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Thomas RJ, Yerkovich ST, Goyal V, Chang AB, Rutter C, Masters IB, Marchant JM. The utility of elective flexible bronchoscopy to improve quality of life and clinical outcomes for children: A systematic review. Pediatr Pulmonol 2024. [PMID: 38411339 DOI: 10.1002/ppul.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there is limited evidence regarding the utility of elective FB in children. This systematic review (SRs) aimed to determine the utility of FB on its impact in clinical decision making and quality of life (QoL). METHODS We searched Pubmed, Cochrane central register of controlled trials, Embase, World Health Organization Clinical Trials Registry Platform and Cochrane database of SRs from inception to April 20, 2023. We included SRs and randomized controlled trials (RCTs) that used parallel group design (comparing use of elective FB vs. no FB, or a wait-list approach [early FB vs. usual wait FB]) in children aged ≤ 18 years. Our protocol was prospectively registered and used Cochrane methodology for systemic reviews of interventions. RESULTS Our search identified 859 articles; 102 duplicates were removed, and 753 articles were excluded by title and abstract. Four full text articles were reviewed and subsequently excluded, as none met the inclusion criteria outlined in our patient, intervention, comparator, outcome measures framework. CONCLUSIONS There is a paucity of high-quality RCT evidence to support the routine use of elective FB in children with respiratory conditions. However, available retrospective and a single prospective study demonstrate the high utility of FB in the elective pediatric setting. REGISTRATION PROSPERO CRD42021291305.
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Affiliation(s)
- Rahul J Thomas
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Departments of Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cameron Rutter
- Academic Division, Library, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Thomas R, Marchant JM, Goyal V, Masters IB, Yerkovich ST, Chang AB. Clinical utility of elective paediatric flexible bronchoscopy and impact on the quality of life: protocol for a single-centre, single-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e001704. [PMID: 38413121 PMCID: PMC10900573 DOI: 10.1136/bmjresp-2023-001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there are no randomised controlled trials (RCTs) that have examined its benefits (or otherwise).Our primary aim is to determine the impact of FB on the parent-proxy quality-of-life (QoL) scores. Our secondary aims are to determine if undertaking FB leads to (a) change in management and (b) improvement of other relevant patient-reported outcome measures (PROMs). We also quantified the benefits of elective FB (using 10-point Likert scale). We hypothesised that undertaking elective FB will contribute to accurate diagnosis and therefore appropriate treatment, which will in turn improve QoL and will be deemed to be beneficial from patient and doctor perspectives. METHODS AND ANALYSIS Our parallel single-centre, single-blind RCT (commenced in May 2020) has a planned sample size of 114 children (aged <18 years) recruited from respiratory clinics at Queensland Children's Hospital, Brisbane, Australia. Children are randomised (1:1 concealed allocation) within two strata: age (≤2 vs >2 years) and indication for FB (chronic cough vs other indications) to either (a) early arm (intervention where FB undertaken within 2 weeks) or (b) delayed (control, FB undertaken at usual wait time). Our primary outcome is the difference between groups in their change in QoL at the T2 timepoint when the intervention group has had the FB and the control group has not. Our secondary outcomes are change in management, change in PROMs, adverse events and the Likert scales. ETHICS AND DISSEMINATION The human research ethics committee of the Queensland Children's Hospital granted ethical clearance (HREC/20/QCHQ/62394). Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation. Results will be disseminated through conference presentations, teaching avenues, workshops, websites and publications. REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12620000610932.
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Affiliation(s)
- Rahul Thomas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| | - Anne B Chang
- Respiratory Medicine, Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
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Goyal V, Yerkovich ST, Grimwood K, Marchant JM, Byrnes CA, Masters IB, Chang AB. Phenotypic Features of Pediatric Bronchiectasis Exacerbations Associated With Symptom Resolution After 14 Days of Oral Antibiotic Treatment. Chest 2023; 164:1378-1386. [PMID: 37437879 DOI: 10.1016/j.chest.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/12/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Respiratory exacerbations in children and adolescents with bronchiectasis are treated with antibiotics. However, antibiotics can have variable interindividual effects when treating exacerbations. RESEARCH QUESTION Can phenotypic features associated with symptom resolution after a 14-day course of oral antibiotics for a nonsevere exacerbation of bronchiectasis be identified? STUDY DESIGN AND METHODS Combining data from two multicenter randomized controlled trials, we identified 217 children with bronchiectasis assigned to at least 14 days of oral antibiotics to treat nonsevere (nonhospitalized) exacerbations. Univariable and then multivariable logistic regression were used to identify factors associated with symptom resolution within 14 days of commencing antibiotics. Identified associations were re-evaluated by mediation analysis. RESULTS Of the 217 study participants (52% male patients), 41% were Indigenous (Australian First Nations, New Zealand Māori, or Pacific Islander). The median age was 6.6 years (interquartile range, 4.0-10.1 years). By day 14, symptoms had resolved in 130 children (responders), but persisted in the remaining 87 children (nonresponders). Multivariable analysis found those who were Indigenous (adjusted OR [AOR], 3.59; 95% CI, 1.35-9.54) or showed new abnormal auscultatory findings (AOR, 3.85; 95% CI, 1.56-9.52) were more likely to be responders, whereas those with multiple bronchiectatic lobes at diagnosis (AOR, 0.66; 95% CI, 0.46-0.95) or higher cough scores when starting exacerbation treatment (AOR, 0.55; 95% CI, 0.34-0.90) were more likely to be nonresponders. Detecting a respiratory virus at the beginning of an exacerbation was not associated with antibiotic failure at 14 days. INTERPRETATION Children with Indigenous ethnicity, milder bronchiectasis, mild exacerbations (low reported cough scores), or new abnormal auscultatory signs are more likely to respond to appropriate oral antibiotics than those without these features. These patient and exacerbation phenotypes may assist clinical management and development of biomarkers to identify those whose symptoms are more likely to resolve after 14 days of oral antibiotics. TRIAL REGISTRY Australian New Zealand Clinical Trials Registry; Nos.: ACTRN12612000011886 and ACTRN12612000010897; URL: https://www.anzctr.org.au.
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Affiliation(s)
- Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; Department of Paediatrics, Gold Coast Health, Griffith University, Gold Coast, QLD, Australia.
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis, Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Keith Grimwood
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Griffith University Gold Coast, QLD, Australia; School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand; Paediatric Respiratory Medicine, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand
| | - Ian Brent Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis, Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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Azam S, Montaha S, Rafid AKMRH, Karim A, Jonkman M, De Boer F, McCallum G, Masters IB, Chang A. An Automated Broncho-Arterial (BA) Pair Segmentation Process and Assessment of BA Ratios in Children with Bronchiectasis Using Lung HRCT Scans: A Pilot Study. Biomedicines 2023; 11:1874. [PMID: 37509513 PMCID: PMC10376950 DOI: 10.3390/biomedicines11071874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Bronchiectasis in children can progress to a severe lung condition if not diagnosed and treated early. The radiological diagnostic criteria for the diagnosis of bronchiectasis is an increased broncho-arterial (BA) ratio. From high-resolution computed tomography (HRCT) scans, the BA pairs must be detected first to derive the BA ratio. This study aims to identify potential BA pairs from HRCT scans of children undertaken to evaluate suppurative lung disease through an automated approach. After segmenting the lung regions, the HRCT scans are cleaned using a histogram analysis-based approach followed by a potential arteries identification process comprising four conditions based on imaging features. Potential arteries and their connected components are extracted, and potential bronchi are identified. Finally, the coordinates of potential arteries and potential bronchi are matched as the last step of BA pairs extraction. A total of 8-50 BA pairs are detected for each patient. Additionally, the area and several diameters of the bronchi and arteries are measured, and BA ratios based on these are calculated. Through this approach, the BA pairs of a CT scan datasets are detected and utilizing a deep learning model, a high classification test accuracy of 98.53% is achieved, validating the robustness of the proposed BA detection approach. The results show that visible BA pairs can be identified and segmented automatically, and the BA ratio calculated may help diagnose bronchiectasis with less effort and time.
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Affiliation(s)
- Sami Azam
- Faculty of Science and Technology, Charles Darwin University, Casuarina, NT 0909, Australia
| | - Sidratul Montaha
- Faculty of Science and Technology, Charles Darwin University, Casuarina, NT 0909, Australia
| | | | - Asif Karim
- Faculty of Science and Technology, Charles Darwin University, Casuarina, NT 0909, Australia
| | - Mirjam Jonkman
- Faculty of Science and Technology, Charles Darwin University, Casuarina, NT 0909, Australia
| | - Friso De Boer
- Faculty of Science and Technology, Charles Darwin University, Casuarina, NT 0909, Australia
| | - Gabrielle McCallum
- Child Health Division, Menzies School of Health Research, Darwin, NT 0811, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD 4101, Australia
| | - Anne Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT 0811, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD 4101, Australia
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Xu Z, Masters IB, Barbaro P, Miller S, Kapur N. Hemoglobin I‐Toulouse: A rare hemoglobinopathy presenting with low oxygen saturations. Clin Case Rep 2022; 10:e6111. [PMID: 35898763 PMCID: PMC9309734 DOI: 10.1002/ccr3.6111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/25/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
We report a child with persistently low oxygen saturations (SpO2 90%–92%) [normal SpO2 > 98%], with delayed diagnosis due to the co‐existing congenital pulmonary airway malformation with possible arterio‐venous malformation. The diagnosis was only achieved after low oxygen saturations incidentally discovered from the child's father. The eventual cause was Hemoglobin I‐Toulouse, making both patients the first reported cases with low oxygen saturations.
