAFs were lower for atopic diseases than for LRTI and wheeze. Atopic diseases modified the associations between wheeze and ICS at 18 to 36 months and between LRTI or wheeze and ICS at 3 to 7 years. In conclusion, both wheeze and LRTI were associated with prescriptions of asthma medications in young children, with the strongest associations seen for wheeze. Atopic diseases contributed to these associations only in the oldest age groups.
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Affiliation(s)
- Ingvild Bruun Mikalsen
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Øystein Karlstad
- Department of Chronic Diseases and Aging, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Maria Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Wenche Nystad
- Department of Chronic Diseases and Aging, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Knut Øymar
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Norway
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Simpson SJ, Champion Z, Hall GL, French N, Reynolds V. Upper Airway Pathology Contributes to Respiratory Symptoms in Children Born Very Preterm. J Pediatr 2019; 213:46-51. [PMID: 31402143 DOI: 10.1016/j.jpeds.2019.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the role of upper airway dysfunction, indicated by altered vocal quality (dysphonia), on the respiratory symptoms of children surviving very preterm birth. STUDY DESIGN Children born <32 weeks of gestation participated in 2 separate assessments during midchildhood. The first visit assessed voice quality by a subjective evaluation using the Consensus Auditory-Perceptual Evaluation of Voice and a computerized analysis of the properties of the voice via the Acoustic Voice Quality Index. The second assessment recorded parentally reported respiratory symptoms and measures of lung function, including spirometry, lung volumes, oscillatory mechanics, and a cardiopulmonary exercise test. RESULTS Preterm children (n = 35; median gestation 24.3 weeks) underwent paired voice and lung assessments at approximately 11 years of age. Preterm children with dysphonia (n = 25) reported significantly more respiratory symptoms than those with normal voices (n = 10) including wheeze (92% vs 40%; P = .001) and asthma diagnosed by a physician (60% vs 10%; P = .007). Lung function outcomes were generally not different between the dysphonic group and the group with normal voice (P > .05), except for the oscillatory mechanics measures, which were all at least 0.5 z score lower in the dysphonic group (Xrs8 mean difference = -0.91 z scores, P = .003; fres = 1.06 z scores, P = .019; AX = -0.87 z scores, P = .010; Rrs8 = 0.63 z scores, P = .068). CONCLUSIONS The upper airway may play a role in the respiratory symptoms experienced by some very preterm children and should be considered by clinicians, especially when symptoms are in the presence of normal lung function and are refractory to treatment.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute; School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University.
| | | | - Graham L Hall
- Telethon Kids Institute; School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University
| | - Noel French
- King Edward Memorial Hospital, Perth, Western Australia
| | - Victoria Reynolds
- State University College of New York at Plattsburgh, Plattsburgh, NY
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Wallis C, Alexopoulou E, Antón-Pacheco JL, Bhatt JM, Bush A, Chang AB, Charatsi AM, Coleman C, Depiazzi J, Douros K, Eber E, Everard M, Kantar A, Masters IB, Midulla F, Nenna R, Roebuck D, Snijders D, Priftis K. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J 2019; 54:13993003.00382-2019. [PMID: 31320455 DOI: 10.1183/13993003.00382-2019] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/16/2019] [Indexed: 01/20/2023]
Abstract
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
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Affiliation(s)
- Colin Wallis
- Respiratory Medicine Unit, Great Ormond Street Hospital for Children, London, UK
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit and Pediatric Surgery Division, Universidad Complutense de Madrid, Madrid, Spain
| | - Jayesh M Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | | | | | - Julie Depiazzi
- Physiotherapy Dept, Perth Children's Hospital, Perth, Australia
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Mark Everard
- Division of Paediatrics, University of Western Australia, Perth Children's Hospital, Perth, Australia
| | - Ahmed Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Ian B Masters
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fabio Midulla
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Raffaella Nenna
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Derek Roebuck
- Interventional Radiology Dept, Great Ormond Street Hospital, London, UK
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Kostas Priftis
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
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16
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17
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Lang JE, Bunnell HT, Hossain MJ, Wysocki T, Lima JJ, Finkel TH, Bacharier L, Dempsey A, Sarzynski L, Test M, Forrest CB. Being Overweight or Obese and the Development of Asthma. Pediatrics 2018; 142:peds.2018-2119. [PMID: 30478238 DOI: 10.1542/peds.2018-2119] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Adult obesity is linked to asthma cases and is estimated to lead to 250 000 new cases yearly. Similar incidence and attributable risk (AR) estimates have not been developed for children. We sought to describe the relationship between overweight and obesity and incident asthma in childhood and quantify AR statistics in the United States for overweight and obesity on pediatric asthma. METHODS The PEDSnet clinical data research network was used to conduct a retrospective cohort study (January 2009-December 2015) to compare asthma incidence among overweight and/or obese versus healthy weight 2- to 17-year-old children. Asthma incidence was defined as ≥2 encounters with a diagnosis of asthma and ≥1 asthma controller prescription. Stricter diagnostic criteria involved confirmation by spirometry. We used multivariable Poisson regression analyses to estimate incident asthma rates and risk ratios and accepted formulas for ARs. RESULTS Data from 507 496 children and 19 581 972 encounters were included. The mean participant observation period was 4 years. The adjusted risk for incident asthma was increased among children who were overweight (relative risk [RR]: 1.17; 95% confidence interval [CI]: 1.10-1.25) and obese (RR: 1.26; 95% CI: 1.18-1.34). The adjusted risk for spirometry-confirmed asthma was increased among children with obesity (RR: 1.29; 95% CI: 1.16-1.42). An estimated 23% to 27% of new asthma cases in children with obesity is directly attributable to obesity. In the absence of overweight and obesity, 10% of all cases of asthma would be avoided. CONCLUSIONS Obesity is a major preventable risk factor for pediatric asthma.
