Cardiovascular Effects of Acute Bronchiolitis

ABSTRACT. Twenty-one children with normal hearts were studied during acute bronchiolitis. Doppler echocardiography showed tricuspid valve regurgitation in 11 patients, many of whom had evidence of raised pulmonary artery systolic pressure. Serial studies in those with severe infection showed that tricuspid regurgitation disappears with clinical improvement.     

Croup and recurrent croup: their association with asthma and allergy

The cumulative incidence (i.e. lifetime prevalence) of croup and recurrent croup (RC) was investigated by questionnaire in a large group (n = 5756) of 5–8-year-old children (mean age: 6.8 ± 0.6 years) and the risk for asthma and/or wheezing in children with croup and RC assessed. In a random sample of the children, skin prick testing with common inhalant allergens (n = 614) and spirometry (n = 305) were performed and the results were compared between children with or without croup or RC. Of the children, 15.5% had suffered from croup, while 5.0% had had RC. The cumulative incidence was higher in boys than in girls (P < 0.05). In the children with croup or RC an increased risk for wheezing, asthma, usage of anti-asthma medication, rhinitis and hay fever was found (P < 0.01). There was no difference in the prevalence of positive skin prick tests between children with and without croup or RC. Mean percentage predicted forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow was not different between children with and without croup or RC. However, children who had suffered from croup (with or without wheezing) had a lower mean percentage predicted forced expiratory flow at both 50% and 75% of forced vital capacity than those without croup (P = 0.002). A family history of hay fever, chronic bronchitis and eczema was associated with the presence of croup or RC (P < 0.01), while this was hardly the case for a family history of asthma. Conclusion Croup and recurrent croup are associated with bronchial asthma. The association seems essentially based on the presence of hyperreactive airways and less on the presence of atopy, although the latter can be considered an aggravating factor. Received: 3 March 1998 / Accepted in revised form: 15 July 1998     

Croup in the paediatric emergency department

Croup is a common childhood illness. The majority of children presenting with an acute onset of barky cough, stridor and indrawing have croup. A careful history and physical examination is necessary to confirm the diagnosis of croup, and to rule out potentially serious alternative causes of upper airway obstruction. Nebulized adrenaline is effective for the temporary relief of airway obstruction. Corticosteroids are the mainstay of treatment in children with croup of all levels of severity.     

Daycare attendance and risk of first infectious disease

The health hazards of daycare attendance for the development of upper and lower respiratory tract infections have been well documented; however the importance and the mechanism of this association have not been well defined. In order to ascertain the risk associated with the beginning of daycare (DC) attendance we conducted a survey on 1263 children aged from 3 months to 3 years; the analysis focused on the risk of developing an initial episode of common cold with fever, a first otitis and a first wheezy bronchitis (WB) within the 2 month period following adminission to DC. For each 2 month period, the risk of a first infectious event was much higher in children who had just begun attending DC than in children who remained at home: the risk ratio varied from 1.7 to 2.4 for common cold, from 1.5 to 1.9 for otitis and from 1.8 to 3.2 for WB. Because age at onset of the first infectious event may be related to a higher risk of repeated events we consider that admission to DC under 12 months of age should be quesioned.     

Bronchiolitis: An Evidence-Based Approach to Management

Bronchiolitis is a common respiratory disease in infancy, and it results in a large number of health care visits and expenditures. Despite an abundance of literature addressing various treatment modalities, management remains largely supportive. Emergency department clinicians must continue to develop a comprehensive understanding of the dynamic and variable nature of the disease process and be able to effectively predict the severity of its clinical course. Finally, there is emerging evidence that highlights some newer therapies, such as nebulized hypertonic saline, that may change the way in which bronchiolitis is treated in the ED; vigilance in monitoring the literature is essential to ensure that patients are treated in the most efficient and effective manner.     

