1
|
Lezmi G, Deschildre A, Abou Taam R, Fayon M, Blanchon S, Troussier F, Mallinger P, Mahut B, Gosset P, de Blic J. Remodelling and inflammation in preschoolers with severe recurrent wheeze and asthma outcome at school age. Clin Exp Allergy 2018; 48:806-813. [PMID: 29603800 DOI: 10.1111/cea.13143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/24/2018] [Accepted: 03/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The influence of airway remodelling and inflammation in preschoolers with severe recurrent wheeze on asthma outcomes is poorly understood. OBJECTIVE To assess their association with asthma symptoms and lung function at school age. METHODS Preschoolers (38.4 months) initially investigated with bronchial biopsies were re-assessed for asthma symptoms and lung function at school age. RESULTS Thirty-six of 49 preschoolers (73.5%) were assessed at 10.9 years. Twenty-six (72.2%) had persistent asthma. Submucosal eosinophil counts were higher in children with severe exacerbations at school age than in those without (16/0.1 mm2 [11.2-30.4] vs 8/0.1 mm2 [2.4-17.6], P = .02), and correlated with the number of severe exacerbations (P = .04, r = .35). Submucosal neutrophil counts correlated with FEV1/FVC (P < .01, r = .47) and FEF25-75% predicted (P = .02, r = .43). Airway smooth muscle (ASM) area correlated with FEV1/FVC (P < .01, r = .51). Vessel numbers negatively correlated with FEV1% predicted and FEV1/FVC (P = .03, r = -.42; P = .04, r = -.41; respectively) and FEF25-75% predicted (P = .02, r = -.46). CONCLUSION Eosinophilic inflammation in preschoolers with severe recurrent wheeze might be predictive of future severe exacerbations, neutrophilia might be associated with better lung function. Changes in ASM and vascularity might affect lung function at school age.
Collapse
Affiliation(s)
- G Lezmi
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Université Paris Descartes, Paris, France
| | - A Deschildre
- Unité de Pneumologie-Allergologie Pédiatrique, Clinique de Pédiatrie Jeanne de Flandre, CHRU de Lille, Université Nord de France, Lille, France
| | - R Abou Taam
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - M Fayon
- Centre de Recherche Cardio-thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Centre d'Investigation Clinique (CIC 1401), Bordeaux, France
| | - S Blanchon
- Unité de Pneumologie et Allergologie Pédiatrique, Centre de Compétences des Maladies Respiratoires Rares, Hôpitaux Universitaire de Toulouse, Toulouse, France
| | - F Troussier
- Centre de Ressources et de Compétences en Mucoviscidose Enfants, Service de Pédiatrie, Centre Hospitalier Universitaire, Angers, France
| | - P Mallinger
- Cabinet de Pneumologie et d'Allergologie des Sardières, Bourg-en-Bresse, France
| | - B Mahut
- Cabinet La Berma, Antony, France
| | - P Gosset
- Centre d'Infection et d'Immunité de Lille, Institut Pasteur de Lille, Lille, France.,Centre National de la Recherche Scientifique, Lille, France.,Institut National de la Santé et de la Recherche Médicale, Lille, France.,Institut Fédératif de la Recherche 142, Lille, France
| | - J de Blic
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Université Paris Descartes, Paris, France
| |
Collapse
|
2
|
Lezmi G, Alrowaishdi F, Bados-Albiero A, Scheinmann P, de Blic J, Ponvert C. Non-immediate-reading skin tests and prolonged challenges in non-immediate hypersensitivity to beta-lactams in children. Pediatr Allergy Immunol 2018; 29:84-89. [PMID: 29047169 DOI: 10.1111/pai.12826] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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] [Accepted: 10/15/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND A minority of children reporting non-immediate reactions to beta-lactams (BLs) are allergic. Allergy workup usually includes late-reading (48-72 hours) skin tests (ST) and short (1-3 days) drug provocation tests (DPT), regardless of the chronology of the index reaction. The sensitivity of hyper-late-reading (≥6-7 days) ST and of prolonged DPT for the diagnosis of non-immediate hypersensitivity to BLs is yet to be determined. OBJECTIVES To establish the diagnostic values of late-reading ST and hyper-late-reading ST and of prolonged DPT in children reporting non-immediate reactions to BLs. METHODS Prospective assessment of children reporting non-immediate reactions to BLs with late- and additional hyper-late-reading intradermal (ID) and patch tests, and if negative, with prolonged DPT. RESULTS Five hundred and fifty children reporting reactions to a single or several BLs (674 suspected BLs) were included. Non-immediate hypersensitivity to BLs was diagnosed in 63 children (11.5%), reporting 66 reactions (9.8%), based on responses in ST (n = 17, 25.8%: 5 to ID, 8 to patch tests, and 4 to both tests), DPT (n = 43, 65.2%), and clinical history (n = 6, 9.1%), including 3/9 children with severe cutaneous adverse reactions. Skin test positivity was observed after the 6-7th day in 14/17 children, and DPT positivity after a median time of 3 days. No severe reaction was observed after ST or during prolonged DPT. CONCLUSION Additional hyper-late-reading of ST enhanced their positivity. However, their overall sensitivity remained weak, especially in non-severe cases. Prolonged DPT are safe and may improve the performance of DPT in the diagnosis of non-immediate hypersensitivity to BLs.
Collapse
Affiliation(s)
- G Lezmi
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
| | - F Alrowaishdi
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France
| | | | - P Scheinmann
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
| | - J de Blic
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
| | - C Ponvert
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
| |
Collapse
|
3
|
de Blic J, Brouard J, Vabret A, Deschildre A. [The interactions between microorganisms and the small airways. A paediatric focus]. Rev Mal Respir 2017; 34:134-146. [PMID: 28262277 PMCID: PMC7125672 DOI: 10.1016/j.rmr.2016.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/26/2016] [Indexed: 11/19/2022]
Abstract
The spectrum of respiratory viruses is expanding and emerging diseases have been described regularly over the last fifteen years. The origin of these emerging respiratory viruses may be zoonotic (by crossing species barrier, after changes to RNA viruses such as avian influenza virus type A or coronaviruses), or related to the use of new identification techniques (metapneumovirus, bocavirus). The relationship between bronchiolitis and asthma is now better understood thanks to prospective follow up of birth cohorts. The role of rhinovirus has become predominant with respect to respiratory syncytial virus. The identification of predisposing factors immunological, functional, atopic and genetic, for the onset of asthma after rhinovirus infection suggests that viral infection reveals a predisposition rather than itself being a cause of asthma. The role of bacteria in the natural history of asthma is also beginning to be better understood. The results of the COPSAC Danish cohort have shown the frequency of bacterial identification during wheezy episodes before 3 years, and the impact of bacterial colonization at the age of one month on the onset of asthma by age 5 years. The role of bacterial infections in severe asthma in young children is also discussed.