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Affiliation(s)
- Jason E Lang
- Nemours Children's Hospital, Nemours Children's Health System, Orlando, Florida; .,Divisions of Allergy and Immunology and.,Pulmonary Medicine, School of Medicine, Duke University and Duke Children's Hospital and Health Center, Durham, North Carolina
| | - H Timothy Bunnell
- Department of Biomedical Research, Nemours Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Md Jobayer Hossain
- Department of Biomedical Research, Nemours Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Tim Wysocki
- Centers for Health Care Delivery Science and
| | - John J Lima
- Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, Florida
| | - Terri H Finkel
- Nemours Children's Hospital, Nemours Children's Health System, Orlando, Florida
| | | | - Amanda Dempsey
- Department of Pediatrics, School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Lisa Sarzynski
- Section of Pulmonary Medicine, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Matthew Test
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; and
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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18
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Ullmann N, Mirra V, Di Marco A, Pavone M, Porcaro F, Negro V, Onofri A, Cutrera R. Asthma: Differential Diagnosis and Comorbidities. Front Pediatr 2018; 6:276. [PMID: 30338252 PMCID: PMC6178921 DOI: 10.3389/fped.2018.00276] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022] Open
Abstract
Childhood asthma remains a multifactorial disease with heterogeneous clinical phenotype and complex genetic inheritance. The primary aim of asthma management is to achieve control of symptoms, in order to reduce the risk of future exacerbations and progressive loss of lung function, which results especially challenging in patients with difficult asthma. When asthma does not respond to maintenance treatment, firstly, the correct diagnosis needs to be confirmed and other diagnosis, such as cystic fibrosis, primary ciliary dyskinesia, immunodeficiency conditions or airway and vascular malformations need to be excluded. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Moreover, all possible risk factors or comorbidities (gastroesophageal reflux, rhinosinusitis, dysfunctional breathing and/or vocal cord dysfunction, obstructive sleep apnea and obesity) should be investigated. At the same time, the possible reasons for poor symptom control need to be find in all modifiable factors which need to be carefully assessed. Non-adherence to medication or inadequate inhalation technique, persistent environmental exposures and psychosocial factors are, currently, recognized as the more common modifiable factors. Based on these premises, investigation and management of asthma require specialist multidisciplinary expertise and a systematic approach to characterizing patients' asthma phenotypes and delivering individualized care. Moreover, since early wheezers are at higher risk of developing asthma, we speculate that precocious interventions aimed at early diagnosis and prevention of modifiable factors might affect the age at onset of wheezing, reduce the prevalence of persistent later asthma and determine long term benefits for lung health.
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Affiliation(s)
- Nicola Ullmann
- Paediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Department of Paediatrics, Paediatric Hospital “Bambino Gesù” Research Institute, Rome, Italy
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19
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Paradoxical Vocal Cord Motion in a Pair of Twin Preterm Infants. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Mirra V, Montella S, Santamaria F. Pediatric severe asthma: a case series report and perspectives on anti-IgE treatment. BMC Pediatr 2018; 18:73. [PMID: 29466963 PMCID: PMC5820802 DOI: 10.1186/s12887-018-1019-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/29/2018] [Indexed: 12/22/2022] Open
Abstract
Background The primary goal of asthma management is to achieve disease control for reducing the risk of future exacerbations and progressive loss of lung function. Asthma not responding to treatment may result in significant morbidity. In many children with uncontrolled symptoms, the diagnosis of asthma may be wrong or adherence to treatment may be poor. It is then crucial to distinguish these cases from the truly “severe therapy-resistant” asthmatics by a proper filtering process. Herein we report on four cases diagnosed as difficult asthma, detail the workup that resulted in the ultimate diagnosis, and provide the process that led to the prescription of omalizumab. Case presentation All children had been initially referred because of asthma not responding to long-term treatment with high-dose inhaled steroids, long-acting β2-agonists and leukotriene receptor antagonists. Definitive diagnosis was severe asthma. Three out four patients were treated with omalizumab, which improved asthma control and patients’ quality of life. We reviewed the current literature on the diagnostic approach to the disease and on the comorbidities associated with difficult asthma and presented the perspectives on omalizumab treatment in children and adolescents. Based on the evidence from the literature review, we also proposed an algorithm for the diagnosis of pediatric difficult-to-treat and severe asthma. Conclusions The management of asthma is becoming much more patient-specific, as more and more is learned about the biology behind the development and progression of asthma. The addition of omalizumab, the first targeted biological treatment approved for asthma, has led to renewed optimism in the management of children and adolescents with atopic severe asthma.