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Affiliation(s)
- Ziheng Xu
- Griffith University South Brisbane Queensland Australia
| | | | - Pasquale Barbaro
- Queensland Children's Hospital South Brisbane Queensland Australia
| | | | - Nitin Kapur
- Queensland Children's Hospital South Brisbane Queensland Australia
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Thomas R, Chang A, Masters IB, Grimwood K, Marchant J, Yerkovich S, Chatfield M, O'Brien C, Goyal V. Association of childhood tracheomalacia with bronchiectasis: a case-control study. Arch Dis Child 2022; 107:565-569. [PMID: 34649867 DOI: 10.1136/archdischild-2021-322578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/27/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Children with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis. DESIGN Single-centre, case-control study. SETTING AND PATIENTS 45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT. INTERVENTIONS The bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area). MAIN OUTCOME MEASURES AND RESULTS Cases were younger (median age=2.6 years, IQR 1.5-4.1) than controls (7.8 years, IQR 3.4-12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (ORadj)=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (ORadj=24.4, 95% CI 3.4 to infinity). CONCLUSION Bronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic (>4 weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.
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Affiliation(s)
- Rahul Thomas
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia .,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anne Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia's Northern Territory, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University Faculty of Health, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases, Gold Coast University Hospital, Southport, Queensland, Australia.,Department of Paediatrics, Gold Coast Health, Southport, Queensland, Australia
| | - Julie Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia's Northern Territory, Australia
| | - Mark Chatfield
- Faculty of Medicine, The University of Queensland Faculty of Health Sciences, Herston, Queensland, Australia
| | - Christopher O'Brien
- Department of Radiology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Paediatrics, Gold Coast Health, Southport, Queensland, Australia
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Wong MD, Thomas RJ, Powell J, Masters IB. Flexible Bronchoscopy Diagnosis of Uncommon Congenital H-type Tracheoesophageal Fistula, Dual Fistulae, Bronchoesophageal Fistula, and Recurrence of Fistula in Children: A 20-year Experience. J Bronchology Interv Pulmonol 2022; 29:99-108. [PMID: 34282086 DOI: 10.1097/lbr.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interventional pediatric flexible bronchoscopy has many advantages over radiologic investigations in diagnosing uncommon congenital H-type tracheoesophageal fistula (TEF), dual TEF, bronchoesophageal fistula (BEF) and fistula recurrence including higher rates of identification and anatomic localization with guide wire cannulation. We compare the diagnostic utility of flexible bronchoscopy to radiologic techniques for congenital aerodigestive fistula. METHODS A single center retrospective review was completed of all cases of pediatric TEF and BEF diagnosed with flexible bronchoscopy between January 2000 and November 2020. RESULTS Fistulae were diagnosed 21 times in 18 patients at a median age of 1.22 years (interquartile range: 0.50 to 2.99). The median time from diagnosis to repair was 17.5 days (interquartile range: 5.5 to 43). Symptoms commonly related to fistula were found in all patients. Uncommon fistulae included single H-type TEF (n=10, 47.6%), dual H-type TEF (n=2, 9.5%), dual proximal and distal TEF with esophageal atresia (n=5, 23.8%), TEF recurrence (n=2, 14.3%), BEF (n=1, 4.8%), and a BEF recurrence (n=1, 4.8%). Flexible bronchoscopy confirmed the diagnosis in all fistulae using a guide wire cannulation or methylene blue dye injection. A combined procedure with simultaneous bronchoscopy and esophagoscopy was used for 6 fistulae. The positive examination rate was 75% for bronchoscopy compared with 2.6% for contrast swallow studies and 28.6% for tube esophagograms. CONCLUSIONS Flexible bronchoscopy should be considered as a first line investigation in uncommon aerodigestive fistulae. In the absence of a skilled bronchoscopist, the best radiologic investigation is a pull-back tube esophagogram but may still require endoscopic confirmation at the time of fistula repair.
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Affiliation(s)
- Matthew D Wong
- Departments of Pediatric Respiratory and Sleep Medicine
- Centre for Children's Health Research, South Brisbane
- School of Clinical Medicine, University of Queensland
| | - Rahul J Thomas
- Departments of Pediatric Respiratory and Sleep Medicine
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jennifer Powell
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital
- School of Clinical Medicine, University of Queensland
| | - Ian Brent Masters
- Departments of Pediatric Respiratory and Sleep Medicine
- Centre for Children's Health Research, South Brisbane
- School of Clinical Medicine, University of Queensland
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Masters IB, Chang AB. Impact of using spirometry on clinical decision making and quality of life in children: protocol for a single centre randomised controlled trial. BMJ Open 2021; 11:e050974. [PMID: 34548360 PMCID: PMC8458340 DOI: 10.1136/bmjopen-2021-050974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/05/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Although spirometry has been available for decades, it is underused in paediatric practice, other than in specialist clinics. This is unsurprising as there is limited evidence on the benefit of routine spirometry in improving clinical decision making and/or outcomes for children. We hypothesised that using spirometry for children being evaluated for respiratory diseases impacts on clinical decision making and/or improves patient-related outcome measures (PROMs) and/or quality of life (QoL), compared with not using spirometry. METHODS AND ANALYSIS We are undertaking a randomised controlled trial (commenced in March 2020) that will include 106 children (aged 4-18 years) recruited from respiratory clinics at Queensland Children's Hospital, Australia. Inclusion criteria are able to perform reliable spirometry and a parent/guardian who can complete questionnaire(s). Children (1:1 allocation) are randomised to clinical medical review with spirometry (intervention group) or without spirometry (control group) within strata of consultation status (new/review), and cough condition (present/absent). The primary outcome is change in clinical decision making. The secondary outcomes are change in PROM scores, opinions regarding spirometry and degree of diagnosis certainty. Intergroup differences of these outcomes will be determined by χ2 test or unpaired t-test (or Mann-Whitney if not normally distributed). Change in outcomes within the control group after review of spirometry will also be assessed by McNemar's test or paired t-test/Wilcoxon signed-rank test. ETHICS AND DISSEMINATION The Human Research Ethics Committee of the Queensland Children's Hospital approved the study. The trial results will be disseminated through conference presentations, teaching avenues and publications. TRIAL REGISTRATION NUMBER ACTRN12619001686190; Pre-results.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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King Z, Josee-Leclerc M, Wales P, Masters IB, Kapur N. Can CPAP Therapy in Pediatric OSA Ever Be Stopped? J Clin Sleep Med 2019; 15:1609-1612. [PMID: 31739850 PMCID: PMC6853401 DOI: 10.5664/jcsm.8022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/14/2020] [Accepted: 07/15/2019] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVES Continuous positive airway pressure (CPAP) has been increasingly used in children with obstructive sleep apnea (OSA), though it is unclear whether it can ever be ceased. We describe the clinical, demographic, and polysomnographic (PSG) characteristics of a cohort of children with OSA who were successfully weaned off CPAP. METHODS From a pediatric cohort on CPAP for OSA at the Queensland Children's Hospital between January 2016 and December 2017, a subgroup of children who were taken off CPAP were retrospectively studied. RESULTS CPAP therapy was stopped for 53 children over a 2-year period; 29 of these were excluded from analysis due to change to bilevel support (n = 2), transition to adult care (n = 12), or cessation due to poor adherence (n = 15). A total of 24 children [median (interquartile range, IQR) age 4.1 years (1.0-10.5); 18 males] were successfully weaned off CPAP therapy based on improvement in clinical and PSG parameters; and were included in the analysis. These children had a median (IQR) apnea-hypopnea index (AHI) of 9.8 (5.7-46.0) at CPAP initiation, which improved to 3.3 (0.4-2.2) at CPAP cessation after a median (IQR) duration of 1.0 (0.5-2.0) year. The reasons for CPAP cessation included improved symptoms and/or PSG parameters with time (n = 11); improvement after airway surgery (n = 7), and improvement of body mass index (n = 2). In four children, CPAP therapy was ceased after initial trial due to low physician perceived clinical benefit. CONCLUSIONS This is the first study describing the characteristics of children and likely reasons for successful CPAP cessation. Children on CPAP should be regularly screened for ongoing CPAP need.