Collapse
Affiliation(s)
- J de Blic
- Service de pneumologie et allergologie pédiatriques, hôpital universitaire Necker-Enfants-Malades, université Paris Descartes, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France.
| | - J Brouard
- EA 4655 U2RM, UCBN, service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14032 Caen, France
| | - A Vabret
- EA 4655 U2RM, UCBN, laboratoire de virologie, CHU de Caen, avenue Clémenceau, 14032 Caen, France
| | - A Deschildre
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Avinée, 59037 Lille cedex, France
| |
Collapse
|
4
|
Charatsi A, Dusser P, Freund R, Maruani G, Rossin H, Boulier A, Le Bourgeois M, Chedevergne F, de Blic J, Letourneur A, Casimir G, Jais J, Sermet-Gaudelus I. Bioelectrical impedance in young patients with cystic fibrosis: Validation of a specific equation and clinical relevance. J Cyst Fibros 2016; 15:825-833. [DOI: 10.1016/j.jcf.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/28/2016] [Accepted: 05/07/2016] [Indexed: 01/10/2023]
|
5
|
Belhassen M, de Blic J, Laforest L, Laigle V, Chanut-Vogel C, Lamezec L, Brouard J, Fauroux B, de Pouvourville G, Ginoux M, Van Ganse E. Partenariat public/privé : étude observationnelle quantifiant en vie réelle l’apport du Singulair® 4mg chez le nourrisson âgé de 6 à 24 mois. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.04.005] [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: 10/20/2022] Open
|
6
|
Abstract
El asma es la enfermedad crónica infantil más frecuente. El diagnóstico es fácil en la mayoría de las ocasiones por la aparición de episodios de disnea espiratoria con sibilancias reversibles espontáneamente o por el efecto de broncodilatadores. En el momento del diagnóstico, se requieren tres pruebas complementarias: las radiografías de tórax, las pruebas funcionales respiratorias y un estudio alergológico. El tratamiento de las exacerbaciones se basa en los beta2-adrenérgicos inhalados y, si es preciso, en la corticoterapia oral. El objetivo del tratamiento de fondo es mantener el control, prevenir las exacerbaciones y restaurar o mantener las funciones pulmonares normales. Se debe adaptar al nivel de control del asma y en él tiene un lugar destacado la corticoterapia inhalada y los broncodilatadores de acción prolongada. En los menores de tres años, el asma se diagnostica a partir de tres episodios de sibilancias. Se debe buscar la presencia de antecedentes particulares, de manifestaciones atípicas o persistentes y de anomalías en la radiografía de tórax para descartar las demás causas de manifestaciones sibilantes recidivantes. Cuando es necesario un tratamiento de fondo, se basa en la corticoterapia inhalada. Las cohortes prospectivas han permitido demostrar que la atopia, la gravedad clínica y la persistencia de una obstrucción clínica son los factores principales tanto de la persistencia como de la gravedad del asma durante la vida.
Collapse
Affiliation(s)
- J de Blic
- Service de pneumologie et d'allergologie pédiatriques, Centre de référence des maladies respiratoires rares, Hôpital universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France.,Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
| |
Collapse
|
7
|
Fuger M, Clair MP, El Ayoun Ibrahim N, L'Excellent S, Nizery L, O'Neill C, Tabone L, Truffinet O, Yakovleff C, de Blic J. [Chronic interstitial lung disease in children: Diagnostic approach and management]. Arch Pediatr 2016; 23:525-31. [PMID: 27021883 DOI: 10.1016/j.arcped.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/05/2016] [Accepted: 02/23/2016] [Indexed: 02/06/2023]
Abstract
Chronic interstitial lung disease (ILD) in children is a heterogeneous group of rare lung disorders characterized by an inflammatory process of the alveolar wall and the pulmonary interstitium that induces gas exchange disorders. The diagnostic approach to an ILD involves three essential steps: recognizing the ILD, appreciating the impact, and identifying the cause. The spectrum of clinical findings depends to a large extent on age. In the newborn, the beginning is often abrupt (neonatal respiratory distress), whereas there is a more gradual onset in infants (failure to thrive, tachypnea, indrawing of the respiratory muscles). In older children, the onset is insidious and the diagnosis can only be made at an advanced stage of the disease. The diagnosis is based on noninvasive methods (clinical history, respiratory function tests, chest X-ray, and high-resolution CT scan) and invasive techniques (bronchoalveolar lavage, transbronchial biopsy, video-assisted thoracoscopic biopsy, and open lung biopsy). The treatment of interstitial lung disease in children depends on the nature of the underlying pathology. The most common therapeutic approach involves the use of corticosteroids and immunosuppressive agents for their anti-inflammatory and antifibrotic effects. Children with ILD also need support therapy (oxygen therapy, nutritional support, treatment of pulmonary arterial hypertension, vaccination). Lung transplantation is discussed in patients with severe respiratory failure.