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Affiliation(s)
- Virginia Mirra
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
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21
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Lands LC. Dyspnea in Children: What is driving it and how to approach it. Paediatr Respir Rev 2017; 24:29-31. [PMID: 28433261 DOI: 10.1016/j.prrv.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
Dyspnea in children has important physical and psychosocial impact. It is useful to define the quality of the dyspnea and quantify its magnitude in a child-friendly manner. Through careful history taking and physical examination, a targeted investigation can lead to identification of the cause and potential treatment. This article provides a framework for the clinical approach to dyspnea in children, including important information to gather during the history, physical assessment, how to quantify dyspnea, and choice and use of laboratory measurements.
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Affiliation(s)
- Larry C Lands
- Pediatric Respiratory medicine, Montreal Children's Hospital-McGill University, Health Centre.
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22
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GÓMEZ-SÁEZ F, NAVAZO-EGUÍA AI, VEGA-VAL C, GÓMEZ-SÁNCHEZ E, MIRÁS-VEIGA A, VALENCIA-RAMOS J. Exploración de la vía aérea en el paciente pediátrico. REVISTA ORL 2017. [DOI: 10.14201/orl.15900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Key points Educational aims Summary Involuntary cough without an identified underlying organic reason has been given various names and recommended treatments. Current experience in children and adolescents suggests that “habit cough” best describes this entity, and suggestion therapy is a highly effective treatment that most physicians can learn. Diagnosis of the functional disorder called habit cough can be readily made by the unique clinical characteristicshttp://ow.ly/Al5B3094oxj
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Affiliation(s)
- Miles Weinberger
- University of Iowa, Iowa City, IA, USA; Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Boris Lockshin
- University of Nevada, Reno, NV, USA; Allergy and Asthma Associates, Reno, NV, USA
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24
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Abstract
VCD has several clinical and physiological phenotypes, which should be individually identifiedhttp://ow.ly/orfb309fMxh.
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Affiliation(s)
- Miles Weinberger
- University of Iowa, Iowa City, IA, USA; Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Devang Doshi
- Oakland University, William Beaumont School of Medicine, Rochester, MI, USA
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25
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Exercise inducible laryngeal obstruction: diagnostics and management. Paediatr Respir Rev 2017; 21:86-94. [PMID: 27492717 DOI: 10.1016/j.prrv.2016.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022]
Abstract
Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine.
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26
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de Benedictis D, Bush A. Asthma in adolescence: Is there any news? Pediatr Pulmonol 2017; 52:129-138. [PMID: 27273858 DOI: 10.1002/ppul.23498] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/18/2016] [Accepted: 05/25/2016] [Indexed: 12/22/2022]
Abstract
Asthma is a chronic disease that has a significant impact quality of life, which is particularly important in adolescence. We will discuss aspects of epidemiology, the clinical spectrum, diagnostics, and management of asthma in adolescence. In particular, we will highlight the psychological implications of having asthma during this developmental period. Data published in the past 10 years, since we last reviewed the subject, will be the main focus of this paper. The care of the teenager with asthma should take into account the rapid physical, emotional, cognitive, and social changes that occur during normal adolescence. The diagnostic process may be more difficult since teenagers tend to deny their illness. Thus, both under-diagnosis and under-assessment of asthma severity may lead to under-treatment and potentially avoidable morbidity and even mortality. Conversely, teenagers may be often misdiagnosed as having asthma or their asthma severity may be overestimated leading to inappropriate and sometimes excessive treatment. Educational programs, environmental avoidance measures, proper use of medications along with a skilled approach, and a caring attitude of health providers are all very important for successful management. Pediatr Pulmonol. 2017;52:129-138. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Andrew Bush
- Department of Pediatrics, Imperial College, London, UK.,Department of Pediatric Respiratory Medicine, National Heart and Lung Institute, London, UK.,Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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27
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Weiler JM, Brannan JD, Randolph CC, Hallstrand TS, Parsons J, Silvers W, Storms W, Zeiger J, Bernstein DI, Blessing-Moore J, Greenhawt M, Khan D, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Tilles SA, Wallace D. Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol 2016; 138:1292-1295.e36. [PMID: 27665489 DOI: 10.1016/j.jaci.2016.05.029] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 12/26/2022]
Abstract
The first practice parameter on exercise-induced bronchoconstriction (EIB) was published in 2010. This updated practice parameter was prepared 5 years later. In the ensuing years, there has been increased understanding of the pathogenesis of EIB and improved diagnosis of this disorder by using objective testing. At the time of this publication, observations included the following: dry powder mannitol for inhalation as a bronchial provocation test is FDA approved however not currently available in the United States; if baseline pulmonary function test results are normal to near normal (before and after bronchodilator) in a person with suspected EIB, then further testing should be performed by using standardized exercise challenge or eucapnic voluntary hyperpnea (EVH); and the efficacy of nonpharmaceutical interventions (omega-3 fatty acids) has been challenged. The workgroup preparing this practice parameter updated contemporary practice guidelines based on a current systematic literature review. The group obtained supplementary literature and consensus expert opinions when the published literature was insufficient. A search of the medical literature on PubMed was conducted, and search terms included pathogenesis, diagnosis, differential diagnosis, and therapy (both pharmaceutical and nonpharmaceutical) of exercise-induced bronchoconstriction or exercise-induced asthma (which is no longer a preferred term); asthma; and exercise and asthma. References assessed as relevant to the topic were evaluated to search for additional relevant references. Published clinical studies were appraised by category of evidence and used to document the strength of the recommendation. The parameter was then evaluated by Joint Task Force reviewers and then by reviewers assigned by the parent organizations, as well as the general membership. Based on this process, the parameter can be characterized as an evidence- and consensus-based document.