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Affiliation(s)
- Zachary King
- Queensland Children’s Hospital, South Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | | | - Pat Wales
- Queensland Children’s Hospital, South Brisbane, Australia
| | - Ian Brent Masters
- Queensland Children’s Hospital, South Brisbane, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Nitin Kapur
- Queensland Children’s Hospital, South Brisbane, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, Australia
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Su SC, Masters IB, Buntain H, Frawley K, Sarikwal A, Watson D, Ware F, Wuth J, Chang AB. A comparison of virtual bronchoscopy versus flexible bronchoscopy in the diagnosis of tracheobronchomalacia in children. Pediatr Pulmonol 2017; 52:480-486. [PMID: 27641078 DOI: 10.1002/ppul.23606] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/11/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Flexible bronchoscopy (FB) is the current gold standard for diagnosing tracheobronchomalacia. However, it is not always feasible and virtual bronchoscopy (VB), acquired from chest multi-detector CT (MDCT) scan is an alternative diagnostic tool. We determined the sensitivity, specificity, and positive and negative predictive values of VB compared to FB in diagnosing tracheobronchomalacia. METHODS Children aged <18-years scheduled for FB and MDCT were recruited. FB and MDCT were undertaken within 30-min to 7-days of each other. Tracheobronchomalacia (mild, moderate, severe, very severe) diagnosed on FB were independently scored by two pediatric pulmonologists; VB was independently scored by two pairs (each pair = pediatric pulmonologist and radiologist), in a blinded manner. RESULTS In 53 children (median age = 2.5 years, range 0.8-14.3) evaluated for airway abnormalities, tracheomalacia was detected in 37 (70%) children at FB. Of these, VB detected tracheomalacia in 20 children, with a sensitivity of 54.1% (95%CI 37.1-70.2), specificity = 87.5% (95%CI 60.4-97.8), and positive predictive value = 90.9% (95%CI 69.4-98.4). The agreement between pediatric pulmonologists for diagnosing tracheomalacia by FB was excellent, weighted κ = 0.8 (95%CI 0.64-0.97); but only fair between the pairs of pediatric pulmonologists/radiologists for VB, weighted κ = 0.47 (95%CI 0.23-0.71). There were 42 cases of bronchomalacia detected on FB. VB had a sensitivity = 45.2% (95%CI 30.2-61.2), specificity = 95.5% (95%CI 94.2-96.5), and positive predictive value = 23.2 (95%CI 14.9-34.0) compared to FB in detecting bronchomalacia. CONCLUSION VB cannot replace FB as the gold standard for detecting tracheobronchomalacia in children. However, VB could be considered as an alternative diagnostic modality in children with symptoms suggestive of tracheobronchomalacia where FB is unavailable. Pediatr Pulmonol. 2017;52:480-486. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Siew Choo Su
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia.,Respiratory Unit, Department of Pediatrics, Hospital Tengku Ampuan Rahimah, Jalan Langat, Klang 41200, Selangor, Malaysia
| | - Ian Brent Masters
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia
| | - Helen Buntain
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia
| | - Kieran Frawley
- Department of Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anubhav Sarikwal
- Department of Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Debbie Watson
- Department of Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Frances Ware
- Department of Anesthesia, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Jan Wuth
- Department of Anesthesia, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anne Bernadette Chang
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Nguyen P, Bashirzadeh F, Hundloe J, Salvado O, Dowson N, Ware R, Masters IB, Ravi Kumar A, Fielding D. Grey scale texture analysis of endobronchial ultrasound mini probe images for prediction of benign or malignant aetiology. Respirology 2015; 20:960-6. [DOI: 10.1111/resp.12577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/31/2014] [Accepted: 03/02/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Phan Nguyen
- Department of Thoracic Medicine; The Royal Adelaide Hospital; Adelaide South Australia
| | - Farzad Bashirzadeh
- Department of Thoracic Medicine; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Justin Hundloe
- Department of Thoracic Medicine; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Olivier Salvado
- The Australian eHealth Research Centre; CSIRO Information and Communication Technologies Centre; Brisbane Queensland Australia
| | - Nicholas Dowson
- The Australian eHealth Research Centre; CSIRO Information and Communication Technologies Centre; Brisbane Queensland Australia
| | - Robert Ware
- Queensland Children's Medical Research Institute; Brisbane Queensland Australia
| | - Ian Brent Masters
- Department of Respiratory Medicine; The Royal Children's Hospital; Brisbane Queensland Australia
| | - Aravind Ravi Kumar
- Queensland PET Service; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - David Fielding
- Department of Thoracic Medicine; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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Jackson M, Kapur N, Goyal V, Choo K, Sarikwal A, Masters IB, Isles AF. Barium aspiration in an infant: a case report and review of management. Front Pediatr 2014; 2:37. [PMID: 24818122 PMCID: PMC4013468 DOI: 10.3389/fped.2014.00037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/16/2014] [Indexed: 11/23/2022] Open
Abstract
We describe a case of bilateral inhalation of barium in an infant following a barium swallow for investigation of dusky spells associated with feeds. A bronchoscopy subsequently revealed the presence of a mid-tracheal tracheo-esophageal cleft. To date, little has been reported on barium aspiration in children and there is no consensus for management. We review the literature on barium aspiration, its consequences, and make recommendations for management.
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Affiliation(s)
- M Jackson
- Department of Respiratory Medicine, Royal Children's Hospital, Queensland Children's Respiratory Centre , Brisbane, QLD , Australia
| | - N Kapur
- Department of Respiratory Medicine, Royal Children's Hospital, Queensland Children's Respiratory Centre , Brisbane, QLD , Australia ; University of Queensland , Brisbane, QLD , Australia ; The Queensland Children's Medical Research Institute , Brisbane, QLD , Australia
| | - V Goyal
- Department of Respiratory Medicine, Royal Children's Hospital, Queensland Children's Respiratory Centre , Brisbane, QLD , Australia ; University of Queensland , Brisbane, QLD , Australia ; The Queensland Children's Medical Research Institute , Brisbane, QLD , Australia
| | - K Choo
- University of Queensland , Brisbane, QLD , Australia ; Department of Paediatric Surgery, Royal Children's Hospital , Brisbane, QLD , Australia
| | - A Sarikwal
- University of Queensland , Brisbane, QLD , Australia ; Department of Medical Imaging, Royal Children's Hospital , Brisbane, QLD , Australia
| | - I B Masters
- Department of Respiratory Medicine, Royal Children's Hospital, Queensland Children's Respiratory Centre , Brisbane, QLD , Australia ; University of Queensland , Brisbane, QLD , Australia ; The Queensland Children's Medical Research Institute , Brisbane, QLD , Australia
| | - Alan F Isles
- Department of Respiratory Medicine, Royal Children's Hospital, Queensland Children's Respiratory Centre , Brisbane, QLD , Australia ; University of Queensland , Brisbane, QLD , Australia ; The Queensland Children's Medical Research Institute , Brisbane, QLD , Australia
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Chang AB, Robertson CF, van Asperen PP, Glasgow NJ, Masters IB, Teoh L, Mellis CM, Landau LI, Marchant JM, Morris PS. A cough algorithm for chronic cough in children: a multicenter, randomized controlled study. Pediatrics 2013; 131:e1576-83. [PMID: 23610200 DOI: 10.1542/peds.2012-3318] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children. METHODS A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm ("early-arm"); or (2) usual care until review and use of cough algorithm ("delayed-arm"). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm's reliability, validity, and feasibility. RESULTS Cough resolution (at week 6) was significantly more likely in the early-arm group compared with the delayed-arm group (absolute risk reduction: 24.7% [95% confidence interval: 13-35]). The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group (mean difference between groups: 0.6 [95% confidence interval: 0.29-1.0]). Duration of cough postrandomization was significantly shorter in the early-arm group than in the delayed-arm group (P = .001). The cough algorithm was reliable (κ = 1 in key steps). Feasibility was demonstrated by the algorithm's validity (93%-100%) and efficacy (99.6%). Eighty-five percent of children had etiologies easily diagnosed in primary care. CONCLUSIONS Management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes irrespective of when it is implemented. Further testing of this standardized clinical algorithm in different settings is recommended.
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Affiliation(s)
- Anne Bernadette Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
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Moore P, Smith H, Greer RM, McElrea M, Masters IB. Pulmonary function and long-term follow-up of children with tracheobronchomalacia. Pediatr Pulmonol 2012; 47:700-5. [PMID: 22170871 DOI: 10.1002/ppul.21612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 10/16/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Primary tracheobronchomalacia (TBM) is a disease of the large airways. Long-term follow-up studies of TBM patients have not been reported. This study was undertaken to further elicit the natural history of this condition and the presence of concomitant reactive airways disease through clinical profiling and pulmonary function testing. METHODS Twenty-one children diagnosed with TBM by bronchoscopy between 1998 and 2001 in Queensland were recruited in 2008. Parents completed a questionnaire detailing their child's respiratory symptoms over the previous 12 months. Children then undertook pulmonary function and flow-volume loop classification. Mannitol bronchial provocation testing or post-bronchodilator spirometry was performed to assess for the confounding presence of reactive airways disease. RESULTS Data from 19 children (12 males) were able to be analyzed. The median age was 9.4 (range 7.6-14.3) years. 15 parents indicated their child's symptoms were unresolved. The mean FEV(1) was 81% predicted with 7 <80% predicted. This was significantly lower than the percent predicted population mean (P = 0.0005). Mean FEV(1) /FVC, FEF(25-75) , and PEF were also significantly reduced (P = < 0.0001). Four participants had a classical TBM flow-volume loop on analysis. One of 15 (6.7%) participants recorded a positive test for reactive airways disease. CONCLUSIONS Clinical symptom profiles and pulmonary function indicate persistent functional mechanical abnormalities of the large and small airways in TBM patients, and the absence of reactive airways disease.
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Affiliation(s)
- Peter Moore
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
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Nguyen P, Bashirzadeh F, Hodge R, Agnew J, Farah CS, Duhig E, Clarke B, Perry-Keene J, Botros D, Masters IB, Fielding D. High specificity of combined narrow band imaging and autofluorescence mucosal assessment of patients with head and neck cancer. Head Neck 2012; 35:619-25. [PMID: 22740333 DOI: 10.1002/hed.22999] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate combined autofluorescence (AF) and narrow band imaging (NBI) for detection of mucosal lesions additional to known primary head and neck cancers and to determine impact on management. METHODS Patients with head and neck cancer requiring preoperative screening or posttreatment surveillance had white light (WL), AF and NBI inspection of the head and neck and bronchus. Known primary cancers were not analyzed, only additional lesions. Moderate dysplasia or worse was considered significant. RESULTS In all, 73 patients were recruited. Respectively, there were 24 and 18 additional lesions in the head and neck and bronchus that had significant histopathology. In both regions, AF and NBI were more sensitive than WL for detecting significant dysplasia with NBI demonstrating better specificity than AF (p = .003); 11 of 73 patients (15.1%) had additional findings detected by AF and NBI, which had an impact on management. CONCLUSION Combined AF and NBI inspection is highly specific at panendoscopy and can influence management.