毛细支气管炎280例长期随访及其与支气管哮喘的相关因素分析

目的对毛细支气管炎患儿280例3~10 a随访,观察其日后支气管哮喘的发生率。方法采用回顾性研究和临床随访方法,选择1995年1月-2002年12月确诊为毛细支气管炎在本科住院治疗患儿280例为研究对象。男220例,女60例。就是否进行大剂量静脉用免疫球蛋白（IVIG）治疗、是否按时接种卡介苗（BCG）、喂养方式、哮喘家族史及有无过敏性体质等调查和分析。结果毛细支气管炎患儿280例中,发展成支气管哮喘82例,发生率为29.29%。大剂量IVIG组、按时接种BCG组、无过敏性体质患儿、无哮喘家族史患儿及母乳喂养儿哮喘发生率均显著低于非大剂量IVIG组、未按时接种BCG组、过敏性体质患儿、哮喘家族史患儿及非母乳喂养儿（Pa〈0.01）。结论婴幼儿毛细支气管炎易发展为支气管哮喘。过敏性体质和哮喘家族史是哮喘发生、发展高危因素,而大剂量IVIG治疗、及时接种BCG及单纯母乳喂养对哮喘发生呈保护作用。     

Chest X-ray Appearances in Pneumonia and Bronchiolitis

ABSTRACT. Chest X-ray findings were related to virus diagnosis, age and secretory bacterial findings in 128 infants and children under 7 years of age with clinical pneumonia and bronchiolitis. They belonged to a cohort examined in connection with the introduction of rapid methods for virological diagnosis. Seventy-six children had a virus infection diagnosed by examination of nasopharyngeal secretion and/or by serological methods. Thirty-seven of these children were classified as having pathogenic bacteria of importance in the respiratory tract. Four groups were compared: virus infected children with or without bacteria in the secretion and the corresponding virus negative groups. The X-rays were normal significantly more often in the virus positive/bacteria negative group compared with the other groups. Alveolar pneumonia appearing as lobar or segmental consolidations ("lobar" pneumonia) was observed with equal frequency and without relation to bacterial findings in the virus positive and the virus negative groups. But it was more often observed in the respiratory syncytial virus (RSV) infected children under 6 months of age compared with the older RSV children. In comparison disperse alveolar infiltrations ("bronchopneumonia") mostly appeared in the virus positive group. Interstitial pneumonia and peribronchitis were often present together in children over 6 months of age. There was no significant difference in the X-ray appearances in the groups with and without bacterial findings in the tracheal secretion except for a higher frequency of normal chest radiographs in the bacteria negative group.     

闭塞性细支气管炎31例

目的 明确小儿闭塞性细支气管炎(BO)的临床特点、治疗措施及随访结果.方法 对2008年4月- 2011年6月在本科明确诊断为BO患儿的临床资料进行归纳、总结,对其治疗效果进行随访分析.结果 31例患儿反复咳嗽及喘息均＞6周,查体肺部听诊可闻及哮鸣音和(或)粗湿啰音.入院给予雾化吸入支气管扩张剂无反应.31例患儿均存在肺功能异常,24例患儿为阻塞性通气功能障碍,7例患儿肺功能示混合性通气功能障碍;31例肺CT均存在Mosaic灌注征、双肺均可见斑片状密度增高影,肺不张6例,支气管壁增厚5例,支气管扩张2例.31例X线胸片均有过度通气表现,可见斑片状密度增高影,4例呈毛玻璃样改变.患儿均口服泼尼松、阿奇霉素并配合雾化吸入布地奈德及沙丁胺醇.对其中26例患儿进行2个月～3 a随访,规律治疗的6例患儿临床症状明显改善,无明显喘息发作,活动耐力好转,复查肺部高分辨率CT示肺部病变明显改善;10例临床症状略好转,仍有活动后气促,复查肺部高分辨率CT示肺部病变轻微改善;10例患儿依从性差,未按医嘱规律用药及回访,病情经常反复,于呼吸道感染后出现喘息发作,于本院住院3～6次,临床疗效欠佳,复查肺部高分辨率CT示肺部病变无改善,现仍在随访中.结论 BO大多为肺部感染后引起的反复咳嗽、喘息,肺部听诊可闻及明显的呼气相哮鸣音,吸入支气管扩张剂效果不佳,肺功能大多表现为阻塞性通气功能障碍,CT可见肺部典型的Mosaic灌注征.本病预后不佳.     