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28
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Asumeng Koffuor G, Boye A, Kyei S, Ofori-Amoah J, Akomanin Asiamah E, Barku A, Acheampong J, Amegashie E, Kumi Awuku A. Anti-asthmatic property and possible mode of activity of an ethanol leaf extract of Polyscias fruticosa. PHARMACEUTICAL BIOLOGY 2016; 54:1354-1363. [PMID: 26449896 DOI: 10.3109/13880209.2015.1077465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
CONTEXT Polyscias fruticosa (L.) Harms (Araliaceae) is used as a traditional remedy for asthma in Ghana. OBJECTIVE The objective of this study is to establish the anti-asthmatic property and a possible mode of activity of an ethanol leaf extract of P. fruticosa (PFE). MATERIALS AND METHODS The time (min) for pre-convulsive dyspnea, and time for recovery, after sensitization with 150 μg OVA and induction of bronchospasm with 1% acetylcholine or histamine in normal, and 100, 250, and 500 mg/kg PFE-treated Dunkin Hartley guinea pigs, were recorded. Atropine (0.1 mg), mepyramine (0.1 mg), and PFE (1 mg) effect on a contractile response of 2.0 × 10(-2) μg/ml acetylcholine and 5.8 × 10(-2) μg/ml histamine on the isolated guinea pig ileum was investigated. Cytological and histological studies were conducted using guinea pig peritoneal mast cells and mesenteric cells, respectively, to establish PFE effect on compound 48/80-induced mast cell degranulation. RESULTS PFE (100-500 mg/kg) prolonged the onset of pre-convulsive dyspnea by 76.1-180.2% (p ≤ 0.01-0.001), and decreased recovery time by 71.9-78.5% (p ≤ 0.01-0.001). It also enhanced percentage protection against histamine-induced bronchospasm by 15.8-80.1-fold (p ≤ 0.05-0.01), and decreased percentage recovery time 2.5-3.3-fold (p ≤ 0.05-0.01). PFE significantly inhibited (60.4 ± 8.3%) contractile responses of histamine and produced significant inhibition (56-79%: p ≤ 0.001) of mast cell degranulation. CONCLUSION PFE has anti-asthmatic, antihistaminic, and mast cell stabilization effect making it useful in traditional asthma management.
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Affiliation(s)
- George Asumeng Koffuor
- a Department of Pharmacology , Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
- b Department of Medical Laboratory Technology , School of Physical Sciences, University of Cape-Coast , Cape-Coast , Ghana
| | - Alex Boye
- b Department of Medical Laboratory Technology , School of Physical Sciences, University of Cape-Coast , Cape-Coast , Ghana
| | - Samuel Kyei
- c Department of Optometry , School of Physical Sciences, University of Cape-Coast , Cape-Coast , Ghana
| | - Jones Ofori-Amoah
- a Department of Pharmacology , Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | | | - Atsu Barku
- e Department of Chemistry , School of Physical Sciences, University of Cape-Coast , Cape-Coast , Ghana
| | - Jacqueline Acheampong
- b Department of Medical Laboratory Technology , School of Physical Sciences, University of Cape-Coast , Cape-Coast , Ghana
| | - Elikplim Amegashie
- b Department of Medical Laboratory Technology , School of Physical Sciences, University of Cape-Coast , Cape-Coast , Ghana
| | - Albert Kumi Awuku
- b Department of Medical Laboratory Technology , School of Physical Sciences, University of Cape-Coast , Cape-Coast , Ghana
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29
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Powell CV. Acute severe asthma. J Paediatr Child Health 2016; 52:187-91. [PMID: 27062622 DOI: 10.1111/jpc.13075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 02/02/2023]
Abstract
Acute exacerbations of asthma are very common reasons for a presentation to emergency departments. This paper focuses on defining the high-risk group, consideration of the concept of phenotypes of acute asthma, the assessment of severe and life-threatening exacerbations and an emphasis on the management of the more severe end of the exacerbation severity. A number of evidence-based guidelines exist throughout the world and are all slightly different. This reflects the poor evidence base for some of those recommendations. Thus, a large variation of treatment drugs, doses and regimen are used and clearly not standardised. This paper aims to present a summary of the best evidence and discuss some of these controversies. The most important aspect of treating an exacerbation of acute asthma is to review regularly and assess response to treatment. Severe and life-threatening episodes should be treated with early use of intravenous treatment in a stepwise manner following the local guidelines. Non-invasive ventilation and high flow nasal cannulae delivery of oxygen in the emergency department are evolving modalities, but evidence for their use is currently limited.