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Affiliation(s)
- Phan Nguyen
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Marchant J, Masters IB, Champion A, Petsky H, Chang AB. Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax 2012; 67:689-93. [DOI: 10.1136/thoraxjnl-2011-201506] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sanchez MO, Greer MC, Masters IB, Chang AB. A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia. Pediatr Pulmonol 2012; 47:63-7. [PMID: 21830315 DOI: 10.1002/ppul.21517] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 06/16/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Flexible bronchoscopy (FB) is the gold standard method of diagnosing tracheomalacia but it is not always feasible in settings with limited resources. Fluoroscopy is sometimes performed as an alternative diagnostic tool but there are no prospective studies that have evaluated the diagnostic accuracy of airway fluoroscopy for tracheomalacia using a-priori definitions. We determined the sensitivity, specificity, and likelihood predictive ratio of airway fluoroscopy compared with FB in children suspected of having an airway abnormality. METHODS Airway fluoroscopic examination was undertaken within 2-weeks of a FB in children aged <18-years and reported by a pediatric radiologist blinded to FB data. Fluoroscopic and FB methods and diagnostic criteria were standardized and defined a-priori. Tracheomalacia diagnosed by FB were independently scored (mild, moderate, severe) by 2 pulmonologists in a blinded manner. RESULTS In 22 children (median age 33 months, range 1-187) evaluated for airway abnormality, tracheomalacia was found in 21 children at bronchoscopy. Of these, fluoroscopy detected tracheomalacia in five children. Airway fluoroscopy was poorly sensitive (23.8%) but highly specific (100%), positive likelihood ratio was 8.6. However, in moderate-severe tracheomalacia, the sensitivity improved to 57.1% but the specificity reduced (93.3%). The agreement between bronchoscopists for tracheomalacia severity was excellent, weighted kappa 0.74 (95% CI 0.77, 0.98). CONCLUSION Airway fluoroscopy cannot replace FB which remains the tool for definitively diagnosing airway malacia. However, in absence of other modalities for diagnosis fluoroscopy should be considered in the setting of persistent respiratory symptoms compatible with the clinical picture of tracheomalacia.
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Affiliation(s)
- M O Sanchez
- Queensland Children's Respiratory Centre and Queensland Children's Medical Research Institute, Brisbane, Queensland, Australia.
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Nguyen P, Bashirzadeh F, Hundloe J, Salvado O, Dowson N, Ware R, Masters IB, Bhatt M, Kumar AR, Fielding D. Optical differentiation between malignant and benign lymphadenopathy by grey scale texture analysis of endobronchial ultrasound convex probe images. Chest 2011; 141:709-715. [PMID: 21885729 DOI: 10.1378/chest.11-1016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Morphologic and sonographic features of endobronchial ultrasound (EBUS) convex probe images are helpful in predicting metastatic lymph nodes. Grey scale texture analysis is a well-established methodology that has been applied to ultrasound images in other fields of medicine. The aim of this study was to determine if this methodology could differentiate between benign and malignant lymphadenopathy of EBUS images. METHODS Lymph nodes from digital images of EBUS procedures were manually mapped to obtain a region of interest and were analyzed in a prediction set. The regions of interest were analyzed for the following grey scale texture features in MATLAB (version 7.8.0.347 [R2009a]): mean pixel value, difference between maximal and minimal pixel value, SEM pixel value, entropy, correlation, energy, and homogeneity. Significant grey scale texture features were used to assess a validation set compared with fluoro-D-glucose (FDG)-PET-CT scan findings where available. RESULTS Fifty-two malignant nodes and 48 benign nodes were in the prediction set. Malignant nodes had a greater difference in the maximal and minimal pixel values, SEM pixel value, entropy, and correlation, and a lower energy (P < .0001 for all values). Fifty-one lymph nodes were in the validation set; 44 of 51 (86.3%) were classified correctly. Eighteen of these lymph nodes also had FDG-PET-CT scan assessment, which correctly classified 14 of 18 nodes (77.8%), compared with grey scale texture analysis, which correctly classified 16 of 18 nodes (88.9%). CONCLUSIONS Grey scale texture analysis of EBUS convex probe images can be used to differentiate malignant and benign lymphadenopathy. Preliminary results are comparable to FDG-PET-CT scan.
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Affiliation(s)
- Phan Nguyen
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; The University of Queensland, UQ Centre for Clinical Research, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia.
| | - Farzad Bashirzadeh
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Justin Hundloe
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Olivier Salvado
- The Australian eHealth Research Centre, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia
| | - Nicholas Dowson
- The Australian eHealth Research Centre, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia
| | - Robert Ware
- Queensland Children's Medical Research Institute, The Royal Children's Hospital, Herston, Australia
| | - Ian Brent Masters
- Department of Respiratory Medicine, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Manoj Bhatt
- Queensland PET Service, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Aravind Ravi Kumar
- Queensland PET Service, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - David Fielding
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
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Chang AB, Robertson CF, van Asperen PP, Glasgow NJ, Masters IB, Mellis CM, Landau LI, Teoh L, Morris PS. Can a management pathway for chronic cough in children improve clinical outcomes: protocol for a multicentre evaluation. Trials 2010; 11:103. [PMID: 21054884 PMCID: PMC2989328 DOI: 10.1186/1745-6215-11-103] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 11/06/2010] [Indexed: 12/04/2022] Open
Abstract
Background Chronic cough is common and is associated with significant economic and human costs. While cough can be a problematic symptom without serious consequences, it could also reflect a serious underlying illness. Evidence shows that the management of chronic cough in children needs to be improved. Our study tests the hypothesis that the management of chronic cough in children with an evidence-based management pathway is feasible and reliable, and improves clinical outcomes. Methods/Design We are conducting a multicentre randomised controlled trial based in respiratory clinics in 5 major Australian cities. Children (n = 250) fulfilling inclusion criteria (new patients with chronic cough) are randomised (allocation concealed) to the standardised clinical management pathway (specialist starts clinical pathway within 2 weeks) or usual care (existing care until review by specialist at 6 weeks). Cough diary, cough-specific quality of life (QOL) and generic QOL are collected at baseline and at 6, 10, 14, 26, and 52 weeks. Children are followed-up for 6 months after diagnosis and cough resolution (with at least monthly contact from study nurses). A random sample from each site will be independently examined to determine adherence to the pathway. Primary outcomes are group differences in QOL and proportion of children that are cough free at week 6. Discussion The clinical management pathway is based on data from Cochrane Reviews combined with collective clinical experience (250 doctor years). This study will provide additional evidence on the optimal management of chronic cough in children. Trial registration ACTRN12607000526471
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Affiliation(s)
- A B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
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Kapur N, Masters IB, Chang AB. Longitudinal growth and lung function in pediatric non-cystic fibrosis bronchiectasis: what influences lung function stability? Chest 2010; 138:158-64. [PMID: 20173055 DOI: 10.1378/chest.09-2932] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Longitudinal FEV(1) data in children with non-cystic fibrosis (non-CF) bronchiectasis (BE) are contradictory, and there are no multifactor data on the evolution of lung function and growth in this group. We longitudinally reviewed lung function and growth in children with non-CF BE and explored biologically plausible factors associated with changes in these parameters over time. METHODS Fifty-two children with > or = 3 years of lung function data were retrospectively reviewed. Changes in annual anthropometry and spirometry at year 3 and year 5 from baseline were analyzed. The impact of sex, age, cause, baseline FEV(1), exacerbation frequency, radiologic extent, socioeconomic status, environmental tobacco smoke exposure, and period of diagnosis was evaluated. RESULTS Over 3 years, the group mean forced expiratory flow midexpiratory phase percent predicted and BMI z-score improved by 3.01 (P = .04; 95% CI, 0.14-5.86) and 0.089 (P = .01; 95% CI, 0.02-0.15) per annum, respectively. FEV(1)% predicted, FVC% predicted, and height z-score all showed nonsignificant improvement. Over 5 years, there was improvement in FVC% predicted (slope 1.74; P = .001) annually, but only minor improvement in other parameters. Children with immunodeficiency and those with low baseline FEV(1) had significantly lower BMI at diagnosis. Frequency of hospitalized exacerbation and low baseline FEV(1) were the only significant predictors of change in FEV(1) over 3 years. Decline in FEV(1)% predicted was large (but nonsignificant) for each additional year in age of diagnosis. CONCLUSIONS Spirometric and anthropometric parameters in children with non-CF BE remain stable over a 3- to 5-year follow-up period once appropriate therapy is instituted. Severe exacerbations result in accelerated lung function decline. Increased medical cognizance of children with chronic moist cough is needed for early diagnosis, better management, and improving overall outcome in BE.
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Affiliation(s)
- Nitin Kapur
- Queensland Children's Respiratory Centre and Queensland Children's Medical Research Institute, Department of Respiratory Medicine, Royal Children's Hospital, Herston, QLD 4029, Australia.