毛细支气管炎患儿肺功能特点及应用吸入性糖皮质激素的疗效

目的探讨毛细支气管炎患儿肺功能特点及吸入性布地奈德（普米克令舒）、丙酸氟替卡松（辅舒酮）治疗毛细支气管炎的疗效。方法毛细支气管炎患儿100例分为观察组、对照组。2组均采用综合治疗,观察组加用普米克令舒/辅舒酮吸入。测定治疗前、出院时、出院后3个月二组患儿潮气呼吸肺功能;观察其急性期症状缓解情况;回访出院后3个月及1a后健康情况。30例同龄健康儿童的肺功能为健康对照组。结果1.观察组在改善临床症状、减少住院天数上优于对照组（Pa〈0.05）。2.观察组出院后3个月,咳嗽、气喘发作次数较对照组减少（Pa〈0.05）。3.出院时观察组潮气量（TV/kg）的增加、呼吸频率（RR）的下降优于对照组（Pa〈0.05）;观察组25%潮气量时的潮气呼气流速（TEF25%）、达峰时间比（TPEF/TE）、达峰容积比（VPEF/VE）较入院时上升（Pa〈0.05）,3个月后恢复正常,与健康对照组比较无明显差异（P〉0.05）。对照组出院时TEF25%、TPEF/TE、VPEF/VE与入院时无明显改变（Pa〉0.05）,3个月后仍未恢复正常。4.随访1a,观察组发展为支气管哮喘的几率低于对照组（P〈0.05）。5.毛细支气管炎急性期临床评分与TPEF/TE、VPEF/VE呈负相关,临床评分数值越高,病情越重,TPEF/TE、VPEF/VE值越低。结论1.毛细支气管炎患儿用吸入性糖皮质激素早期干预治疗,对急性期症状的缓解、降低发展为支气管哮喘的几率有较好疗效。2.TPEF/TE及VPEF/VE可判断毛细支气管炎呼吸道阻塞严重程度。     

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??Acute infectious bronchiolitis could be caused by virus??bacteria??fungus and Mycoplasma pneumoniae with non-specific histology in children. Fever??cough and wheeze were the clinical manifestations??while centrilobular nodules??tree-in-bud and bronchiolar wall thickening were the main HRCT findings. The short-term prognosis was often good??although long-term prognosis was not optimistic with asthma and recurrent wheezing left. Since acute Mycoplasma pneumoniae bronchiolitis cases seemed to increase recently??it should be paid attention to by pediatrician.     

毛细支气管炎患儿Th1/Th2的改变

目的了解毛细支气管炎(毛支)患儿淋巴细胞亚群的改变及Th1/Th2平衡状况。方法对2003～2005年确诊为急性期毛细支气管炎的住院患儿34例,采用流式细胞仪对其外周血淋巴细胞亚群进行检测。其中呼吸道合胞病毒(RSV)性毛支23例,非RSV毛细支11例,均与22例健康对照组比较。结果毛细支气管炎组CD3 及CD4 细胞百分率均较对照组高(P<0.05,P<0.01),但CD4/CD8比值毛支组1.95%±0.64%与对照组1.87%±1.18%比较统计学无差异(P>0.05)。Th1/Th2在毛支组明显高于对照组,分别为6.06%±4.15%及2.90%±1.45%,有显著差异(Z=3.121Pa<0.01)。结论毛细支气管炎患儿细胞免疫功能增强,并呈现Th1应答优势。     