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Affiliation(s)
- Colin Ve Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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30
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Stelmach I, Cichalewski Ł, Majak P, Smejda K, Podlecka D, Jerzyńska J, Stelmach W. School environmental factors are predictive for exercise-induced symptoms in children. Respir Med 2016; 112:25-30. [PMID: 26847408 DOI: 10.1016/j.rmed.2016.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/23/2015] [Accepted: 01/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Environmental factors in schools have a significant effect on the exercise-induced bronchoconstriction and symptoms in a general paediatric population. OBJECTIVES To determine the environmental factors such as atmospheric conditions and the presence of allergens in gymnasiums, that could be predictive of the presence of exercise-induced symptoms/bronchospasm in children during physical education (PE). METHODS 1370 schoolchildren were enrolled. Children attended 45 min PE lesson with similar exercise intensity. Pulmonary function tests were performed before and after PE lesson. Air temperature, humidity and pressure, samples of dust for allergen exposure in the gymnasiums were taken. Children who reported symptoms induced during PE lesson were invited to the clinic for ETC (exercise treadmill challenge) and atopy measurement. RESULTS 1033 participants were included into the analysis. Sixty seven(6.5%) children reported dyspnea/cough, and in 94(9.4%) children bronchoconstriction induced during PE lesson was documented. There is a correlation between the results of the ETC and bronchoconstriction after PE (OR: 2.55; 95%CI: 1.07-6.05; p = 0.034). Exposure to higher air pressure and higher humidity independently increase the risk of clinical symptoms reported during or after PE lesson. Exposure to cat's allergens increase the risk of bronchoconstriction (independently from atopy status). We showed significant interaction between presence of asthma and current ICS therapy as a risk of physical inactivity at school (OR: 4; 95%CI: 1.3-12; p < 0.001). CONCLUSION This study showed an effect of cat allergen and environmental factors (humidity, air pressure) on the appearance of exercise related cough/bronchoconstriction during activity class in a natural environment at school in a large urban population of schoolchildren.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland.
| | - Łukasz Cichalewski
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Paweł Majak
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Katarzyna Smejda
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Daniela Podlecka
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Włodzimierz Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
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D'Alba I, Carloni I, Ferrante AL, Gesuita R, Palazzi ML, de Benedictis FM. Hyperventilation syndrome in adolescents with and without asthma. Pediatr Pulmonol 2015; 50:1184-90. [PMID: 25470247 DOI: 10.1002/ppul.23145] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/09/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data on the prevalence of hyperventilation syndrome (HVS) in adolescents are scanty. OBJECTIVES To determine the prevalence of HVS in a population of adolescents with and without asthma, and to verify whether HVS was related to asthma activity. METHODS A population of adolescents was asked to self-complete a questionnaire, including the Nijmegen questionnaire to assess HVS, and a standardized asthma questionnaire. RESULTS Seven hundred and sixty questionnaires were suitable for analysis. One hundred and twenty subjects (15.8%) were classified as asthmatic. Forty-seven subjects (6.2%) had a Nijmegen score ≥ 23, which was suggestive of HVS. Symptoms indicative of HVS were ten times more common in subjects with asthma (25%) than in those without asthma (2.5%). Nijmegen score was significantly higher in subjects with lifetime asthma (P < 0.001), current episodic asthma (P < 0.05) and current active asthma (P < 0.001) than in those with no asthma. In the whole population, girls presented HVS more frequently than boys (P < 0.001). There was a significant effect of gender (females, OR 3.2) and status of asthma (lifetime asthma, OR 11.2; current episodic asthma, OR 8.9; current active asthma, OR 41.5) on the probability of suffering from HVS. CONCLUSIONS The prevalence of symptoms indicative of HVS in an unselected population of adolescents was relatively high. Symptoms were more common in girls and in subjects with asthma, and there was a significant effect of asthma activity on the probability of suffering from HVS. Further studies need to be performed in order to validate a screening tool for HVS in both adolescents and asthmatic subjects.
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Affiliation(s)
- Irene D'Alba
- Department of Mother and Child Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Ines Carloni
- Department of Mother and Child Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Anna Lisa Ferrante
- School Department for Educational Sciences, Research and Programs, Province of Pesaro Urbino, Italy
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnics University of Marche, Italy
| | - Maria Laura Palazzi
- Department of Mother and Child Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
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Mehlum CS, Walsted ES, Godballe C, Backer V. Supraglottoplasty as treatment of exercise induced laryngeal obstruction (EILO). Eur Arch Otorhinolaryngol 2015; 273:945-51. [DOI: 10.1007/s00405-015-3823-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Røksund OD, Heimdal JH, Olofsson J, Maat RC, Halvorsen T. Larynx during exercise: the unexplored bottleneck of the airways. Eur Arch Otorhinolaryngol 2015; 272:2101-9. [PMID: 25033930 PMCID: PMC4526593 DOI: 10.1007/s00405-014-3159-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/15/2014] [Indexed: 11/17/2022]
Abstract
Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3-15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes.