Collapse
Affiliation(s)
- M Fuger
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
| | - M-P Clair
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - N El Ayoun Ibrahim
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - S L'Excellent
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - L Nizery
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - C O'Neill
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - L Tabone
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - O Truffinet
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - C Yakovleff
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - J de Blic
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| |
Collapse
|
8
|
Affiliation(s)
- Z Keli-Bhija
- Department Pediatrics, Pulmonology and Allergy Service, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - J de Blic
- Department Pediatrics, Pulmonology and Allergy Service, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - C Ponvert
- Department Pediatrics, Pulmonology and Allergy Service, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France
| |
Collapse
|
9
|
Belhassen M, Ginoux M, Laigle V, Chanut-Vogel C, Lamezec L, de Blic J, Fauroux B, de Pouvourville G, Laforest L, Van Ganse E. Effectiveness of Montelukast on Asthma Control in Infants: A Claims Data Study. Value Health 2014; 17:A588. [PMID: 27202002 DOI: 10.1016/j.jval.2014.08.2010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - M Ginoux
- University of Lyon, Lyon, France
| | - V Laigle
- Laboratoires MSD France, Courbevoie, France
| | | | - L Lamezec
- Laboratoires MSD France, Courbevoie, France
| | - J de Blic
- Pediatric Medicine Necker University, Paris, France
| | - B Fauroux
- Pediatric Medicine Necker University, Paris, France
| | | | | | | |
Collapse
|
10
|
Houdouin V, Pouessel G, Angoulvant F, Brouard J, Derelle J, Fayon M, Ferroni A, Gangneux JP, Hau I, Le Bourgeois M, Lorrot M, Menotti J, Nathan N, Vabret A, Wallet F, Bonacorsi S, Cohen R, de Blic J, Deschildre A, Gandemer V, Pin I, Labbe A, Le Roux P, Martinot A, Rammaert B, Dubus JC, Delacourt C, Marguet C. Erratum à l’article « Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois » [Arch. Pediatr. 21(4) (2014) 418–423]. Arch Pediatr 2014. [DOI: 10.1016/j.arcped.2014.05.022] [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: 11/16/2022]
|
11
|
Deschildre A, Pin I, El Abd K, Belmin-Larrar S, El Mourad S, Thumerelle C, Le Roux P, Langlois C, de Blic J. Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C-ACT), and physician's rating. Allergy 2014; 69:784-90. [PMID: 24725204 DOI: 10.1111/all.12402] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool. AIM To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist. METHODS Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT. RESULTS Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P < 0.0001). According to PA, 89% of patients with a C-ACT > 21 were controlled and 85% of patients with a C-ACT < 17 not controlled. CONCLUSION We observed discrepancies between the different tools applied to assess asthma control in children, and the impact of age and exacerbations. Cutoff point of 19 of C-ACT was not associated with the best performance compared to PA. Assessment of control should take into account symptoms and lung function as suggested by the latest GINA guidelines as well as exacerbation over a long period.
Collapse
Affiliation(s)
- A. Deschildre
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - I. Pin
- Pédiatrie, Pôle Couple Enfants, CHU de Grenoble; INSERM U823; Institut Albert Bonniot; Université Joseph Fourier; Grenoble France
| | - K. El Abd
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
- Pédiatrie; CHC Espérance - Montegnée; Liège Belgium
| | - S. Belmin-Larrar
- Service de pneumologie et allergologie pédiatriques, AP-HP; Hôpital Necker Enfants Malades; Paris France
| | - S. El Mourad
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - C. Thumerelle
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - P. Le Roux
- Pédiatrie, groupe hospitalier du Havre; Le Havre France
| | - C. Langlois
- Département de biostatistiques, CHRU de Lille; Université Nord de France; Lille France
| | - J. de Blic
- Service de pneumologie et allergologie pédiatriques, AP-HP; Hôpital Necker Enfants Malades; Paris France
| |
Collapse
|
12
|
Masson A, Launay O, Delaisi B, Remus N, Lebourgeois M, Chedevergne F, Corvol H, Bonnel AS, Bassinet L, Bailly C, de Blic J, Sermet-Gaudelus I. 142 Immunisation coverage in children with cystic fibrosis: a French multicenter survey. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60278-2] [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: 10/25/2022]
|
13
|
Houdouin V, Pouessel G, Angoulvant F, Brouard J, Derelle J, Fayon M, Ferroni A, Gangneux JP, Hau I, Le Bourgeois M, Lorrot M, Menotti J, Nathan N, Vabret A, Wallet F, Bonacorsi S, Cohen R, de Blic J, Deschildre A, Gandemer V, Pin I, Labbe A, Le Roux P, Martinot A, Rammaert B, Dubus JC, Delacourt C, Marguet C. Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois. Arch Pediatr 2014; 21:418-23. [DOI: 10.1016/j.arcped.2014.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/16/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
|
14
|
Matar R, Le Bourgeois M, Scheinmann P, de Blic J, Ponvert C. Regarding the article entitled “Hypersensitivity to antibiotics in patients with cystic fibrosis”. J Cyst Fibros 2014; 13:238-9. [DOI: 10.1016/j.jcf.2013.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 01/29/2023]
|
15
|
Affiliation(s)
- C Ponvert
- Department Paediatrics, Pulmonology and Allergy Service, Necker-Enfants Malades Hospital, Paris, France.
| | | | | |
Collapse
|
16
|
Abstract
Post-infectious bronchiolitis obliterans (BO) is characterized by inflammatory and fibrotic lesions of small airways following a pulmonary infection and leading to some degree of airway obstruction. It represents a rare cause of chronic obstructive pulmonary disease, and is probably underestimated, especially when the lesions affect small areas of the lungs. The clinical features differ between children and adults. In children, adenovirus is the most frequently involved infectious agent, especially the more virulent serotypes 3, 7 and 21. The clinical and radiological signs vary widely and the functional outcome depends on the extent of the lung injury. The diagnosis is based on the medical history, the CT-scan and functional data. The treatment is symptomatic. The most severe forms may result in chronic respiratory insufficiency. In adults, the frequency of obstructive injuries of the small airways in the context of lung infection is unclear. Parenchymal lesions are often present, resulting in BO with organizing pneumonia. These lesions alter the clinical presentation and the radiographic features of the initial infectious disease and often prove difficult to diagnose and manage. Several authors have published clinical cases describing presumed efficacy of systemic corticosteroids but the data are scarce.
Collapse
Affiliation(s)
- J de Blic
- Service de pneumologie et allergologie pédiatriques, université Paris Descartes, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France.
| | | | | |
Collapse
|
17
|
Deschildre A, Tillie Leblond I, Mordacq C, de Blic J, Scheinmann P, Chanez P. [Mild asthma in children: new data and a revival of interest]. Rev Mal Respir 2012; 30:115-24. [PMID: 23419442 DOI: 10.1016/j.rmr.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 09/15/2012] [Indexed: 02/04/2023]
Abstract
According to the Global Initiative for Asthma (GINA) classification, mild asthma includes intermittent and mild persistent asthma. It represents more than 75% of asthmatic children. The symptoms and functional impact are well described. Mild asthma can lead to severe exacerbations. Progression to more severe disease may occur. Consequently, it is important to diagnose mild asthma, to initiate the appropriate treatment early, and to identify the risk factors for aggravation. Nevertheless, mild asthma is under-diagnosed and under-treated. Bronchial inflammation and remodeling are observed in mild asthma. A daily low-dose of inhaled corticosteroids is the reference treatment for mild persistent asthma. Intermittent inhaled corticosteroids cannot be recommended in children with mild persistent asthma.
