Background
Lung function testing in small children is cumbersome. However, reduced variability of tidal breathing recorded using impedance pneumography (IP) during sleep was recently found to be a ...potential objective marker of wheeze in children aged 1‐5 years. We aimed to investigate how an acute bronchial obstruction (BO) and its severity, and recovery thereof reflect in expiratory variability index (EVI).
Methods
EVI was measured using a wearable IP system (Ventica®) during sleep in 40 healthy controls (aged 1.5‐5.9 years) and 30 patients hospitalized due to acute BO (aged 1.3‐5.3 years). In healthy controls, EVI was measured for 1‐3 nights at their homes. Patients were measured for several nights during hospitalization, as practically feasible, and at home 2 and 4 weeks post‐discharge.
Results
We received 79 EVI results from 39 controls and 139 from 30 patients. 90% had previous BO episodes, 30% used asthma controller medication before and 100% after hospitalization. Compared to controls, EVI was significantly lower during hospitalization (P < .0001) having significant correlation with number of days to discharge (r = −.38, P = .004). At 2 or 4 weeks post‐discharge, EVI was not significantly different from the controls (P = .14, P = .49, respectively). EVI was significantly associated with chest auscultation findings (P = .0001) being 17.5 (4.9) (median, IQR) with normal auscultation, 15.6 (7.4) in those with prolonged expiration and 11.4 (6.8) in those with wheeze and/or rales and crackles.
Conclusions
EVI was found to be a sensitive, objective marker of acute BO, showing strong association with changes in clinical status in wheezy children aged 1‐5 years.
Mjerenje plućne funkcije kod predškolske djece predstavlja jedno od najdinamičnijih i najizazovnijih područja istraživanja fiziologije dišnog sustava te integralnu komponentu kliničkog praćenja i ...liječenja. Cilj ovoga preglednog članka jest pružiti uvid o metodi i primjeni najčešćih testova plućne funkcije u djece predškolske dobi koji su nam dostupni (spirometrija, impulsna oscilometrija, tjelesna pletizmografija), kao i potencijalne probleme ispitivanja plućne funkcije u toj dobi. Spirometrija je najčešće primjenjivani test plućne funkcije koji se izvodi u pedijatrijskoj populaciji na standardiziran način kao i kod odraslih. U predškolskoj dobi primjena spirometrije ima nekoliko izazova poput dobi ispitanika, osiguravanja maksimalnog napora kod izvođenja, duljine izdisaja tijekom spirometrijskog manevra, pouzdanosti dobivenih parametra. Mjerenje specifičnog otpora dišnih putova putem tjelesne pletizmografije kao i impulsna oscilometrija također daju uvid u plućnu funkciju, a glavna im je prednost što se izvode tijekom mirnog disanja te zahtijevaju samo minimalnu suradnju. Kod odabira metode procjene plućne funkcije važno je odrediti moguću kliničku dijagnozu, a ne da se izbor pretrage temelji na dostupnoj opremi. Važno je i primijeniti odgovarajuće dostupne referentne intervale za pojedine pretrage. Potrebna su dodatna istraživanja koja će odrediti ulogu pojedinih testova, standardizirati postupak i odrediti prikladne referentne vrijednosti što bi olakšalo praćenje bolesnika, ali i omogućilo uspoređivanje različitih metoda u cilju dobivanja kompletnije kliničke slike.
Profesionalni sportaši često su podvrgnuti treninzima izdržljivosti u okolišu u kojem su kronično izloženi inhalacijskim onečišćivačima/iritansima, alergenima ili hladnom zraku. Ti čimbenici dovode ...do povećanog rizika od razvoja disfunkcije gornjih i donjih dišnih putova. Upravo je u toj specifičnoj populaciji dijagnoza astme krucijalna zbog potencijalnog učinka ne samo na njihovo opće stanje nego i na natjecateljske sposobnosti. Simptomi astme u vrhunskih sportaša nisu nužno povezani s klasičnim obilježjima astme u općoj populaciji. I drugi klinički entiteti mogu stvarati simptome slične onima u astmi i zbog toga mogu voditi netočnoj dijagnozi i neuspješnu liječenju. Zbog toga je za postavljanje konačne dijagnoze potrebna kombinacija simptoma i pozitivnih laboratorijskih testova. Trenutačno ne postoji dokaz da se postupanje s astmom u sportaša treba razlikovati od postupanja s astmom u nesportaša. Međutim, neka specifična pitanja treba uzeti u obzir u vrhunskih sportaša, poput usklađenosti s pravilima Svjetske antidopinške agencije i Međunarodnog olimpijskog odbora.