毛细支气管炎患儿免疫功能状态评价的意义

目的探讨毛细支气管炎(毛支)患儿的免疫功能状态的意义。方法采用酶联免疫吸附分析法(ELISA)和逆转录聚合酶链反应(RT-PCR)测定25例毛支患儿外周血单个核细胞体外产生IL-12、18、10、4,IFN-γ及血浆IgE的水平及膜表面蛋白分子淋巴细胞活化基因3(LAG-3)mRNA的表达。门诊体检的健康儿童14例作为正常对照组。结果毛支患儿急性期IL-12 (390．94±95．88)ng／L及II-18(146．23±55 81)ng／L水平明显低于正常对照组[(452．44±195．07)、(246．69±121．29)ng／L] (P<0．05),IL-10(302．40±100．04)ng／L、IL-4(30．52±17．65)ng／L及IgE(82．90±51．4)ng／L水平明显升高(P分别<0．05, 0．01,0．05),IFN-γ(103．25±82．15)ng／L水平虽低于正常对照组,但无显著差异(P>0．05)。IFN-γ/IL-4比率(3．6±0．9:1．0) 较对照组(9．7±2．1:1．0)降低约3倍(P<0．05)。TH1细胞表面标记LAG-3 mRNA的表达明显低(P<0．05)。结论毛支患儿存在TH1/TH2失衡、TH1功能下降、TH2功能占优势的状态,与APC的功能状态及其所分泌的上游调控细胞因子(IL-12、18、 10)的平衡紊乱有关。     

人类博卡病毒感染所致细支气管炎的临床特点

目的探讨人类博卡病毒(HBoV)所致细支气管炎的临床特点。方法收集因细支气管炎于2007年6月-2008年5月住院治疗的271例患儿的呼吸道标本(鼻咽分泌物或咽拭子),应用多重PCR技术检测其HBoV,呼吸道合胞病毒(RSV),腺病毒(ADV),鼻病毒(RhV),流感病毒A、B型(FluA、FluB),副流感病毒1、3型(PIV1、PIV3),人类偏肺病毒(hMPV)9种病毒。随机选取RSV感染阳性患儿28例作为对照组。分析HBoV感染组与对照组患儿的临床特点。结果271例标本中,病毒阳性标本163例(60.1%)。其中HBoV阳性21例(12.9%),RSV阳性61例(37.4%);HBoV并其他病毒感染8例(38.1%),与RSV、FluA合并感染各3例,与ADV、RhV合并感染各2例,与hMPV合并感染1例。HBoV感染组与对照组患儿临床资料除在流行季节上有差异外,在性别、发病年龄、临床症状、肺部体征、辅助检查、住院天数、病情严重程度方面比较均无差异。结论HBoV是小儿细支气管炎的另一重要病原体,与RSV感染者在临床表现上无明显差异。HBoV细支气管炎的临床症状较轻,呼吸功能均属于轻中度受损,且以轻度为...     

Acute viral bronchiolitis and its sequelae in developing countries

Acute viral bronchiolitis (AVB) is a common disease found throughout the world. Various aspects of it are being studied: its epidemiology, diagnosis, prognosis and treatment. Most of these studies are being conducted in developed countries, with only a few taking place in developing countries. Risk factors such as poor nutrition, an adverse environment and early weaning should be studied where these features are common. Treatment aspects such as cost-effectiveness in low income settings need further study. Use of ribavirin and respiratory syncytial virus (RSV)-immunoglobulin are good examples. Post-bronchiolitic sequelae also need to be studied in low income countries. There is evidence that bronchiolitis obliterans is unusually frequent in some Latin-American countries such as Argentina and Brazil. It will be helpful to undertake combined studies in countries with the same socio-economics, investigating the preventive and management aspects of AVB and its sequelae to reduce the morbidity and mortality.     