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Kapur N, Slater A, McEniery J, Greer ML, Masters IB, Chang AB. Therapeutic bronchoscopy in a child with sand aspiration and respiratory failure from near drowning--case report and literature review. Pediatr Pulmonol 2009; 44:1043-7. [PMID: 19746438 DOI: 10.1002/ppul.21088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Foreign matter aspiration occurs relatively commonly in drowning and near-drowning events. In most cases, stomach contents are aspirated. Sand aspiration rarely occurs and there are no reported cases in children with near drowning. Limited data are available on clinical presentation and management of sand aspiration with accidental burial. We report a 3-year-old boy who nearly drowned while swimming in brackish waters and was found face down in sand. Sand aspiration was suspected when the child continued to have persistent wheezing and high ventilatory requirement despite intensive bronchodilator and corticosteroids therapy with an inability to wean after 4 days post-near-drowning event. Radiology was non-specific in the absence of sand bronchogram. Presence of sand in the airways was confirmed when a bronchoscopy was undertaken and sand seen in the bronchoalveolar lavage fluid. Sequential lung washing followed by exogenous surfactant administration (3 ml/kg) was undertaken and lead to significant improvement such that within 12 hr post-therapeutic lavage, his ventilatory requirements reduced substantially. The child was extubated 4 days post-lavage and on review 2 months post-event, was clinically well with airway resistance within normal predicted values measured on forced oscillatory spirometry (IOS).
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Affiliation(s)
- N Kapur
- Queensland Children's Respiratory Centre and Queensland Children's Medical Research Institute, Royal Children's Hospital, QLD, Australia.
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Kapur N, Masters IB, Chang AB. Exacerbations in noncystic fibrosis bronchiectasis: Clinical features and investigations. Respir Med 2009; 103:1681-7. [PMID: 19501498 DOI: 10.1016/j.rmed.2009.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 04/25/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Children with bronchiectasis have recurrent acute pulmonary exacerbations and many of these exacerbations require hospital admission when oral therapies fail. However there is no standardized definition and little published data is available about the features of an exacerbation. Our aim was to determine the clinical and investigational features of exacerbations in bronchiectasis, the proportion that fail to resolve on oral antibiotics and the factors associated with it. METHODS A retrospective cohort study of 115 respiratory exacerbations from 30 children with noncystic fibrosis bronchiectasis diagnosed on HRCT chest. Clinical features, investigations and treatment related to the exacerbations were extracted and analysed. RESULTS Increase in frequency of cough (88%) and a change in its character (67%) were the most common symptoms associated with an exacerbation. Fever (28%), increase in sputum volume (42%) and purulence (35%) were also common features. Chest pain, dyspnea, hemoptysis and tachypnea were rare. 56% had a worsening in their chest auscultatory findings during an exacerbation. Spirometry was not significantly different between stable and exacerbation state. 35% of exacerbations failed to respond to oral antibiotic therapy and required hospital admission. Prophylactic antibiotic therapy was the only significant predictor of failure of oral therapy with adjusted odds ratio of 6.77 (95% CI 2.06-19.90; p=0.003). CONCLUSIONS Important clinical features of non-CF exacerbation in bronchiectasis were changes in cough frequency or character, and worsening chest signs; which resolved on therapies. However there is a high failure rate of oral antibiotic therapy and use of prophylactic antibiotic therapy increases this risk.
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Affiliation(s)
- Nitin Kapur
- Queensland Children's Respiratory Centre, Royal Children's Hospital, Australia.
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Abstract
The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in children. The present retrospective study was undertaken to: 1) identify specific clinical markers associated with radiographic evidence of OPA, isolated laryngeal penetration (ILP) and post-swallow residue (PSR); 2) determine the sensitivity and specificity of clinical markers associated with OPA; and 3) determine the influence of age and neurological impairment on clinical markers of OPA. In total, 11 clinical markers of dysphagia were compared with the videofluoroscopic swallow study (VFSS) results (OPA, ILP and PSR) in 150 children on diets of thin fluid and purée consistencies. Chi-squared and logistic regression were used to analyse the association between clinical markers and VFSS-identified swallowing dysfunction. In children with OPA, wet voice (odds ratio (OR) 8.90, 95% confidence interval (CI) 2.87-27.62), wet breathing (OR 3.35, 95% CI 1.09-10.28) and cough (OR 3.30, 95% CI 1.17-9.27) were significantly associated with thin fluid OPA. Predictive values included: wet voice (sensitivity 0.67; specificity 0.92); wet breathing (sensitivity 0.33; specificity 0.83); and cough (sensitivity 0.67; specificity 0.53). No clinical markers were significantly associated with OPA, ILP or PSR on the purée consistency. Cough was significantly associated with PSR on thin fluids (OR 3.59, 95% CI 1.22-10.55). Differences were found for age. Wet voice, wet breathing and cough were good clinical markers for children with oropharyngeal aspiration on thin fluid but not on purée. Age and neurological status influenced the significance of these clinical markers.
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Affiliation(s)
- K Weir
- Department of Speech Pathology, Royal Children's Hospital, Herston Rd, Herston, QLD 4029, Australia.
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Abstract
BACKGROUND Asthma education is regarded as an important step in the management of asthma in national guidelines. Racial and socio-economic factors are associated with markers of asthma severity, including recurrent acute presentations to emergency health facilities. Worldwide, indigenous groups are disproportionately represented in the severe end of the asthma spectrum. Appropriate models of care are important in the successful delivery of services, and are likely contributors to improved outcomes for people with asthma. OBJECTIVES To determine whether involvement of an indigenous healthcare worker (IHW) in comparison to absence of an IHW in asthma education programmes, improves asthma related outcomes in indigenous children and adults with asthma. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases, review articles and reference lists of relevant articles. The latest search was in December 2006. SELECTION CRITERIA All randomised controlled trials comparing involvement of an indigenous healthcare worker (IHW) in comparison to absence of an IHW in asthma education programmes for indigenous people with asthma. DATA COLLECTION AND ANALYSIS Two independent review authors selected data for inclusion, a single author extracted the data. Both review authors independently assessed study quality. We contacted authors for further information. As it was not possible to analyse data as "intention-to-treat", we analysed data as "treatment received". MAIN RESULTS Only a single study was applicable for this review, and included 24 children randomised to an asthma education programme involving an IHW, compared to a similar intervention without an IHW. Twenty two of these children completed the trial. Only one outcome (asthma knowledge in children, mean difference of 3.30 units, 95% CI 1.07 to 5.53) significantly favoured the IHW involvement group. However, although not statistically significant, all the outcomes favoured the group that had IHW involvement in the asthma education program. There were no studies in adults. AUTHORS' CONCLUSIONS The involvement of IHW in asthma programs targeted for their own ethnic group in one small trial was beneficial for some but not all asthma outcomes. Thus there is insufficient data to be confident that the involvement of IHW is beneficial in all settings. Nevertheless, given the complexity of health outcomes and culture as well as the importance of self-determination for indigenous peoples, the practice of including IHW in asthma education programs for indigenous children and adults with asthma is justified, but should be subject to further randomised controlled trials.
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Affiliation(s)
- A B Chang
- Royal Children's Hospital, Brisbane and Menzies School of Health Research, CDU, Respiratory Medicine Level 3 Woolworths Bldg, Herston Road, Herston, Brisbane, Queensland, Australia, 4029.
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Chang AB, Faoagali J, Cox NC, Marchant JM, Dean B, Petsky HL, Masters IB. A bronchoscopic scoring system for airway secretions--airway cellularity and microbiological validation. Pediatr Pulmonol 2006; 41:887-92. [PMID: 16858700 DOI: 10.1002/ppul.20478] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is currently no validated scoring system for quantification of airway secretions in children. A user friendly, valid scoring system of airway secretions during flexible bronchoscopy (FB) would be useful for comparative purposes in clinical medicine and research. The objective of this study was to validate our bronchoscopic secretion (BS) scoring system by examining the relationship between the amount of secretions seen at bronchoscopy with airway cellularity and microbiology. In 106 children undergoing FB, the relationship of BS grades with bronchocalveolar lavage (BAL) cellularity and infective state (bacterial and viral infections) were examined using receptor operator curves (ROC). BAL was obtained according to European Respiratory Society guidelines; first lavage for microbiology and second lavage for cellularity. Area under the ROC was significant for total cell count (TCC) and neutrophil % but not for lymphocyte %. BS grade significantly related to infection positive state (chi(trend) (2) = 5.85, P = 0.016). The area under the ROC for infection positive state versus BS grade was 0.645, 95% CI 0.527-0.763. The BS scoring system is a valid method for quantifying airway secretions in children undergoing bronchoscopy. The system related well to airway cellularity and neutrophilia, as well as to an airway infective state. However, the system is only complementary to cell counts and cultures and cannot replace these laboratory quantification techniques.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia.
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Abstract
BACKGROUND Paediatricians rely on cough descriptors to direct them to the level of investigations needed for a child presenting with chronic cough, yet there is a lack of published data to support this approach. A study was undertaken to evaluate (1) whether historical cough pointers can predict which children have a specific cause for their cough and (2) the usefulness of chest radiography and spirometry as standard investigations in children with chronic cough. METHODS This was a prospective cohort study of children referred to a tertiary hospital with a cough lasting >3 weeks between June 2002 and July 2004. All included children completed a detailed history and examination using a standardised data collection sheet and followed a pathway of investigation until a diagnosis was made. RESULTS In 100 consecutively recruited children of median age 2.8 years, the best predictor of specific cough observed was a moist cough at the time of consultation with an odds ratio (OR) of 9.34 (95% CI 3.49 to 25.03). Chest examination or chest radiographic abnormalities were also predictive with OR 3.60 (95% CI 1.31 to 9.90) and 3.16 (95% CI 1.32 to 7.62), respectively. The most significant historical pointer for predicting a specific cause of the cough was a parental history of moist cough (sensitivity 96%, specificity 26%, positive predictive value 74%). CONCLUSIONS The most useful clinical marker in predicting specific cough is the presence of a daily moist cough. Both chest examination and chest radiographic abnormalities are also useful in predicting whether children have a specific cause of their cough.