Pandemija COVID-19 uzrokovala je pad kvalitete medicinske skrbi oboljelih od tuberkuloze. Iako se broj prijavljenih novooboljelih slučajeva tijekom pandemije smanjio, povisio se broj umrlih od ...tuberkuloze uz pretpostavku povećanja broja novooboljelih. Tuberkuloza pluća u djece stoga je ostala izazov u zbrinjavanju pacijenata te važan javnozdravstveni problem. Osnova dijagnoze tuberkuloze u djece predstavlja dobro uzimanje anamnestičkih podataka koji se odnose na karakteristike izvornoga indeksnog pacijenta, karakteristike i vrstu kontakta te karakteristike djeteta, prvenstveno njegove dobi te imunološkog stanja. Karakteristični simptomi bolesti prisutni su u starije djece, dok mlađa djeca mogu biti i asimptomatska. Također, radiološki nalaz postaje specifičan u adolescentnoj dobi, dok u manje djece može pokazivati nekarakteristične promjene. Za dokaz infekcije s Mycobacterium tuberculosis koristi se interferon gamma releasing assay, brza i sigurna pretraga iz krvi kojom se dokazuje imunološka reakcija na Mycobacterium tuberculosis. Mikrobiološka obrada sputuma i želučanih lavata mikroskopski i uzgojem kultura neizostavan je stupanj obrade, no u mlađe djece također je smanjene osjetljivosti. Terapija u djece odnosi se na profilaktičku terapiju tuberkulozne infekcije kojoj je svrha spriječiti razvoj aktivnih oblika bolesti i punu intenzivnu antituberkulotsku terapiju kod aktivne tuberkuloze pluća. Praćenje i obrada djece sa suspektnom ili dokazanom tuberkulozom u domeni je dječjeg pulmologa u suradnji s primarnim pedijatrom i nadležnom epidemiološkom službom, a u svrhu pravodobne dijagnostike bilo latentne ili aktivne tuberkuloze te adekvatnog liječenja i suzbijanja bolesti.
Anafilaksija potaknuta naporom (EIA, od engl. exercise-induced anaphylaxis) rijedak je poremećaj čije je obilježje razvoj teške alergijske reakcije nakon tjelesne aktivnosti. Bolest se očituje ...postupnim razvojem sljedećih simptoma: svrbež, crvenilo kože, urtike, angioedem, anafilaktički šok u užem smislu (hipotenzija, sinkopa, gubitak svijesti, gušenje, stridor, mučnina i povraćanje) i završna faza, obilježena prolongiranom urtikarijom i glavoboljom. Čimbenici koji potiču EIA su izloženost višoj koncentraciji peluda, ubodi insekata, ekstremne temperature okoline, povećana vlažnost zraka, uzimanje nesteroidnih protuupalnih lijekova. Od nutritivnih alergena najčešći provokativni čimbenici su proteini pšenice, rakovi i školjke. Prevencija pojave EIA temelji se na izbjegavanju mogućih okidača. Radi lakšeg prepoznavanja EIA bolesnik bi uvijek trebao sa sobom nositi pisani dokument u kojem se navodi mogućnost nastanka EIA. Također je poželjno da vježbanje ili drugi potencijalni tjelesni napor bolesnik izvodi u prisutnosti osoba koje mu mogu pružiti medicinsku pomoć.