雾化吸入糖皮质激素联合特布他林及异丙托溴铵治疗毛细支气管炎的疗效及预后

目的观察糖皮质激素联合异丙托溴铵、特布他林雾化吸入治疗毛细支气管炎的疗效,探讨不同疗程吸入糖皮质激素对毛细支气管炎预后的影响。方法将108例收治住院的毛细支气管炎患儿随机分为3组,均采用综合治疗。治疗1组予布地奈德混悬液联合特布他林、异丙托溴铵三联雾化吸入治疗7d,继续丙酸氟替卡松雾化吸入治疗至12周;治疗2组予布地奈德混悬液联合特布他林溶液二联雾化吸入治疗7d;对照组单用特布他林溶液雾化吸入治疗7d。观察3组患儿临床症状消失时间、住院天数,并进行临床疗效评定及追踪停药1a为喘息性疾病患病人数及患病率。结果治疗1组和治疗2组在咳嗽、喘憋症状缓解、肺部哮鸣音消失时间及缩短住院天数方面均优于对照组(Pa<0.05),治疗1组在临床缓解率方面较治疗2组更具优势(P<0.05)。治疗1组在停药1a喘息性疾病患病率明显降低,与对照组比较差异有统计学意义(P<0.05),治疗2组在停药1a喘息性疾病患病率与对照组比较稍低,但无显著性差异(P>0.05)。结论糖皮质激素联合特布他林二联雾化吸入治疗毛细支气管炎疗效肯定,糖皮质激素联合特布他林、异丙托溴铵三联雾化吸入治疗毛细支气管炎,对急性期症状的缓解优势更为明显,毛细支气管炎患儿吸入性糖皮质激素早期干预治疗至12周,可降低发展为支气管哮喘的几率。     

大剂量静脉丙种球蛋白防治毛细支气管炎发展为哮喘的临床研究

目的探讨大剂量静脉丙种球蛋白(IVIG)对预防毛细支气管炎发展成哮喘的临床疗效。方法选择确诊为毛细支气管炎而采用不同治疗方案住院患儿196例,观察其5~10年后哮喘发病情况。随访168例。其中男132例,女36例;分为对照组87例,予常规治疗。大剂量IVIG组81例,在常规治疗基础上予IVIG 0.4 g/(kg.d),连用5 d。结果大剂量IVIG组81例,发生哮喘17例,占20.99%;常规治疗组87例,发生哮喘46例,占52.87%,两组哮喘发生率比较,有显著差异(P<0.01)。结论大剂量IVIG能有效降低毛细支气管炎日后哮喘的发生率。     

Bronchial asthma and wheeze in a desert country

A cross-sectional, population-based study was conducted among school children (3300), aged 7–12 years, in the Kingdom of Saudi Arabia, during the period January, 1988–February, 1990. The aim of the study was to investigate the association between asthma, allergic rhinitis, wheeze and eczema among Saudi school children. The relationship between pet-ownership and respiratory allergy was also studied. Detailed information was collected about wheeze and asthma in 3041 children and history of asthma and allergic rhinitis in their parents. The population sample had a high prevalence rate of diagnosed asthma (6.8%), history of wheeze (10.5%), allergic rhinitis (17.9%), and eczema (10.8%). Allergic rhinitis was the most frequently seen respiratory illness when compared to other respiratory symptoms. The prevalence rate of asthma, allergic rhinitis and eczema among parents reflected the same pattern as that seen in the children. Prevalence rate for asthma in children with pets is twice that of children without pets (OR:2.4; 95%, Cl:1.8–3.1). The odds of having chronic cough (OR:3.9; 95%, Cl:2.8–5.2), chronic wheeze (OR:4.2; 95%, 3.3–5.4), allergic rhinitis (OR:8.0; 95% Cl:6.3–10.3) and eczema (OR:2.8:95 Cl:2.1–3.7) was higher in children with pets than in children without pets. The present study revealed that petownership was associated with increased respiratory symptoms.