Background Pulmonary function in preschool wheezing phenotypes based on wheeze onset and duration and atopic status has been extensively described but has not been studied in symptom-pattern ...phenotypes of episodic (viral) and multiple-trigger wheeze. Objective We investigated whether multiple-trigger wheezers were more likely to have abnormal pulmonary function and increased fraction of exhaled nitric oxide (FeNO) than episodic (viral) wheezers and whether multiple-breath wash-out was more sensitive at detecting abnormal pulmonary function than specific airways resistance (sRaw ) in preschool wheezers. Methods FeNO, multiple-breath wash-out indices (lung clearance index LCI and conductive airways ventilation inhomogeneity Scond ) and sRaw were measured in healthy children and those with recurrent wheeze aged 4 to 6 years. Subgroup analysis was performed according to current symptom-pattern (multiple-trigger vs episodic viral), atopic status (atopic vs nonatopic), and wheeze status (currently symptomatic vs asymptomatic). Results Seventy-two control subjects and 62 wheezers were tested. Multiple-trigger wheezers were associated with an average increase of 11% (95% CI, 7% to 18%; P < .001) in LCI, 211% (95% CI, 70% to 470%; P < .001) in Scond , and 15% (95% CI, 3% to 28%; P = .01) in sRaw compared with episodic (viral) wheezers. Pulmonary function in episodic (viral) wheezers did not differ significantly from control subjects. The presence of current atopy or wheeze was associated with higher FeNO ( P = .05) but did not influence pulmonary function significantly. On average, LCI was abnormal in 39% (95% CI, 32% to 45%), Scond was abnormal in 68% (95% CI, 61% to 74%), and sRaw was abnormal in 26% (95% CI, 16% to 35%) of multiple-trigger wheezers. Conclusions Multiple-trigger wheeze is associated with pulmonary function abnormalities independent of atopic and current wheeze status. Scond is the most sensitive indicator of abnormal pulmonary function in preschool wheezers.
Background Ethnic differences in lung function in school-aged children and adults are well recognized, but little is known about such differences in preschool children. We investigated whether ...differences exist in fraction of exhaled nitric oxide (F eno ), multiple-breath washout (MBW) indices, specific airways resistance (sRaw), and spirometry indices between healthy preschool children of South Asian and white European origin. Methods F eno , MBW indices (lung clearance index, functional residual capacity, conductive airways inhomogeneity, and acinar airways inhomogeneity), sRaw, and spirometry were measured in healthy South Asian and white children aged 4 to 6 years, and comparisons were made between the two groups. Statistical analyses were by multiple linear regression and t tests. Results Thirty-seven white (mean age 5.8 ± 0.7 years, 49% boys) and 31 South Asian children (mean age 5.4 ± 0.8 years, 52% boys) were recruited. F eno was, on average, 36% higher ( P < .05) in South Asian children compared with white children. FVC and FEV1 and fractions thereof (FEV0.75 and FEV0.5 ) z -scores were significantly lower in South Asian compared with white children by 0.69 ( P = .01), 0.76 ( P = .004), 0.76 ( P = .009), and 0.85 ( P = .002) z -scores, respectively, but there were no significant differences in FEV1 /FVC, FEF25-75 , sRaw, or MBW indices. Conclusions Differences in F eno and forced expiratory lung volumes between South Asian and white children exist from a very young age. Ethnic differences should be taken into account when interpreting lung function results in preschool children for effective management of respiratory conditions.
Background Increased airway smooth muscle (ASM) is a feature of established asthma in schoolchildren, but nothing is known about ASM in preschool wheezers. Objective We sought to determine ...endobronchial biopsy specimen ASM area fraction in preschool wheezers and its association with asthma at school age. Methods ASM area, reticular basement membrane thickness, and mucosal eosinophil and ASM mast cell values were quantified in endobronchial biopsy specimens previously obtained from preschool children undergoing clinically indicated bronchoscopy: severe recurrent wheezers (n = 47; median age, 26 months) and nonwheezing control subjects (n = 21; median age, 15 months). Children were followed up, and asthma status was established at age 6 to 11 years. Preschool airway pathology was examined in relation to asthma at school age. Results Forty-two (62%) of 68 children had 1 or more evaluable biopsy specimens for ASM. At school age, 51 of 68 children were followed up, and 15 (40%) of 37 preschool wheezers had asthma. Children who had asthma and an evaluable biopsy specimen had increased preschool ASM area fraction (n = 8; median age, 8.2 years range, 6-10.4 years; median ASM, 0.12 range, 0.08-0.16) compared with that seen in children without asthma (n = 24; median age, 7.3 years range, 5.9-11 years; median ASM, 0.07 range, 0.02-0.23; P = .007). However, preschool reticular basement membrane thickness and mucosal eosinophil or ASM mast cell values were not different between those who did or did not have asthma at school age. Conclusion Increased preschool ASM is associated with those children who have asthma at school age. Thus a focus on early changes in ASM might be important in understanding the subsequent development of childhood asthma.
Pneumonia and other respiratory infections Ranganathan, Sarath C; Sonnappa, Samantha
Pediatric clinics of North America/The Pediatric clinics of North America,
02/2009, Letnik:
56, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Pneumonia is a leading killer of children in developing countries and results in significant morbidity worldwide. This article reviews the management of pneumonia and its complications from the ...perspective of both developed and resource-poor settings. In addition, evidence-based management of other respiratory infections, including tuberculosis, is discussed. Finally, the management of common complications of pneumonia is reviewed.
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