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Affiliation(s)
- Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway,
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Rother AK, Schwerk N, Brinkmann F, Klawonn F, Lechner W, Grigull L. Diagnostic Support for Selected Paediatric Pulmonary Diseases Using Answer-Pattern Recognition in Questionnaires Based on Combined Data Mining Applications--A Monocentric Observational Pilot Study. PLoS One 2015; 10:e0135180. [PMID: 26267801 PMCID: PMC4534438 DOI: 10.1371/journal.pone.0135180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/17/2015] [Indexed: 01/20/2023] Open
Abstract
Background Clinical symptoms in children with pulmonary diseases are frequently non-specific. Rare diseases such as primary ciliary dyskinesia (PCD), cystic fibrosis (CF) or protracted bacterial bronchitis (PBB) can be easily missed at the general practitioner (GP). Objective To develop and test a questionnaire-based and data mining-supported tool providing diagnostic support for selected pulmonary diseases. Methods First, interviews with parents of affected children were conducted and analysed. These parental observations during the pre-diagnostic time formed the basis for a new questionnaire addressing the parents’ view on the disease. Secondly, parents with a sick child (e.g. PCD, PBB) answered the questionnaire and a data base was set up. Finally, a computer program consisting of eight different classifiers (support vector machine (SVM), artificial neural network (ANN), fuzzy rule-based, random forest, logistic regression, linear discriminant analysis, naive Bayes and nearest neighbour) and an ensemble classifier was developed and trained to categorise any given new questionnaire and suggest a diagnosis. For estimating the diagnostic accuracy, we applied ten-fold stratified cross validation. Results All questionnaires of patients suffering from CF, asthma (AS), PCD, acute bronchitis (AB) and the healthy control group were correctly diagnosed by the fusion algorithm. For the pneumonia (PM) group 19/21 (90.5%) and for the PBB group 17/18 (94.4%) correct diagnoses could be reached. The program detected the correct diagnoses with an overall sensitivity of 98.8%. Receiver operating characteristics (ROC) analyses confirmed the accuracy of this diagnostic tool. Case studies highlighted the applicability of the tool in the daily work of a GP. Conclusion For children with symptoms of pulmonary diseases a questionnaire-based diagnostic support tool using data mining techniques exhibited good results in arriving at diagnostic suggestions. In the hands of a doctor, this tool could be of value in arousing awareness for rare pulmonary diseases such as PCD or CF.
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Affiliation(s)
- Ann-Katrin Rother
- Department of Paediatric Haematology and Oncology, University Children’s Hospital, Hanover Medical School, Hanover, Germany
| | - Nicolaus Schwerk
- Department of Paediatric Pneumology, Allergy and Neonatology, University Children's Hospital, Hanover Medical School, Hanover, Germany
| | - Folke Brinkmann
- Department of Paediatric Pneumology, University Children's Hospital, Ruhr- University Bochum, Bochum, Germany
| | - Frank Klawonn
- Helmholtz Centre for Infection Research, Braunschweig, Germany
- Ostfalia University of Applied Sciences, Wolfenbuettel, Germany
| | | | - Lorenz Grigull
- Department of Paediatric Haematology and Oncology, University Children’s Hospital, Hanover Medical School, Hanover, Germany
- * E-mail:
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Abstract
INTRODUCTION Recent studies have shown a remarkably high frequency of poorly controlled asthma. Several reasons for this treatment failure have been discussed, however, the basic question of whether the diagnosis is always correct has not been considered. Follow-up studies have shown that in many patients asthma cannot be verified despite ongoing symptoms. Mechanisms other than bronchial obstruction may therefore be responsible. The current definition of asthma may also include symptoms that are related to mechanisms other than bronchial obstruction, the clinical hallmark of asthma. AIM Based on a review of the four cornerstones of asthma - inflammation, hyperresponsiveness, bronchial obstruction and symptoms - the aim was to present some new aspects and suggestions related to the diagnosis of adult non-allergic asthma. CONCLUSION Recent studies have indicated that "classic" asthma may sometimes be confused with asthma-like disorders such as airway sensory hyperreactivity, small airways disease, dysfunctional breathing, non-obstructive dyspnea, hyperventilation and vocal cord dysfunction. This confusion may be one explanation for the high proportion of misdiagnosis and treatment failure. The current diagnosis, focusing on bronchial obstruction, may be too "narrow". As there may be common mechanisms a broadening to include also non-obstructive disorders, forming an asthma syndrome, is suggested. Such broadening requires additional diagnostic steps, such as qualitative studies with analysis of reported symptoms, non-effort demanding methods for determining lung function, capsaicin test for revealing airway sensory hyperreactivity, careful evaluation of the therapeutic as well as diagnostic effect of corticosteroids and testing of suggested theories.
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Affiliation(s)
- Olle Löwhagen
- a Institute of Medicine, Sahlgrenska Academy, University of Göteborg , Göthenburg , Sweden
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Montojo J, González R, Hernández E, Zafra M, Plaza G. Office-based laryngeal injection of botulinum toxin for paradoxical vocal fold motion in a child. Int J Pediatr Otorhinolaryngol 2015; 79:1161-3. [PMID: 26032616 DOI: 10.1016/j.ijporl.2015.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
We describe the case of a 13-year-old girl with paradoxical vocal fold motion (PVFM) who failed to improve with repeated medical treatment, speech therapy and psychotherapy, but was successfully treated with botulinum toxin A (BTX-A) injection to the vocal folds. For delivering the BTX-A we used a channeled fiber-optic laryngoscope under local anesthesia, in an office setting. The patient remained asymptomatic of PVFM for 5 months, was successfully treated again with the same method, and had no important side effects.