Collapse
Affiliation(s)
- A Deschildre
- Unité de pneumologie et allergologie pédiatriques, pôle de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | | | | | | | | | | |
Collapse
|
18
|
Legendre M, Blanchon S, Copin B, Duquesnoy P, Montantin G, Kott E, Dastot F, Jeanson L, Cachanado M, Rousseau A, Papon JF, Tamalet A, Vojtek AM, Escalier D, Coste A, de Blic J, Clément A, Escudier E, Amselem S. Delineation of CCDC39/CCDC40 mutation spectrum and associated phenotypes in primary ciliary dyskinesia. Cilia 2012. [PMCID: PMC3555958 DOI: 10.1186/2046-2530-1-s1-p91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
19
|
Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern J, Lemanske R, Le Souef P, Mäkelä M, Roberts G, Wong G, Zar H, Akdis CA, Bacharier LB, Baraldi E, van Bever HP, de Blic J, Boner A, Burks W, Casale TB, Castro-Rodriguez JA, Chen YZ, El-Gamal YM, Everard ML, Frischer T, Geller M, Gereda J, Goh DY, Guilbert TW, Hedlin G, Heymann PW, Hong SJ, Hossny EM, Huang JL, Jackson DJ, de Jongste JC, Kalayci O, Aït-Khaled N, Kling S, Kuna P, Lau S, Ledford DK, Lee SI, Liu AH, Lockey RF, Lødrup-Carlsen K, Lötvall J, Morikawa A, Nieto A, Paramesh H, Pawankar R, Pohunek P, Pongracic J, Price D, Robertson C, Rosario N, Rossenwasser LJ, Sly PD, Stein R, Stick S, Szefler S, Taussig LM, Valovirta E, Vichyanond P, Wallace D, Weinberg E, Wennergren G, Wildhaber J, Zeiger RS. International consensus on (ICON) pediatric asthma. Allergy 2012; 67:976-97. [PMID: 22702533 DOI: 10.1111/j.1398-9995.2012.02865.x] [Citation(s) in RCA: 259] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 01/08/2023]
Abstract
Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices; however, this goal has not yet been achieved.
Collapse
|
20
|
Hadchouel-Duvergé A, Lezmi G, de Blic J, Delacourt C. [Congenital lung malformations: natural history and pathophysiological mechanisms]. Rev Mal Respir 2012; 29:601-11. [PMID: 22542416 DOI: 10.1016/j.rmr.2011.09.049] [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] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 09/22/2011] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Congenital lung lesions comprise a broad spectrum of various malformations including congenital cystic adenomatoid malformation (CCAM), bronchopulmonary sequestration (BPS), congenital lobar emphysema, bronchial atresia and bronchogenic cyst. This review aims at the description of their natural history, and of the underlying pathophysiological mechanisms. STATE OF THE ART Congenital lung lesions are frequently diagnosed antenatally and many remain asymptomatic after birth. In the absence of antenatal identification, they are usually revealed by the occurrence of infection. In some cases, spontaneous resolution of the malformation can occur. Different pathogenic hypotheses are discussed for the origin of these abnormalities, and common processes appear likely to all of these malformations. Factors involved in the process of branching seem to play a particularly important role. PERSPECTIVES Prospective follow-up of operated and unoperated children would complete our knowledge about the natural history of these lesions. The contribution of experimental models has led to advances in the understanding of pathogenic mechanisms. Further studies are needed to identify the factors initiating the malformative process.
Collapse
Affiliation(s)
- A Hadchouel-Duvergé
- Service de pneumologie et d'allergologie pédiatriques, hôpital Necker-Enfants-Malades, 149 rue de Sévres, Paris cedex 15, France
| | | | | | | |
Collapse
|
21
|
Abstract
Fungal colonization in cystic fibrosis patient is frequent and dominated by Aspergillus fumigatus (A. fumigatus). Mycological analysis on specific media showed other filamentous species Scedosporium, Geosmithia argillacea. Prospective studies are necessary to appreciate prevalence and pathogenicity in this pathology. A. fumigatus causes the most frequently allergic bronchopulmonary aspergillosis (ABPA). Invasive infection is exceptional in this context. An early diagnosis is important to avoid bronchial deterioration but is very difficult despite international consensus. New more specific biological markers are evaluated. Oral corticotherapy is the cornerstone of therapy but adverse effects are more frequent in cystic fibrosis. Antifungal therapy has a corticosteroid-sparing effect. New therapeutic strategies have to be evaluated.
Collapse
Affiliation(s)
- M Le Bourgeois
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
| | | | | | | | | |
Collapse
|
22
|
Pham Thi T, Scheinmann P, Karila C, Laurent J, Paty E, de Blic J. Syndrome dermorespiratoire : un phénotype sévère. Revue Française d'Allergologie 2011. [DOI: 10.1016/j.reval.2011.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Burgel PR, Bourdin A, Chanez P, Chabot F, Chaouat A, Chinet T, de Blic J, Devillier P, Deschildre A, Didier A, Garcia G, Jebrak G, Laurent F, Morel H, Perez T, Pilette C, Roche N, Tillie-Leblond I, Verbanck S, Dusser D. Update on the roles of distal airways in COPD. Eur Respir Rev 2011; 20:7-22. [DOI: 10.1183/09059180.10010610] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
24
|
Burgel PR, de Blic J, Chanez P, Delacourt C, Devillier P, Didier A, Dubus JC, Frachon I, Garcia G, Humbert M, Laurent F, Louis R, Magnan A, Mahut B, Perez T, Roche N, Tillie-Leblond I, Tunon de Lara M, Dusser D. Update on the roles of distal airways in asthma. Eur Respir Rev 2011; 18:80-95. [PMID: 20956128 DOI: 10.1183/09059180.00001109] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The present review is the summary of an expert workshop that took place in Vence (France) in 2007 on the role of distal airways in asthma. The evidence showing inflammation and remodelling in distal airways, and their possible involvement in asthma control and natural history, was reviewed. The usefulness and limitations of various techniques used for assessing distal airways were also evaluated, including pulmonary function tests and imaging. Finally, the available data studying the benefit of treatment better targeting distal airways in asthma was examined. It was concluded that both proximal and distal airways were involved in asthma and that distal airways were the major determinant of airflow obstruction. Inflammation in distal airways appeared more intense in severe and uncontrolled asthma. Distal airways were poorly attained by conventional aerosol of asthma medications owing to their granulometry, being composed of 3-5 μm particles. Both proximal and distal airways might be targeted either by delivering medications systemically or by aerosol of extra-fine particles. Extra-fine aerosols of long-acting β-agonists, inhaled corticosteroids or inhaled corticosteroid/long-acting β-agonist combinations have been shown in short-term studies to be not inferior to non-extra-fine aerosols of comparators. However, available studies have not yet demonstrated that extra-fine inhaled medications offer increased benefit compared with usual aerosols in asthmatic patients.