Published data indicate that during the last decades there is a possible change in the pattern of sensitization to different aeroallergens in adult population with atopy. The aim of this ...investigation was based on the hypothesis that during last 15 years there has been a change in the structure of prevalence of sensitization to different aeroallergens in adult population of Zagreb and its surroundings with atopy. Medical records from outpatient allergy clinic were screened for the period 1991-2004. We included 794 patients during years 1991-1994, 814 patients during years 1995-1999, and 969 patients during years 2000-2004. Following data were analyzed: age, gender, education level, residence, referral diagnosis, dominant symptoms, results of skin-prick test (SPT), total and specific serum immunoglobulin E. As risk factors for allergic sensitization we determined the decade of birth (p < 0.0001), male gender (p < 0.008), level of education (p < 0.0001), and place of residence (p < 0.05). Proportion of sensitized individuals to pollen significantly increased from the period 1991-1994 towards 2000-2004 (p < 0.001 for the trend) with a significant increase in the proportion of sensitized individuals to weed pollen (p = 0.002 for the trend) while the proportion of sensitized to other two groups of pollen (grasses and trees) was not significantly different. A significant increase in the proportion of sensitized individuals was determined for sensitization to ragweed pollen (p = 0.004 for the trend), and to mugwort (p = 0.005 for the trend). Despite all its limitations primarily based on the selection bias the results of this study are conclusive about the significant change in the proportion of sensitization to different aeroallergens and different pollen groups and individual pollen species during the investigated 15-year time interval.
Elite athletes are often subjected to endurance training in the environment in which they are chronically exposed to pollutants/irritants, allergens or cold air. These factors lead to an increased ...risk of upper and lower respiratory tract dysfunction. The diagnosis of asthma is crucial in elite athletes because of potential implications on athlete's general well-being as well as their competitive ability. Symptoms of asthma in elite athletes are not necessarily associated with the classic features of asthma seen in general population. Other clinical entities can create symptoms similar to those of asthma and therefore can lead to an incorrect diagnosis and ineffective treatment. The diagnosis requires a combination of symptoms and positive laboratory tests. Currently, there is no evidence that the treatment of asthma in athletes should be different from the treatment of asthma in non-athletes. However, some specific issues need to be considered in the elite athletes, such as compliance with the rules of World Anti-Doping Agency and International Olympic Committee.
Exercise-induced anaphylaxis (EIA) is a syndrome in which patients experience the symptoms of anaphylaxis, which occur only after increased physical activity. It is characterised by a gradual ...development of symptoms: itching, erythema, urticaria, angioedema, anaphylactic shock (hypotension, syncope, loss of consciousness, shortness of breath, wheezing, nausea and vomiting), and at the end of the late phase prolonged urticaria and headache. The triggering factors for EIA are as follows: significant exposure to airborne allergens, insect sting, weather extremes, higher air humidity, taking nonsteroidal anti-inflammatory drugs. The most frequent causative nutritive allergens include wheat, crabs and shells. Prophylactic management for EIA comprises avoding the triggers. Exercise or other physical activity should be performed in proximity of medically trained companion.
Published data indicate that during the last decades there is a possible change in the pattern of sensitization to different
aeroallergens in adult population with atopy. The aim of this ...investigation was based on the hypothesis that during
last 15 years there has been a change in the structure of prevalence of sensitization to different aeroallergens in adult population
of Zagreb and its surroundings with atopy. Medical records from outpatient allergy clinic were screened for the
period 1991.–2004.We included 794 patients during years 1991–1994, 814 patients during years 1995–1999, and 969 patients
during years 2000–2004. Following data were analyzed: age, gender, education level, residence, referral diagnosis,
dominant symptoms, results of skin-prick test (SPT), total and specific serum immunoglobulin E. As risk factors for allergic
sensitization we determined the decade of birth (p<0.0001), male gender (p<0.008), level of education (p<0.0001),
and place of residence (p<0.05). Proportion of sensitized individuals to pollen significantly increased from the period
1991–1994 towards 2000–2004 (p<0.001 for the trend) with a significant increase in the proportion of sensitized individuals
to weed pollen (p=0.002 for the trend) while the proportion of sensitized to other two groups of pollen (grasses and
trees) was not significantly different. A significant increase in the proportion of sensitized individuals was determined
for sensitization to ragweed pollen (p=0.004 for the trend), and to mugwort (p=0.005 for the trend). Despite all its limitations
primarily based on the selection bias the results of this study are conclusive about the significant change in the proportion
of sensitization to different aeroallergens and different pollen groups and individual pollen species during the
investigated 15-year time interval.
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