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Affiliation(s)
- José Montojo
- Otolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Ramón González
- Otolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Estefanía Hernández
- Otolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Miguel Zafra
- Pediatrics Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Guillermo Plaza
- Otolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
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Hilvering B, Pavord ID. What goes up must come down: biomarkers and novel biologicals in severe asthma. Clin Exp Allergy 2015; 45:1162-9. [DOI: 10.1111/cea.12500] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- B. Hilvering
- Department of Respiratory Medicine; Nuffield Department of Medicine; University of Oxford; Oxford UK
- Department of Respiratory Medicine; Laboratory of Translational Immunology; University Medical Center Utrecht; Utrecht The Netherlands
| | - I. D. Pavord
- Department of Respiratory Medicine; Nuffield Department of Medicine; University of Oxford; Oxford UK
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Cuerpo extraño bilateral en radiografía torácica. An Pediatr (Barc) 2015; 82:e205-6. [DOI: 10.1016/j.anpedi.2014.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 11/11/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
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Barker N, Everard ML. Getting to grips with 'dysfunctional breathing'. Paediatr Respir Rev 2015; 16:53-61. [PMID: 25499573 DOI: 10.1016/j.prrv.2014.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 11/25/2022]
Abstract
Dysfunctional breathing (DB) is common, frequently unrecognised and responsible for a substantial burden of morbidity. Previously lack of clarity in the use of the term and the use of multiple terms to describe the same condition has hampered our understanding. DB can be defined as an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms. It can be subdivided into thoracic and extra thoracic forms. Thoracic DB is characterised by breathing patterns involving relatively inefficient, excessive upper chest wall activity with or without accessory muscle activity. This is frequently associated with increased residual volume, frequent sighing and an irregular pattern of respiratory effort. It may be accompanied by true hyperventilation in the minority of subjects. Extra thoracic forms include paradoxical vocal cord dysfunction and the increasingly recognised supra-glottic 'laryngomalacia' commonly seen in young sportsmen and women. While the two forms would appear to be two discreet entities they often share common factors in aetiology and respond to similar interventions. Hence both forms are considered in this review which aims to generate a more coherent approach to understanding, diagnosing and treating these conditions.
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Affiliation(s)
- Nicki Barker
- Department of Respiratory Medicine, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Roberts Road, Subiaco 6008, Western Australia.
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41
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All that wheezes is not asthma! A case of cavitatory pediatric tuberculosis. J Emerg Med 2014; 48:331-2. [PMID: 25497841 DOI: 10.1016/j.jemermed.2014.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/26/2014] [Accepted: 09/30/2014] [Indexed: 11/21/2022]
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Fischer AJ, Singh SB, Adam RJ, Stoltz DA, Baranano CF, Kao S, Weinberger MM, McCray PB, Starner TD. Tracheomalacia is associated with lower FEV1 and Pseudomonas acquisition in children with CF. Pediatr Pulmonol 2014; 49:960-70. [PMID: 24166775 PMCID: PMC4711356 DOI: 10.1002/ppul.22922] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 09/17/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tracheomalacia (TM) occurs in approximately 1 in 2,100 children. Because the trachea develops abnormally in animal models of cystic fibrosis (CF), we hypothesized this may also occur in children with CF, increasing their risk of TM. PURPOSE To examine the prevalence and clinical consequences of TM in children with CF. METHODS We studied children with CF born between 1995 and 2012. TM was defined as dynamic collapse of the trachea, and the severity was recorded as described in the chart. The effect of TM on patient outcomes, including FEV1 , CT changes, and acquisition of CF pathogens, was assessed using a longitudinal patient dataset. RESULTS Eighty-nine percent of children with CF had at least one bronchoscopy (n = 97/109). Fifteen percent of these children had TM described in any bronchoscopy report (n = 15/97). Of the patients with TM, eight had meconium ileus (P = 0.003) and all were pancreatic insufficient. Pseudomonas aeruginosa infection occurred 1.3 years earlier among children with TM (P = 0.01). Starting FEV1 values by age 8 were diminished by over 18% of predicted for patients with TM. Life-threatening episodes of airway obstruction occurred in 3 of 15 patients with CF and TM, including one leading to death. Gender, prematurity, and hepatic disease were not associated with TM. No difference was observed in the frequency of bronchiectasis. CONCLUSIONS TM is significantly more common in infants and children with CF than in the general population and is associated with airway obstruction and earlier Pseudomonas acquisition.
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Abstract
The adolescent with asthma experiences a period of physical and psychosocial changes that affect their health and well-being. Overall, adolescents with asthma are at increased risk for asthma morbidity and death. Increased rates of depression and anxiety, for the adolescent and their caregivers, can lead to non-adherence to their medical regimens, poor symptom control, and poor treatment outcomes. Contextual factors, such as race, ethnicity, and living situation, affect the prevalence, morbidity, and mortality for the adolescent with asthma. These factors also affect the transition process for adolescents entering adult medical care. An overview is presented of how the adolescent with asthma differs and how healthcare providers can promote effective asthma management and better asthma control.