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Affiliation(s)
- J M Marchant
- Department of Respiratory Medicine, Royal Children's Hospital, Australia.
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Abstract
BACKGROUND Tracheomalacia, a disorder of the large airways where the trachea is deformed or malformed during respiration is commonly seen in tertiary paediatric practice. It is associated with a wide spectrum of respiratory symptoms from life threatening recurrent apnea to common respiratory symptoms such as chronic cough and wheeze. Current practice following diagnosis of tracheomalacia include medical approaches aimed at reducing associated symptoms of tracheomalacia, ventilation modalities of continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) and, surgical approaches aimed at improving the caliber of the airway (airway stenting, aortopexy, tracheopexy). OBJECTIVES To evaluate the efficacy of medical and surgical therapies for children with intrinsic (primary) tracheomalacia. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. The latest searches were performed in Feb 2005. SELECTION CRITERIA All randomised controlled trials of therapies related to symptoms associated with primary or intrinsic tracheomalacia. DATA COLLECTION AND ANALYSIS Results of searches were reviewed against pre-determined criteria for inclusion. No eligible trials were identified and thus no data were available for analysis. MAIN RESULTS No randomised controlled trials (RCTs) that examined therapies for intrinsic tracheomalacia were found. Eight of the more recent (last 11 years) non randomised controlled trials reported a benefit from the various surgical interventions. The success was however not universal and in some studies severe adverse events occurred. AUTHORS' CONCLUSIONS There is currently an absence of evidence to support any of the therapies currently utilised for management of intrinsic tracheomalacia. It is unlikely that any RCT on surgically based management will ever be available for children with severe life threatening illness associated with tracheomalacia. For those with less severe disease, RCTs are clearly needed. Outcomes of these RCTs should include measurements of the trachea and physiological outcomes in addition to clinical outcomes.
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Affiliation(s)
- I B Masters
- Royal Children's Hospital, Respiratory Medicine, Herston Rd, Herston, Brisbane, Queensland, Australia 4029.
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Masters IB, Eastburn MM, Wootton R, Ware RS, Francis PW, Zimmerman PV, Chang AB. A new method for objective identification and measurement of airway lumen in paediatric flexible videobronchoscopy. Thorax 2005; 60:652-8. [PMID: 16061706 PMCID: PMC1747475 DOI: 10.1136/thx.2004.034421] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Accurate measurements of airway and lesion dimensions are important to the developmental progress of paediatric bronchoscopy. The malacia disorders are an important cause of respiratory morbidity in children, but no methods are currently available to measure these lesions or the airway lumen accurately. A new measurement technique is described here. METHODS The magnification power of a paediatric videobronchoscope was defined and a simple and user friendly computer based program (Image J) was used to develop an objective technique (colour histogram mode technique, CHMT) for measurement of the airway lumen. RESULTS In vivo intra-observer and inter-observer repeatability coefficients for repeated area measurements from 28 images using the Bland-Altman method were 0.9 mm2 and 1.6 mm2, respectively. The average intraclass correlation coefficient for repeated measurements of area was 0.93. In vitro validation measurements using a 2 mm diameter tube resolved radii measurements to within 0.1 mm (coefficient of variability 8%). An "acceptable result" was defined in 92% of 734 images completed with the CHMT alone and 8% with its modification. The success rate for two of three images being within 10% of each other's area was 100%. Measurements of cricoid cross sectional areas from 116 patients compared with expected airway areas for age derived from endotracheal tube sizes were comparable. CONCLUSIONS The CHMT method of identifying and measuring airway dimensions is objective, accurate, and versatile and, as such, is important to the future development of flexible videobronchoscopy.
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Affiliation(s)
- I B Masters
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia.
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Masters IB, Chang AB. Interventions for primary (intrinsic) tracheomalacia in children. Hippokratia 2005. [DOI: 10.1002/14651858.cd005304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Masters IB, Eastburn MM, Francis PW, Wootton R, Zimmerman PV, Ware RS, Chang AB. Quantification of the magnification and distortion effects of a pediatric flexible video-bronchoscope. Respir Res 2005; 6:16. [PMID: 15705204 PMCID: PMC549513 DOI: 10.1186/1465-9921-6-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Accepted: 02/10/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flexible video bronchoscopes, in particular the Olympus BF Type 3C160, are commonly used in pediatric respiratory medicine. There is no data on the magnification and distortion effects of these bronchoscopes yet important clinical decisions are made from the images. The aim of this study was to systematically describe the magnification and distortion of flexible bronchoscope images taken at various distances from the object. METHODS Using images of known objects and processing these by digital video and computer programs both magnification and distortion scales were derived. RESULTS Magnification changes as a linear function between 100 mm (x1) and 10 mm (x9.55) and then as an exponential function between 10 mm and 3 mm (x40) from the object. Magnification depends on the axis of orientation of the object to the optic axis or geometrical axis of the bronchoscope. Magnification also varies across the field of view with the central magnification being 39% greater than at the periphery of the field of view at 15 mm from the object. However, in the paediatric situation the diameter of the orifices is usually less than 10 mm and thus this limits the exposure to these peripheral limits of magnification reduction. Intraclass correlations for measurements and repeatability studies between instruments are very high, r = 0.96. Distortion occurs as both barrel and geometric types but both types are heterogeneous across the field of view. Distortion of geometric type ranges up to 30% at 3 mm from the object but may be as low as 5% depending on the position of the object in relation to the optic axis. CONCLUSION We conclude that the optimal working distance range is between 40 and 10 mm from the object. However the clinician should be cognisant of both variations in magnification and distortion in clinical judgements.
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Affiliation(s)
- IB Masters
- School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia
| | - MM Eastburn
- University of Queensland, Department of Information Technology and Electrical Engineering, St Lucia 4072, Brisbane, Australia
| | - PW Francis
- School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia
| | - R Wootton
- University of Queensland Centre for Online Health, Level 3 Foundation Building, Royal Children's Hospital, Herston 4029, Brisbane, Australia
| | - PV Zimmerman
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside 4032, Brisbane, Australia
| | - RS Ware
- Longitudinal Studies Unit, School of Population Health, The University of Queensland, Herston 4006, Brisbane, Australia
| | - AB Chang
- School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia
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Chang AB, Gaffney JT, Eastburn MM, Faoagali J, Cox NC, Masters IB. Cough quality in children: a comparison of subjective vs. bronchoscopic findings. Respir Res 2005; 6:3. [PMID: 15638942 PMCID: PMC545936 DOI: 10.1186/1465-9921-6-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2004] [Accepted: 01/08/2005] [Indexed: 12/04/2022] Open
Abstract
Background Cough is the most common symptom presenting to doctors. The quality of cough (productive or wet vs dry) is used clinically as well as in epidemiology and clinical research. There is however no data on the validity of cough quality descriptors. The study aims were to compare (1) cough quality (wet/dry and brassy/non-brassy) to bronchoscopic findings of secretions and tracheomalacia respectively and, (2) parent's vs clinician's evaluation of the cough quality (wet/dry). Methods Cough quality of children (without a known underlying respiratory disease) undergoing elective bronchoscopy was independently evaluated by clinicians and parents. A 'blinded' clinician scored the secretions seen at bronchoscopy on pre-determined criteria and graded (1 to 6). Kappa (K) statistics was used for agreement, and inter-rater and intra-rater agreement examined on digitally recorded cough. A receiver operating characteristic (ROC) curve was used to determine if cough quality related to amount of airway secretions present at bronchoscopy. Results Median age of the 106 children (62 boys, 44 girls) enrolled was 2.6 years (IQR 5.7). Parent's assessment of cough quality (wet/dry) agreed with clinicians' (K = 0.75, 95%CI 0.58–0.93). When compared to bronchoscopy (bronchoscopic secretion grade 4), clinicians' cough assessment had the highest sensitivity (0.75) and specificity (0.79) and were marginally better than parent(s). The area under the ROC curve was 0.85 (95%CI 0.77–0.92). Intra-observer (K = 1.0) and inter-clinician agreement for wet/dry cough (K = 0.88, 95%CI 0.82–0.94) was very good. Weighted K for inter-rater agreement for bronchoscopic secretion grades was 0.95 (95%CI 0.87–1). Sensitivity and specificity for brassy cough (for tracheomalacia) were 0.57 and 0.81 respectively. K for both intra and inter-observer clinician agreement for brassy cough was 0.79 (95%CI 0.73–0.86). Conclusions Dry and wet cough in children, as determined by clinicians and parents has good clinical validity. Clinicians should however be cognisant that children with dry cough may have minimal to mild airway secretions. Brassy cough determined by respiratory physicians is highly specific for tracheomalacia.