Collapse
Affiliation(s)
- P-R Burgel
- Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
de Blic J, Deschildre A. Racines pédiatriques de la bronchopneumopathie chronique obstructive. Rev Mal Respir 2011; 28:187-91. [DOI: 10.1016/j.rmr.2010.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 10/23/2010] [Indexed: 12/21/2022]
|
26
|
Ponvert C, Scheinmann P, de Blic J. Anaphylaxis to the 23-valent pneumococcal vaccine: A second explored case by means of immediate-reading skin tests with pneumococcal vaccines. Vaccine 2010; 28:8256-7. [DOI: 10.1016/j.vaccine.2010.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 09/28/2010] [Accepted: 10/12/2010] [Indexed: 11/25/2022]
|
27
|
Mechri M, Epaud R, Emond S, Coulomb A, Jaubert F, Tarrant A, Feldmann D, Flamein F, Clement A, de Blic J, Taam RA, Brunelle F, le Pointe HD. Surfactant protein C gene (SFTPC) mutation-associated lung disease: high-resolution computed tomography (HRCT) findings and its relation to histological analysis. Pediatr Pulmonol 2010; 45:1021-9. [PMID: 20658481 DOI: 10.1002/ppul.21289] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [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: 11/07/2022]
Abstract
AIM OF THE STUDY Determine high-resolution tomography (HRCT) scan characteristics in children with SFTPC mutation and correlate them to histological findings. PATIENTS AND METHODS This retrospective multicenter study included 15 children (7 females and 8 males) with SFTPC mutations. HRCT scans have been performed in all the children and lung biopsies in 8 children. RESULTS From all signs assessed on initial HRCT scans, ground-glass opacities (n =14, 93%) and lung cysts (n = 6, 40%) were predominant. Interlobular septal thickening (n = 1, 7%), air space consolidation (n = 1, 7%), paraseptal emphysema (n = 2, 13%), and pulmonary nodules (n = 1, 7%) were also found. Histological analysis revealed accumulation of macrophages in the alveolar lumen, type II pneumocyte hyperplasia, and alveolar septal thickening. Dilatation of the respiratory bronchiole and alveolar duct associated with muscular hyperplasia were also described. Interestingly, lung cysts on HRCT scans were associated with dilatation of terminal bronchioli and alveolar duct in lung biopsies. CONCLUSION In children with SFTPC mutations, HRCT scan finding was highly correlated to the histological findings and, as such, represent a useful tool to identify patients that may require SFTPC gene sequencing.
Collapse
Affiliation(s)
- M Mechri
- Pediatric Radiology Department, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Mahut B, Trinquart L, Le Bourgeois M, Becquemin MH, Beydon N, Aubourg F, Jala M, Bidaud-Chevalier B, Dinh-Xuan AT, Randrianarivelo O, Denjean A, de Blic J, Delclaux C. Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity. Allergy 2010; 65:636-44. [PMID: 19845572 DOI: 10.1111/j.1398-9995.2009.02221.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [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: 11/29/2022]
Abstract
BACKGROUND Exhaled NO can be partitioned in its bronchial and alveolar sources, and the latter may increase in the presence of recent asthmatic symptoms and in refractory asthma. The aim of this multicentre prospective study was to assess whether alveolar NO fraction and FE(NO) could be associated with the level of asthma control and severity both at the time of measurement and in the subsequent 3 months. METHODS Asthma patients older than 10 years, nonsmokers, without recent exacerbation and under regular treatment, underwent exhaled NO measurement at multiple constant flows allowing its partition in alveolar (with correction for back-diffusion) and bronchial origins based on a two-compartment model of NO exchange; exhaled NO fraction at 50 ml/s (FE(NO,0.05)) was also recorded. On inclusion, severity was assessed using the four Global initiative for asthma (GINA) classes and control using Asthma Control Questionnaire (ACQ). Participants were followed-up for 12 weeks, control being assessed by short-ACQ on 1st, 4th, 8th and 12th week. RESULTS Two-hundred patients [107 children and 93 adults, median age (25th; 75th percentile) 16 years (12; 38)], 165 receiving inhaled corticosteroid, were included in five centres. The two-compartment model was valid in 175/200 patients (87.5%). Alveolar NO and FE(NO,0.05) did not correlate to control on inclusion or follow-up (either with ACQ /short-ACQ values or their changes), nor was influenced by severity classes. Alveolar NO negatively correlated to MEF(25-75%) (rho = -0.22, P < 0.01). CONCLUSION Alveolar and exhaled NO fractions are not indexes of control or severity in asthmatic children and adults under treatment.
Collapse
Affiliation(s)
- B Mahut
- Cabinet La Berma, Antony, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
de Blic J, Scheinmann P. Asma infantil y del lactante. EMC - Pediatría 2010; 45:1-20. [PMID: 32308525 PMCID: PMC7158999 DOI: 10.1016/s1245-1789(10)70178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
El asma es la enfermedad crónica más frecuente de la infancia. El diagnóstico suele ser fácil cuando se producen episodios de disnea espiratoria con sibilancias reversibles de forma espontánea o mediante el uso de broncodilatadores. Las radiografías de tórax, la exploración funcional respiratoria y el estudio alérgico constituyen el aspecto fundamental de las pruebas complementarias necesarias. El tratamiento de la crisis consiste en el uso de β2-adrenérgicos inhalados y, si es necesario, corticoides orales. El tratamiento de fondo tiene como objetivo limitar al máximo los síntomas y restaurar o mantener las funciones pulmonares normales. Se debe adaptar a la gravedad y al control de la enfermedad y los corticoides inhalados tienen un papel de elección.