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Affiliation(s)
- Matthew J Bitsko
- Children's Hospital of Richmond at VCU, Richmond, VA 23298, USA; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA; Department of Psychology, Virginia Commonwealth University, Richmond, VA, 23284, USA.
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Bruce K Rubin
- Children's Hospital of Richmond at VCU, Richmond, VA 23298, USA; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA
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Abstract
A clinical diagnosis of asthma is often considered when a child presents with recurrent cough, wheeze and breathlessness. However, there are many other causes of wheeze in a young child. These range from recurrent viral infections to chronic suppurative lung disease, gastro-oesophageal reflux disease and rare structural abnormalities. Arriving at a diagnosis includes taking into consideration the symptomatology, triggers, atopic features, family history, absence of red flags and therapeutic trial, where indicated.
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Affiliation(s)
- Mark Chung Wai Ng
- SingHealth Family Medicine Residency Programme, 3 Second Hospital Avenue, Singapore 168937.
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Christensen PM, Maltbæk N, Jørgensen IM, Nielsen KG. Can flow-volume loops be used to diagnose exercise induced laryngeal obstructions? A comparison study examining the accuracy and inter-rater agreement of flow volume loops as a diagnostic tool. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:306-11. [PMID: 23955336 PMCID: PMC6442823 DOI: 10.4104/pcrj.2013.00067] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Pre- and post-exercise flow-volume loops are often recommended as an easy non-invasive method for diagnosing or excluding exercise-induced laryngeal obstructions in patients with exercise-related respiratory symptoms. However, at present there is no evidence for this recommendation. Aims: To compare physician evaluated pre- and post-exercise flow-volume loops and flow data with laryngoscopic findings during exercise. Methods: Data from 100 consecutive exercise tests with continuous laryngoscopy during the test were analysed. Laryngoscopic images were compared with the corresponding pre- and post-exercise flow-volume loops assessed by four separate physicians and with data from the loops (forced inspiratory flow (FIF) at 25% vs. FIF at 75% of forced inspiratory vital capacity (FIVC), forced expiratory flow at 50% of forced expiratory volume vs. FIF at 50% of FIVC, and FIVC vs. FIF at 50% of FIVC). Results: There was no significant association between the laryngoscopic findings and the flow-volume data. There was no agreement between the four physicians in their assessment of the flow-volume loops (kappa <0.00), and none of the individual physician's assessments were significantly associated with the laryngoscopic findings. Conclusions: Exercise-induced laryngeal obstructions cannot be diagnosed or excluded by physician evaluated pre- and post-exercise flow-volume loops or flow data alone.
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Affiliation(s)
- Pernille M Christensen
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Johansson H, Norlander K, Hedenström H, Janson C, Nordang L, Nordvall L, Emtner M. Exercise-induced dyspnea is a problem among the general adolescent population. Respir Med 2014; 108:852-8. [PMID: 24731799 DOI: 10.1016/j.rmed.2014.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
RATIONALE Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. OBJECTIVE To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. METHODS A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). RESULTS Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often than the group without EID. No difference was found in the level of physical activity between participants with and without EID. CONCLUSION Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms.
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Affiliation(s)
- H Johansson
- Physiotherapy, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
| | - K Norlander
- Otolaryngology and Head & Neck Surgery, Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - H Hedenström
- Clinical Physiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - C Janson
- Respiratory Medicine and Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - L Nordang
- Otolaryngology and Head & Neck Surgery, Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - L Nordvall
- Pediatrics, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Emtner
- Physiotherapy, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Weinberger M. Exercise-induced dyspnea: more than vocal cord dysfunction or laryngomalacia. Ann Allergy Asthma Immunol 2014; 112:270-1. [PMID: 24428967 DOI: 10.1016/j.anai.2013.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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48
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Abstract
Pediatric asthma is a disease that is managed across outpatient physicians, hospitalists, critical care physicians, and emergency department (ED) physicians. Scoring systems may facilitate a rapid assessment of the child with asthma in the ED. Short-acting beta agonists are still the mainstay of therapy for acute exacerbations along with corticosteroids and ipratropium bromide. ED providers must also know the indications for noninvasive ventilation and intubation. Most patients can be treated and discharged from the ED after acute exacerbation, and should be given a plan for going home that provides educational material and emergency scenarios to help prevent future acute incidents.
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49
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Abstract
The management of chronic cough, a common complaint in children, is challenging for most health care professionals. Millions of dollars are spent every year on unnecessary testing and treatment. A rational approach based on a detailed interview and a thorough physical examination guides further intervention and management. Inexpensive and simple homemade syrups based on dark honey have proved to be an effective measure when dealing with cough in children.
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50
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Sandnes A, Andersen T, Hilland M, Ellingsen TA, Halvorsen T, Heimdal JH, Røksund OD. Laryngeal Movements During Inspiratory Muscle Training in Healthy Subjects. J Voice 2013; 27:448-53. [DOI: 10.1016/j.jvoice.2013.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/26/2013] [Indexed: 11/16/2022]
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