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Affiliation(s)
- Anne Bernadette Chang
- Dept of Paediatrics & Child Health, University of Queensland; Dept Respiratory Medicine, Royal Children's Hospital, Brisbane, Qld 4029, Australia
| | - Justin Thomas Gaffney
- Department of Respiratory Medicine, Royal Children's Hospital,, Herston Rd, Brisbane, Qld 4029, Australia
| | - Matthew Michael Eastburn
- School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Qld, Australia
| | - Joan Faoagali
- Department of Microbiology, Queensland Health Pathology Service, Royal Brisbane Hospital, Herston, Qld 4029, Australia
| | - Nancy C Cox
- Department of Cytology, Queensland Health Pathology Service, Royal Brisbane Hospital, Herston, Qld 4029, Australia
| | - Ian Brent Masters
- Dept Respiratory Medicine, Royal Children's Hospital, Herston Rd, Brisbane, Qld 4029, Australia
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Abstract
OBJECTIVE Respiratory health of Indigenous and minority ethnic groups in affluent countries is poorer than their non-minority counterparts and sleep disorders are no exception. In children, obstructive sleep apnoea has the potential to result in serious long-term consequences. In 1999, we studied 1650 children and adolescents living in the Torres Strait and the Northern Peninsula Area, Australia. Here we report prevalence of snoring in these communities and relate its association with asthma symptoms. METHODS A population-based cross-sectional study was conducted in the Torres Strait region. Five indigenous communities were randomly selected and information was collected using a structured face-to-face interview based on a standardized questionnaire. There was a 98% response rate, and 1650 children, 0-17 years of age, were included in the study. RESULTS Overall, the prevalence of snoring was 14.2% (95% CI 12.5-15.9); 3.6% (95% CI 2.7-4.6) reported snorting, and 6% (95% CI 4.9-7.2) reported restless sleep. The prevalence of snoring was significantly higher among males (17.1% for males and 10.8 for females, P = 0.005). Children were five times more likely to have experienced snoring and snorting if they reported wheezing in the last 12 months. CONCLUSION We conclude that the prevalence of symptoms suggestive of obstructive sleep problems is relatively high in children of this region. This highlights the need for awareness among the community patients and physicians about the problem of obstructive sleep-disordered breathing, especially in children with asthma, and for the need for further studies to measure prevalence of sleep breathing disorders among Indigenous Australians.
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Affiliation(s)
- P C Valery
- Queensland Institute of Medical Research, Population and Clinical Sciences Division, The Australian Centre for International and Tropical Health and Nutrition, University of Queensland.
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Chang AB, Gibson PG, Masters IB, Dash P, Hills BA. The relationship between inflammation and dipalmitoyl phosphatidycholine in induced sputum of children with asthma. J Asthma 2003; 40:63-70. [PMID: 12699213 DOI: 10.1081/jas-120017208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Animal studies have shown elevated surfactant production in response to lung injury. In human airways, the contribution of surfactant to the airway epithelial barrier and importance of eosinophilic inflammation is increasingly appreciated. The relationship between blood and sputum inflammatory indices of childhood asthma to surfactant levels is unknown. In this study we hypothesized that the degree of inflammation influences the level of dipalmitoyl phosphatidycholine (DPPC) in airways of children with asthma. METHODS Sixteen children with asthma (ages 5.5-16 years) underwent venipuncture, skin prick test, spirometry, hypertonic saline challenge, and induced sputum during a nonacute phase. Sputum (sp) and blood (se) markers of inflammation (eosinophils, neutrophils, eosinophilic cationic protein [ECP]), were related to sputum DPPC levels and several markers of asthma severity (airway hyperresponsiveness, quality of life, FEV1). RESULTS On multiple regression, sp-DPPC significantly correlated to sp-ECP (r=0.53, P=0.0048). Se-ECP, se-Eo, sp-eosinophils, sp-neutrophils, se-neutrophils, and inhaled steroids dose did not significantly influence sp-DPPC. Exposure to smoke did not influence inflammatory markers. FEV1 and quality of life data did not relate to any blood or sputum variable. A significant association between AHR and se-eosinophils, but not between AHR and se-ECP, sp-eosinophils, or sp-ECP was found. CONCLUSION Elevated DPPC levels occur in the presence of chronic eosinophilic inflammation in airways of children with stable asthma. Whether this represents an inherent lung mechanism for epithelial protection remains to be elucidated.
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Affiliation(s)
- Anne B Chang
- Flinders University Northern Territory Clinical School, Alice Springs Hospital, Northern Territory, Australia.
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Abstract
AIMS A failure of the arousal mechanism is a key feature in the apnoea theory for sudden infant death syndrome (SIDS). In infants studied at an age when the incidence of SIDS is highest, we evaluated whether in utero smoke exposed infants have altered arousal response to standardised auditory stimuli, and/or sleep pattern, as recorded on overnight complex sleep polysomnography. METHODS A standardised sequence of audiology stimuli was applied binaurally to 20 in utero smoke and non-smoke exposed infants aged 8-12 weeks during a rapid eye movement (REM) and NREM epoch, in a controlled (temperature, position, pacifier use, noise) sleep environment. Infants were monitored for 10-12 hours using complex sleep polysomnography. RESULTS Five infants exposed to in utero tobacco smoke did not have behavioural arousal response, whereas all non-smoke exposed infants aroused during NREM (p = 0.016). There was, however, no difference in REM sleep, and the groups did not differ in routine overnight complex sleep polysomnography parameters. CONCLUSION At the age when the incidence of SIDS is at its peak, infants of smoking mothers are less rousable than those of non-smoking mothers in NREM sleep; this may partly explain why such infants are more at risk of SIDS.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Royal Children's Hospital Foundation, Brisbane.
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Abstract
Flexible bronchoscopy is an emerging diagnostic, therapeutic and supportive procedure used in paediatric respiratory medicine. Despite the improvements in instruments and anaesthetic support for this procedure, supervised training, strict quality-control measures and ongoing research are essential to ensure standards of safe practice and judicial use of the procedure.
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Affiliation(s)
- I B Masters
- Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia.
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Abstract
OBJECTIVE Children referred for persistent cough were evaluated for the referring and final diagnosis, and the extent of the use of medications prior to referral and the side effects encountered. METHODS Data on children seen by respiratory paediatricians for persistent cough (> or =4 weeks) in a tertiary respiratory setting were collected prospectively over 12 months. RESULTS Of the 49 children, 61.2% were diagnosed with asthma at referral, with similar referral rates from general practitioners and paediatricians. Children with isolated cough were just as likely to have been diagnosed with asthma as children with cough and wheeze. Medication use (asthma, gastro-oesophageal reflux and antibiotics) prior to referral was high, asthma medications were most common, and of these 12.9% had significant steroid side effects. The most common abnormality found (46.9%) was a bronchoscopically defined airway lesion, and in 56.5% of these children, another diagnosis (aspiration, achalasia, gastro-oesophageal reflux) existed. No children had a sole final diagnosis of asthma and pre-referral medications were weaned in all children. CONCLUSION Over diagnosis of asthma and the overuse of asthma treatments with significant side effects is common in children with persistent cough referred to a tertiary respiratory clinic. Children with persistent cough deserve careful evaluation to minimize the use of unnecessary medications and, if medications are used, assessment of response to treatment is important.
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Affiliation(s)
- F Thomson
- Department of Paediatrics, Mater Children's Hospital, South Brisbane, Australia
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Abstract
BACKGROUND Published data on the frequency and types of flexible bronchoscopic airway appearances in children with non-cystic fibrosis bronchiectasis and chronic suppurative lung disease are unavailable. The aims of this study were to describe airway appearances and frequency of airway abnormalities and to relate these airway abnormalities to chest high resolution computed tomography (cHRCT) findings in a cohort of children with non-cystic fibrosis chronic suppurative lung disease (CSLD). METHODS Indigenous children with non-cystic fibrosis CSLD (>4 months moist and/or productive cough) were prospectively identified and collected over a 2.5 year period at two paediatric centres. Their medical charts and bronchoscopic notes were retrospectively reviewed. RESULTS In all but one child the aetiology of the bronchiectasis was presumed to be following a respiratory infection. Thirty three of the 65 children with CSLD underwent bronchoscopy and five major types of airway findings were identified (mucosal abnormality/inflammation only, bronchomalacia, obliterative-like lesion, malacia/obliterative-like combination, and no macroscopic abnormality). The obliterative-like lesion, previously undescribed, was present in 16.7% of bronchiectatic lobes. Structural airway lesions (bronchomalacia and/or obliterative-like lesion) were present in 39.7% of children. These lesions, when present, corresponded to the site of abnormality on the cHRCT scan. CONCLUSIONS Structural airway abnormality is commonly found in children with post-infectious bronchiectasis and a new bronchoscopic finding has been described. Airway abnormalities, when present, related to the same lobe abnormality on the cHRCT scan. How these airway abnormalities relate to aetiology, management strategy, and prognosis is unknown.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Royal Children's Hospital, Herston, Queensland, Australia.
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Masters IB, Chang AB, Patterson L, Wainwright C, Buntain H, Dean BW, Francis PW. Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children. Pediatr Pulmonol 2002; 34:189-95. [PMID: 12203847 DOI: 10.1002/ppul.10156] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Laryngomalacia, bronchomalacia, and tracheomalacia are commonly seen in pediatric respiratory medicine, yet their patterns and associations with other conditions are not well-understood. We prospectively video-recorded bronchoscopic data and clinical information from referred patients over a 10-year period and defined aspects of interrelationships and associations. Two hundred and ninety-nine cases of malacia disorders (34%) were observed in 885 bronchoscopic procedures. Cough, wheeze, stridor, and radiological changes were the most common symptoms and signs. The lesions were most often found in males (2:1) and on the left side (1.6:1). Concomitant malacia lesions ranged from 24% for laryngotracheobronchomalacia to 47% for tracheobronchomalacia. The lesions were found in association with other disorders such as congenital heart disorders (13.7%), tracheo-esophageal fistula (9.6%), and various syndromes (8%). Even though the understanding of these disorders is in its infancy, pediatricians should maintain a level of awareness for malacia lesions and consider the possibility of multiple lesions being present, even when one symptom predominates or occurs alone.
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Affiliation(s)
- I B Masters
- Department of Respiratory Medicine, Royal Children's Hospital, Herston, Brisbane, Queensland, Australia.