Collapse
|
30
|
Guillot L, Epaud R, Thouvenin G, Jonard L, Mohsni A, Couderc R, Counil F, de Blic J, Taam RA, Le Bourgeois M, Reix P, Flamein F, Clement A, Feldmann D. New surfactant protein C gene mutations associated with diffuse lung disease. J Med Genet 2009; 46:490-4. [DOI: 10.1136/jmg.2009.066829] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
31
|
Deschildre A, Pin I, Gueorguieva I, de Blic J. [Asthma and obesity in childhood: what is the link?]. Arch Pediatr 2009; 16:1166-74. [PMID: 19442499 DOI: 10.1016/j.arcped.2009.04.001] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 12/01/2008] [Accepted: 04/01/2009] [Indexed: 11/17/2022]
Abstract
According to the definition (body mass index>97 degrees percentile), overweight and obesity concern 15% of French children. The parallel trends in the increase in asthma and obesity may indicate a potential link between these two conditions. The purpose of this study was to review the epidemiological data indicating a relationship between asthma and obesity, to evaluate the consequences of obesity on asthma and to assess the mechanisms of this association. We conclude with the implications for treatment strategies.
Collapse
Affiliation(s)
- A Deschildre
- Unité de pneumologie pédiatrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France.
| | | | | | | |
Collapse
|
32
|
Brand PLP, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, de Blic J, de Jongste JC, Eber E, Everard ML, Frey U, Gappa M, Garcia-Marcos L, Grigg J, Lenney W, Le Souëf P, McKenzie S, Merkus PJFM, Midulla F, Paton JY, Piacentini G, Pohunek P, Rossi GA, Seddon P, Silverman M, Sly PD, Stick S, Valiulis A, van Aalderen WMC, Wildhaber JH, Wennergren G, Wilson N, Zivkovic Z, Bush A. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2009; 32:1096-110. [PMID: 18827155 DOI: 10.1183/09031936.00002108] [Citation(s) in RCA: 493] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.
Collapse
Affiliation(s)
- P L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
INTRODUCTION Prospective studies of paediatric cohorts contribute to our knowledge of changes in pulmonary function in children with asthma. STATE OF THE ART Asthma is associated with a significant impairment of the distal airways which is more pronounced when asthma has started early, before 5 years of age, or when asthma is persistent. In utero exposure to tobacco smoke allergenic sensitization and persistent bronchial hyperresponsiveness are the main factors associated with an unfavourable respiratory function outcome. This impairment may persist despite the disappearance of symptoms. Distal airway alterations are also poorly responsive to conventional inhaled corticosteroid therapy. This could be due to early remodelling phenomenon or non-optimal deposition of the drugs on distal airways. PERSPECTIVES AND CONCLUSIONS The medium and long term clinical implications of distal airway involvement in paediatric asthma and the impact of treatment need to be evaluated.
Collapse
Affiliation(s)
- C Delacourt
- Service de Pédiatrie, CHI de Créteil, France
| | | | | |
Collapse
|
34
|
Tillie-Leblond I, Montani D, Crestani B, de Blic J, Humbert M, Tunon-de-Lara M, Magnan A, Roche N, Ostinelli J, Chanez P. Relation between inflammation and symptoms in asthma. Allergy 2009; 64:354-67. [PMID: 19210358 DOI: 10.1111/j.1398-9995.2009.01971.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [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: 11/30/2022]
Abstract
Asthma symptoms are the main reason for healthcare utilization and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. A French expert group studied the association between inflammation and asthma symptoms by carrying out a critical review of the international literature. Uncontrolled asthmatics have an increased number of polynuclear eosinophils in the induced sputum and an increased production of exhaled NO. Control by anti-inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggest that there is a relationship between the perception of symptoms and eosinophilic inflammation and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow-up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference disease-modifying therapy for persistent asthma. Recent studies demonstrated that adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total number of doses of inhaled corticosteroids.
Collapse
Affiliation(s)
- I Tillie-Leblond
- Respiratory Diseases Department, Hôpital Albert Calmette, Lille, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Rancé F, Chave C, de Blic J, Deschildre A, Donato L, Dubus JC, Fayon M, Labbe A, Le Bourgeois M, Llerena C, Le Manach G, Pin I, Santos C, Thumerelle C, Aubert M, Weil-Olivier C. [Influenza vaccination coverage in asthmatic children in France in 2006-2007]. Arch Pediatr 2009; 15:1724-8. [PMID: 19090033 DOI: 10.1016/j.arcped.2008.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In France, an annual seasonal influenza vaccination has been recommended since 2000 for patients suffering from chronic respiratory diseases, including asthma. Each year, a free influenza vaccination voucher is sent by the French Public Health Insurance authorities to patients with chronic respiratory disease, including severe asthma. In November 2006, this measure was extended to all asthmatic patients, irrespective of asthma severity. The present paper examines the 2006-2007 influenza vaccination coverage rate in 433 asthmatic children aged six to 17 years (mean age: 9.5 years; male: 61%) who consulted a pediatric pulmonologist between March and September 2007 in eight hospitals throughout France. The influenza vaccination coverage rate was 15.7% for the 2006-2007 season (13.9% for the 2005-2006 season and 10.9% for the 2004-2005 season). General practitioners vaccinated 72.1% of the children. Lack of information (42%) was the most frequently reported reason for non-vaccination. Free vouchers (received by 39.6% of the children) significantly increased the vaccination coverage rate (31% versus 5.9%; p < 0.001). In France, in 2006-2007, the influenza vaccination coverage rate in asthmatic children was far below the national public health objective to achieve for the year 2008 (at least 75%). Concerted action is needed to improve the influenza vaccination coverage rate in asthmatic children.
