Prevention of New Respiratory Episodes in Children with Recurrent Respiratory Infections: An Expert Consensus Statement

In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children.

[PSORIATIC ARTHRITIS IN CHILDREN: CHARACTERISTICS OF THE CLINICAL PICTURE]

The aim of the study is to establish the features of the clinical course of psoriatic arthritis in children. 83 patients with psoriatic arthritis (PSA) were examined. The terms of formation of articular and skin syndromes in PSA in children, as well as options for the onset and height of the disease and features of the course in childhood were revealed. Based on the results of the study, it should be concluded that, in contrast to the literature data, the majority of patients with PSA disease debut falls on the age of 6.5 years, the disease begins with skin lesions and in the debut of the joint syndrome. 6-7 years later from the onset of the disease in patients have asymmetric oligoarthritis, spondylitis in combination with the lesion of peripheral joints, also revealed mutilatng arthritis, however, were the leaders of the symmetric rheumatoid option. It should be noted that all observed patients expressed periarticular osteoporosis, which is not typical for this pathology.

Fluticasone propionate in asthma: a long term dose comparison study

BACKGROUND

Few dose ranging studies have investigated optimal dosing with inhaled corticosteroids in children with asthma.

AIMS

To compare the efficacy and tolerability of fluticasone propionate 100 or 200 microg twice daily in children with moderate to severe asthma for one year.

METHODS

One year, randomised, double blind, parallel group, multicentre study. Children aged 4-11 years (n = 528) with moderate to severe asthma who had previously received high dose inhaled corticosteroids were given fluticasone propionate 100 or 200 microg twice daily for the 52 week treatment period. Efficacy (exacerbations, lung function, and symptoms) and tolerability (adverse events and cortisol levels) were measured.

RESULTS

There was a non-significant decreased risk of experiencing an exacerbation at any time with fluticasone propionate 200 microg twice daily compared with fluticasone propionate 100 microg twice daily. This difference reached significance among patients with more severe asthma (defined by previous inhaled corticosteroid dose >800 microg/day). Daily record card morning peak expiratory flow (PEF) in the total population improved significantly more with the higher dose of fluticasone propionate (between group difference, weeks 1-52: 11.4 l/min). Clinic visit mean PEF improved from baseline with both doses, but the response was significantly greater with the higher dose (between group difference, week 52: 17.8 l/min). Both doses were equally well tolerated and overnight urinary cortisol concentrations were unchanged or slightly increased during treatment with either dose.

CONCLUSION

This long term dose comparison study shows that treatment with fluticasone propionate 200 micro g twice daily may offer benefits over a lower dose, particularly in children with more severe asthma.