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Abstract
BACKGROUND Prospective data on the temporal relation between cough, asthma symptoms, and airway inflammation in childhood asthma is unavailable. AIMS AND METHODS Using several clinical (diary, quality of life), lung function (FEV(1), FEV(1) variability, airway hyperresponsiveness), cough (diary, cough receptor sensitivity (CRS)), and inflammatory markers (sputum interleukin 8, eosinophilic cationic protein (ECP), myeloperoxidase; and serum ECP) of asthma severity, we prospectively described the course of these markers in children with asthma during a non-acute, acute, and resolution phase. A total of 21 children with asthma underwent these baseline tests; 11 were retested during days 1, 3, 7, and 28 of an exacerbation. RESULTS Asthma exacerbations were characterised by increased asthma and cough symptoms and eosinophilic inflammation. Sputum ECP showed the largest increase and peaked later than clinical scores. Asthma scores consistently related to cough score only early in the exacerbation. Neither CRS nor cough scores related to any inflammatory marker. CONCLUSION In mild asthma exacerbations, eosinophilic inflammation is dominant. In asthmatic children who cough as a dominant symptom, cough heralds the onset of an exacerbation and increased eosinophilic inflammation, but cough scores and CRS do not reflect eosinophilic airway inflammation.
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Affiliation(s)
- A B Chang
- Flinders University NT Clinical School, Alice Springs Hospital, Northern Territory Department of Respiratory Medicine, Mater Children's Hospital Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW.
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Valery PC, Chang AB, Shibasaki S, Gibson O, Purdie DM, Shannon C, Masters IB. High prevalence of asthma in five remote indigenous communities in Australia. Eur Respir J 2001; 17:1089-96. [PMID: 11491149 DOI: 10.1183/09031936.01.00099901] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data on the prevalence of asthma in children residing in remote indigenous communities in Australia are sparse, despite the many reports of high prevalence in nonindigenous children of this country. Two previous Australian studies have had poor participation rates, limiting interpretation of their results. A study of children in the Torres Strait and Northern Peninsula Area of Australia was conducted to document the prevalence of asthma symptoms. Five indigenous communities were randomly selected and trained interviewers, who were local indigenous health workers, recruited participants using a house-by-house approach. Information was collected by a structured face-to-face interview based on a standardized questionnaire constructed from the protocol International Study of Asthma and Allergy in Childhood; 1,650 children were included in the study with a 98% response rate. Overall, the prevalence of self-reported ever wheezing was 21%; 12% reported wheezing in the previous year; and 16% reported ever having asthma. There was significant variation in the prevalence of asthma symptoms between communities. It is concluded that there are significant intercommunity variations in the prevalence of asthma symptoms in remote communities and that the prevalence in these communities is as high as in nonindigenous groups.
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Affiliation(s)
- P C Valery
- Epidemiology and Population Health Division, Queensland Institute of Medical Research, Royal Brisbane Hospital, Australia
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Abstract
SUMMARY. High-resolution computed tomography (HRCT) of the chest permits early detection of lung disease; two relevant scoring systems (Bhalla and Nathanson) have been developed to describe CF lung disease. Comparisons between the two scoring systems have not been made, and it is not known which system is more appropriate for young children, i.e., the age group where other objective markers are scarce. We reviewed the clinical findings, pulmonary function data, and HRCT of 16 children aged less than 12 years. The Bhalla scoring system had a better correlation with FEV(1) (r = -0.65, P = 0.012) than the Nathanson score (r = 0.53, P = 0.05). All children had bronchiectasis, including 5 with normal pulmonary function tests. The lower lobes were universally involved, and 5 children did not have any upper lobe disease. Four of these 5 children were aged less than 7 years. We conclude that the Bhalla scoring system is more applicable to young children than is the Nathanson system. Also, in this group of young children with CF, lower lobes are more commonly involved than upper lobes, which is in contrast to the classical teaching that CF lung disease begins in the upper lobes.
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Affiliation(s)
- J M Marchant
- Department of Respiratory Medicine, Mater Children's Hospital, South Brisbane, Queensland, Australia
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Hubbard M, Masters IB, Williams GR, Chang AB. Severe obstructive sleep apnoea secondary to pressure garments used in the treatment of hypertrophic burn scars. Eur Respir J 2000; 16:1205-7. [PMID: 11292128 DOI: 10.1034/j.1399-3003.2000.16f29.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Obstructive sleep apnoea (OSA) secondary to pressure garments used to treat hypertrophic scarring of burns has never been reported. The present study describes two children who presented with OSA following introduction of such garments for management of hypertrophic scars following severe facial and upper body burns. Complex sleep polysomnography confirmed severe OSA with desaturations sufficient to result in physiological dysfunction that significantly improved on removal of the garments. As there is little evidence to suggest that the use of such garments alters the end result, the potentially serious side effect of obstructive sleep apnoea should be considered before their use is advised.
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Affiliation(s)
- M Hubbard
- Dept of Respiratory Medicine, Mater Misericordiae Children's Hospital, South Brisbane, Queensland, Australia
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Chang AB, Shannon C, O'Neil MC, Tiemann AM, Valery PC, Craig D, Fa'Afoi E, Masters IB. Asthma management in indigenous children of a remote community using an indigenous health model. J Paediatr Child Health 2000; 36:249-51. [PMID: 10849226 DOI: 10.1046/j.1440-1754.2000.00505.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the management of asthma in children in a remote indigenous community and the delivery of subspecialist service through the indigenous health-care model. METHODOLOGY Children referred by indigenous health-care workers were evaluated prospectively by paediatric respiratory physicians, based on a standardized protocol, at a primary health care setting at Thursday Island, Queensland. RESULTS Forty of the 54 children referred with a provisional diagnosis of asthma did have asthma, with 30% having persistent asthma. Only 59% of parents knew the dose of the medication prescribed and 80% had minimal knowledge of the medications. In 88% of children, the management of asthma was improved by introduction of an appropriate spacer device and changing the dose and type of medications. CONCLUSIONS The management of children with asthma in the Torres region can be improved substantially by the use of age appropriate delivery devices and medications, and improving knowledge of asthma. Specialist delivery service to remote indigenous communities can be effectively delivered in partnership with the indigenous health service. The high proportion of persistent asthma in the Torres Straits community in comparison to urbanised Australia raises issues of inequity of appropriate medical service delivery to remote indigenous communities.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Mater Misericordiae Children's Hospital, South Brisbane, Queensland.
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Abstract
Infants with high upper airway obstruction (UAO) are managed with a variety of techniques to relieve their UAO. Among these techniques, the least invasive and safest is the nasopharyngeal tube (NPT). However, the traditional NPT is not always satisfactory, and tracheostomies need to be done. We recently described a modified NPT technique that, in contrast to the traditional tube, does not add airway dead space and resistance, is easy to use, is well-tolerated, has proven highly successful, and allows the simultaneous use of oxygen nasal prongs. This modified NPT has many advantages over the traditional NPT as a temporary management of high UAO that resolves with growth of the infant. This report highlights the respiratory care of 10 infants with high UAO (Pierre Robin syndrome, Down syndrome, Goldenhar syndrome, isolated microngathia, and idiopathic hypotonia) who were managed with a modified NPT. The modified NPT described potentially reduces the need for surgical intervention to relieve high UAO in infants.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Mater Misericordiae Children's Hospital, South Brisbane, Queensland, Australia
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Abstract
OBJECTIVE To assess the value of 1-h daytime awake oximetry as a means of weaning oxygen flows in infants with oxygen dependent chronic lung disease. METHODS A cohort study of oxygen dependent infants enrolled in a 3-month period. One hour of awake oximetry data were compared with equal time periods defined within a polysomnographic study and at the same oxygen flow rate. Sensitivity results were derived from the decision to wean oxygen to a lower flow or air. RESULTS Twenty-two infants were enrolled and 27 studies were performed. The infants that could be weaned had an awake median of mean oxygen saturations of 97% and spent 14% of the time < or = 95% but only 2% < or = 92%, while for those not weaned, the awake median of mean oxygen saturations was 94% with 43% of their time < or = 95% and 26.8% < or = 92% saturation. CONCLUSIONS Daytime oximetry can predict the outcome of polysomnography with a sensitivity of 100% and a specificity of 65%, and could be used to wean oxygen or as a screening tool for polysomnographic studies in infants with chronic lung disease provided there are reasonably long periods of monitoring and mean oxygen saturations above 95%.
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Affiliation(s)
- M J Vermeulen
- Department of Respiratory Medicine, Mater Children's Hospital, South Brisbane, Queensland, Australia
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Abstract
OBJECTIVE To examine whether maternal pregnancy complications, adverse birth events, respiratory illnesses, or developmental difficulty were increased in neurologically normal children with obstructive sleep apnoea (OSA) and whether severity of OSA adversely affects the child's development and temperament. METHODOLOGY Maternal report of perinatal events, respiratory illness and developmental difficulty in 37 children with OSA was contrasted with a comparison group (n = 67). Children with OSA were assessed developmentally (Griffiths Scales), had a parental rating of temperament (Australian Temperament Scale) and attended an overnight polysomnographic sleep study. RESULTS Children with OSA had an increased prevalence of adverse maternal pregnancy and perinatal events, respiratory disease and developmental concerns. Limited associations were found between the severity of OSA and development or temperament difficulty. CONCLUSIONS This study suggests a relationship between OSA, though not its severity, and pre/perinatal adversity and child development. Polysomnographic and detailed developmental assessment of community-based samples of children with OSA and control children are necessary to confirm these findings.
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Affiliation(s)
- J M Harvey
- Department of Developmental and Rehabilitation Services, Mater Children's Hospital, Brisbane, Qld., Australia.
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