Collapse
Affiliation(s)
- F Rancé
- Service de pédiatrie-pneumologie-allergologie hôpital-des-enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Delacourt C, de Blic J, Dubus JC. Atteinte des voies aériennes distale dans l’asthme : que nous apprennent les cohortes pédiatriques ? Rev Mal Respir 2009. [DOI: 10.1016/s0761-8425(09)71613-4] [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: 11/24/2022]
|
37
|
Delacourt C, Dubus JC, de Blic J. Atteinte des voies aériennes distales dans l’asthme : que nous apprennent les cohortes pédiatriques ? Rev Mal Respir 2009. [DOI: 10.1016/s0761-8425(09)71604-3] [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: 12/01/2022]
|
38
|
Fabi M, Le Bourgeois M, Bodemer C, Beguin V, Prieur AM, Quartier P, de Blic J. Respiratory involvement in juvenile dermatomyositis. Pediatr Rheumatol Online J 2008. [PMCID: PMC3334023 DOI: 10.1186/1546-0096-6-s1-p219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
39
|
Demoly P, Didier A, Mathelier-Fusade P, Drouet M, David M, Bonnelye G, Blic JD, Klossek JM. Physician and patient survey of allergic rhinitis in France: perceptions on prevalence, severity of symptoms, care management and specific immunotherapy. Allergy 2008; 63:1008-14. [PMID: 18691304 DOI: 10.1111/j.1398-9995.2008.01666.x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Specific immunotherapy (SIT) is the only aetiological treatment used in allergic rhinitis (AR). A telephone survey of patients and physicians in France was carried out to understand better the real and perceived advantages and inconveniences of this therapeutic approach. METHODS A cohort of 453 individuals with AR was selected using the Score For Allergic Rhinitis questionnaire. The survey evaluated the level of understanding of allergic rhinitis and its management, including both pharmacotherapy and SIT. A parallel survey was conducted with 400 general practitioners, allergists and nonallergist specialists. RESULTS Approximately 50% of patients had heard about SIT as a therapeutic option. Of these, 56% had a positive view of SIT and 14% a negative image. A majority of patients and physicians with a positive opinion associated SIT with improved well-being and quality of life, while those with a negative opinion considered it to be a long and inconvenient treatment, with uncertain results. Over 50% of patients who had been offered SIT had accepted it and approximately 60% of these were satisfied with it. The future availability of SIT as sublingual tablets was perceived positively by both patients and physicians. CONCLUSIONS Many patients with AR are unaware of their pathology and few seek help from health professionals. When patients take medication, they are generally satisfied with their treatment, even if it is only symptomatic. Patients and physicians see the notion of definitive recovery as the main benefit of SIT, whereas the main disadvantage is the duration of treatment.
Collapse
Affiliation(s)
- P Demoly
- Unité d'Exploration des Allergies, INSERM U657 Hôpital Arnaud de Villeneuve, Montpellier, France
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
BACKGROUND Severe asthma may involve an irreversible obstructive pattern, and structural changes in bronchial airways are believed to play a key role in this context. The aim of the present study was to compare airway remodeling in severe asthmatic children with or without obstructive pattern. METHODS Two groups of children with severe asthma and persistent symptoms, 5-14 years old were included, 15 with persistent obstructive pattern (group O) and 10 without obstructive pattern (group N). Persistent obstructive pattern was defined as a forced expiratory volume in 1 s (FEV(1)) less than 80% of the predicted value after a course of systemic corticosteroids and no significant improvement after bronchodilator. We examined bronchial biopsies by pathological and immunochemical methods and quantified airway smooth muscle (ASM) and mucus gland areas, reticular basement membrane (RBM) thickening, distance between ASM and RBM, muscle light chain kinase (MLCK) expression and number of vessels (CD31 expression). RESULTS Surface area of ASM (P = 0.009), MLCK expression (P = 0.03) and number of vessels (P = 0.0008) were increased in group O compared with group N. Distance of RBM-ASM was shorter in group O (P = 0.007). FEV(1) negatively correlated with ASM area (r = -0.6; P = 0.002), MLCK expression (r = -0.45; P = 0.02) and CD31 expression (r = -0.7; P = 0.0003), and positively correlated with the distance of RBM-ASM (r = 0.5; P = 0.007). CONCLUSIONS Structural abnormalities of airway remodeling are present in children with severe asthma. Only an increase in surface area of ASM and the density of the vascular network are more pronounced in children with persistent obstructive pattern, while RBM thickening is similar. These results are concordant with longitudinal studies which emphasize the precocity of bronchial obstruction.
Collapse
|
41
|
Woischnik M, Bauer A, Aboutaam R, Pamir A, Stanzel F, de Blic J, Griese M. Cathepsin H and napsin A are active in the alveoli and increased in alveolar proteinosis. Eur Respir J 2008; 31:1197-204. [DOI: 10.1183/09031936.00081207] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
42
|
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma frequently coexist but has rarely been evaluated in children. OBJECTIVE This prospective study aimed to estimate the prevalence of AR in asthmatic children, and ascertain whether AR is a risk factor for the severity of asthma. METHODS The questionnaire, modified from the adult form of the score for allergic rhinitis (SFAR), was completed by 404 asthmatic children aged 3-18 years seen in the outpatient clinic between June 2005 and July 2007. Each item was assigned a number of points with a final score ranging from 0 to 17. AR and asthma were classified according to ARIA and GINA 2004 recommendations, respectively. RESULTS AR was diagnosed in 237 patients (58.7%). It was intermittent in 57.8% of the patients and persistent in 42.2%. A total score >or=9 was discriminant for AR (sensitivity=91.1%, specificity=95.2%, positive predictive value=96.4%, negative predictive value=88.3%, Youden's Index=0.86). The proportion of children having mild or moderate-to-severe asthma was independent of the presence of AR, 61.6% of moderate-to-severe asthmatic children and 55.4% of intermittent and mild asthmatic children having AR. CONCLUSION AR and asthma are frequently associated (58.7%). The SFAR adapted for children seems to be a simple and a reliable tool to detect AR in asthmatic children.
Collapse
Affiliation(s)
- S Hamouda
- Université Paris Descartes, Assistance Publique des hôpitaux de Paris, Hôpital Necker Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France
| | | | | | | | | |
Collapse
|
43
|
Ou P, de Blic J, Emond S, Mamou-Mani T, Sidi D, Bonnet D, Brunelle F. Scanner thoracique multibarette. Arch Pediatr 2007; 14 Suppl 4:S227-32. [DOI: 10.1016/s0929-693x(07)78712-2] [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: 10/22/2022]
|
44
|
Chanez P, de Blic J, Delacourt C, Deschildre A, Devillier P, Didier A, Dusser D, Humbert M, Leroyer C, Marguet C, Martinat Y, Piquet J, Raherison C, Serrier P, Tillie-Leblond I, Tonnel AB, Tunon de Lara M. [Characteristics of mild asthma: clinical signs and medication use. Position statement of the Mild Asthma Working Group (174)]. Rev Mal Respir 2007; 23:607-18. [PMID: 17202966 DOI: 10.1016/s0761-8425(06)72076-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To update on the state of knowledge in mild asthma (intermittent and persistent mild asthma, according to the GINA classification) review the literature, and the position statement of the French Mild Asthma Working Group. METHODS The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the descriptive epidemiology, physiopathology, clinical signs, and management of mild asthma. The position of the working group on the descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation has been presented in a previous article. The present article focuses on the clinical features of mild asthma and the use of medication for it. RESULTS Mild asthma was more frequent, more symptomatic, and less well controlled in children than in adults. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Patients with mild persistent asthma require controller medication every day: permanent low-dose inhaled corticosteroid monotherapy is the reference foundation treatment for persistent mild asthma. CONCLUSIONS The present findings should help clinicians and guide them in their approach to managing this condition.
Collapse
Affiliation(s)
- P Chanez
- Clinique des maladies respiratoires, hôpital Arnaud Villeneuve, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Fonseca MTM, Camargos PAM, Abou Taam R, Le Bourgeois M, Scheinmann P, de Blic J. Incidence rate and factors related to post-bronchoalveolar lavage fever in children. Respiration 2007; 74:653-8. [PMID: 17728531 DOI: 10.1159/000107737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 12/27/2006] [Accepted: 06/05/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Post-bronchoscopy and bronchoalveolar lavage (BAL) fever in children has been described by several authors. OBJECTIVES This study aimed at assessing the occurrence of fever after these examinations and associated risk factors. METHODS The study was performed in the Bronchoscopy Unit of Hôpital Necker-Enfants Malades, Paris, France, from June 2004 to July 2005. 148 children who underwent fiberoptic bronchoscopy and BAL, and remained in the Unit for 24 h, were included. RESULTS 37.8% of the patients presented post-BAL fever. In the multivariate analysis of the selected factors (age, immunodeficiency, general or local anesthesia, mucosal biopsy, inflammation and suppuration at the moment of the examination, abnormal bronchoalveolar fluid cellularity and infection), only age <2 years and presence of infection remained associated with fever. CONCLUSIONS The occurrence of fever is a frequent event in children who underwent BAL. In order to reduce post-BAL fever, antibiotic strategies should be devised based on prospective studies assessing identification of predictive air-way infection criteria and/or rapid bacteriological result analysis.
Collapse
Affiliation(s)
- M T Mohallem Fonseca
- Departamento de Pediatria da Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- J de Blic
- Société de Pneumologie et Allergologie Pédiatriques, Hôpital Necker Enfants Malades, Paris.
| |
Collapse
|
47
|
Mavale-Manuel S, Joaquim O, Nunes E, Pedro A, Bandeira S, Eduardo E, Macome C, Almeida L, Cossa A, Malichocho J, Maciel L, Constance E, Marques S, Tembe A, de Blic J, Annesi-Maesano I. Prevalence of asthma-like symptoms by ISAAC video questionnaire in Mozambican schoolchildren. Monaldi Arch Chest Dis 2007; 65:189-95. [PMID: 17393663 DOI: 10.4081/monaldi.2006.548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire was developed to overcome the language and cultural differences in the assessment of asthma-like symptoms. METHODS 27 schools were included in the Maputo Asthma and Allergies in childhood Study (MAPAAS) using ISAAC methods, and a video questionnaire (VQ) was administered to 1614 adolescents 13-14 years old of 20 schools located in urban, suburban and semi-rural areas of Maputo (Mozambique). Simultaneously, they also replied to the ISAAC written questionnaire (WQ). RESULTS According to the video questionnaire, the prevalence of current asthma was 11.9% (compared with 13.3% using the written questionnaire). Wheezing after exercise in the last year was reported by about 21%. Females reported more frequent wheezing after exercise than males (p < .001). The prevalence of nocturnal cough in the last year was 24.7%, and was more frequent in the suburban area (p < .001). "Severe attacks of asthma" was reported by 11.9% of the individuals. Teenagers instructed in the suburban schools reported more severe asthma-like symptoms than others (p < .05). There was a poor correlation between the WQ and the AVQ3.0 (kappa coefficients varied from 0.09 to 0.24). The lowest agreement was observed for the question regarding severe attacks of asthma. Agreement was better in terms of specificity than in terms of sensitivity. CONCLUSIONS In spite of the poor agreement between the written and the video questionnaires, the prevalence of asthma symptoms estimated using the video questionnaire confirms that asthma is an important public health problem in Maputo.
Collapse
Affiliation(s)
- S Mavale-Manuel
- Maputo Central Hospital--Department of Paediatrics, Mozambique
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
de Blic J, Boucot I, Pribil C, Huas D, Godard P. [Asthma control level in asthmatic children followed in general practice medicine in France: results of ER'ASTHME study]. Arch Pediatr 2007; 14:1069-75. [PMID: 17566720 DOI: 10.1016/j.arcped.2007.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 04/10/2007] [Accepted: 05/02/2007] [Indexed: 11/29/2022]
Abstract
UNLABELLED Little information is available on asthma control level in children in France in general practice medicine although such control is 1 of the essential goals of treatment. The ER'Asthme survey has been set up to assess asthma control among asthmatic patients visiting their general practitioner and to determine the clinical and therapeutic associated factors. METHODS Cross-sectional ancillary study carried out in 1410 asthmatic children aged 6 to 14 years old (B/G 65/35%), with asthma diagnosed at least 12 months earlier and visiting spontaneously their GP. It collected data on self-assessed health status, asthma control (assessed by 3-level composite score based on the Canadian consensus criteria as adapted by Anaes: optimal, acceptable and unacceptable), and compliance (PMAQ3w questionnaire) during the last 4 weeks. RESULTS Children (or their parents) answered the question about their asthma control as follow: 62% "excellent" or "fine", 31% "not very good" and 7% "poor". GPs, however, assessed asthma control as optimal in 27% of children, acceptable in 7% and unacceptable in 66%. Eighty-four per cent of children had taken a maintenance treatment. Only 57% of patients reported complete compliance with their maintenance treatment (60% in 6-12 years old vs 52% in 13-14 years old, P=0.0089). Asthma control level was significantly associated to the asthma severity (P=0.0063), type of maintenance treatment (P<0.0001) and to treatment compliance (P=0.0005). CONCLUSION Asthmatic children aged 6 to 14 years old (or their parents) overestimate their asthma control, which remains inadequate. Severity of asthma, compliance level and the type of maintenance treatment influence the level of asthma control.
Collapse
Affiliation(s)
- J de Blic
- Service de pneumologie et allergologie pédiatrique, Assistance publique-Hôpitaux de Paris, hôpital Necker-Enfants-Malades, Paris, France.
| | | | | | | | | |
Collapse
|
49
|
de Blic J. Fréquence relative des mutations des gènes DNAI1 et DNAH5 au cours des dyskinésies ciliaires primitives. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91712-x] [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: 10/21/2022]
|
50
|
de Blic J. La fonction respiratoire et l’état nutritionnel conditionnent le moment optimal de mise sur liste de transplantation au cours de la mucoviscidose. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91709-x] [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: 11/26/2022]
|