孟鲁司特钠佐治小儿支原体肺炎的疗效观察

目的：探讨盂鲁司特钠辅助治疗小儿支原体肺炎的临床疗效。方法：广州中医药大学祈福医院儿科门诊2009年10月至2011年10月治疗的支原体肺炎患儿96例，随机分为两组各48例。对照组采用阿奇霉素序贯疗法治疗，治疗组在对照组治疗基础上加用盂鲁司特钠4mg／d口服治疗2个月，随访半年比较两组患儿临床疗效以及药物不良反应。结果：治疗组与对照组患儿5d内总有效率分别为89．5％和79．1％，两组患儿疗效差异无统计学意义（P〉0．05）；出院后随访半年治疗组喘息反复发作明显低于对照组，两组患儿均未发生药物不良反应。结论：孟鲁司特钠辅助治疗小儿支原体肺炎，能明显改善患儿咳嗽及喘息，减少运动后咳嗽症状，提高患儿夜间睡眠质量，减少喘息的反复发作，依从性好，药物不良反应少，疗效满意，值得在临床中推广。     

Association of higher adiposity and wheezing in infants with lower respiratory illnesses

Aim: The incidences of asthma and obesity have been steadily increasing over the past two decades, with several studies showing a relationship between these conditions. We investigated the influence of higher weight for height (WFH) Z‐score on wheezing in infants with lower respiratory tract infections (LRTI). Methods: We reviewed the medical charts of all infants younger than l year of age who were admitted with the first episode of LRTI between 2000 and 2008. Subjects were classified into six groups according to WFH Z‐score. Results: Wheezing was more frequent in infants with higher WFH Z‐scores. Especially, wheezing infants aged 3–6 months and 6–9 months had significantly higher WFH Z‐scores than had their non‐wheezing counterparts (p = 0.05 and p < 0.01 respectively). Multivariate logistic regression showed that age (OR = 0.76, p < 0.001), male gender (OR = 1.61, p = 0.005) and WFH Z‐score (OR = 1.12, p = 0.007) were independently associated with wheezing. Conclusion: In this study we could show that a higher WFH Z‐score was independently associated with wheezing in infancy. Attainment of appropriate weight for age may reduce the risk of wheezing in infants with respiratory diseases.     

Long-term respiratory symptoms following oesophageal atresia

Background: Oesophageal atresia (OA) is a congenital malformation that can lead to persistent respiratory symptoms in adulthood. Aim: To describe the prevalence of respiratory symptoms in adulthood in a population‐based study of patients with repaired OA and to compare this with the prevalence in the general population. Methods: Of 80 patients operated for OA in Gothenburg in 1968–1983, 79 were located. The patients received a questionnaire on respiratory symptoms. Controls were 4979 gender‐ and age‐matched subjects who answered the same questions. Results: The questionnaire was answered by 73 of 79 (92%) patients. Physician‐diagnosed asthma was reported by 30% in the OA group vs 10% in the control group (OR 4.1; 95% CI 2.4–6.8), and recurrent wheeze in 29% vs 5.5% (OR 6.9; 4.1–11.6). Also wheeze during the last year, asthma medication, a long‐standing cough, cough with sputum production and chronic bronchitis were significantly more common among the patients with OA. In contrast, there was no significant difference regarding risk factors for asthma. The prevalence of respiratory symptoms did not appear to decrease with age. Conclusion: A high prevalence of respiratory symptoms remains among adult patients with repaired OA. Many of the patients had an asthma diagnosis. However, asthma heredity or allergic rhinitis was not overrepresented.     

肺功能检测对儿童喘息性疾病的临床相关性研究

目的探讨肺功能检测对儿童喘息性疾病的临床意义。方法采用法国迪尔肺功能测定系统分别对90例喘息性疾病患儿发作期、缓解期和48例正常健康儿童进行肺功能测定及临床分析。结果喘息性疾病患儿发作期肺功能指标FVC、FEV1、PEF、FEF25、FEF50、均明显低于预计值,气道阻抗RINT值明显增高与缓解期和对照组比较P〈0.05,说明喘息性疾病患儿存在气道高反应和气流受限,肺功能减损程度与病情及病程一致。结论儿童肺功能检测客观而重复性强,与临床相关性好,动态观察可早期识别喘息性疾病并发现哮喘,有利于早期干预及时治疗,特别对年幼儿哮喘意义重大。     

婴幼儿喘息性疾病92例临床分析

目的：探讨婴幼儿喘息性疾病的临床特点。方法：选择反复喘息患儿42例,毛细支气管炎患儿24例,肺炎患儿26例,入院当日至第五天取外周血常规分析,同时行病原学检查。结果：3组患儿中肺炎组白细胞入院当日明显高于治疗第五天。肺炎组白细胞及中性分类高于毛细支气管炎组和喘息组。嗜酸性粒细胞毛细支气管炎组和反复喘息组高于肺炎组,差异有显著性。3组患儿病原学检测痰培养、血培养均以肺炎组阳性率高,分别达25%和22.2%。肺炎支原体检测3组阳性率均高,但3组间差异无显著性。结论：婴幼儿喘息性疾病多为病毒感染所致,且与过敏因素密切相关,肺炎支原体感染亦是婴幼儿喘息性疾病的常见病原。     

Measuring exhaled breath condensates in infants

There is growing interest in investigating compounds of exhaled breath condensates (EBC) as potential noninvasive markers of airways disease processes. Some of these markers have the potential to provide information on the early stages of disease. In this paper, we present a method for collecting EBC during both oral and nasal breathing in infants. Fifty-four infants (mean age, 13.3 months; range, 1-30 months) undergoing infant lung-function testing were recruited for this study. Breath condensates were collected during sedated sleep, using a custom-made collection device. Collections were made for 10 min during normal tidal breathing. Nasal measurements were attempted in all children by placing a face-mask over the nose and mouth and keeping the mouth closed. In 14 infants, oral measurements were made by placing a face-mask over the mouth only and occluding the nose. Condensates were collected successfully in all but one child. The collected volume ranged from 50-550 microl (mean +/- SD, 281.8 +/- 145.8 microl). The volume of EBC collected was correlated to age, length, weight, and minute ventilation. Significantly more EBC was collected during oral compared to nasal breathing (354.3 vs. 277.5 microl, P=0.03). There were no significant changes in heart rate, respiratory rate, or oxygen saturation during collection. The collection of EBC in young children and infants is feasible and safe, and the method used here allows the successful collection of reasonable amounts of exhaled condensate.     

Asthma?

This challenge case presents an overview of selected applications of general diagnostic radiology in the differential diagnosis and etiology of wheezing or “asthma.”     

Association between house renovation during pregnancy and wheezing in the first year of life: The Japan environment and children's study

BackgroundWheezing is a common symptom in infants, which may occasionally develop into asthma. There are many factors related to infant wheezing, including anatomical features, viral infections, and passive smoking. There are only a few reports on the association between renovation and pregnancy worldwide, and reports on this association are inadequate in Japan. This study aimed to examine the association between house renovation and new construction during pregnancy and wheezing in infants during the first year of life using data from the Japan Environment and Children's Study (JECS).MethodsData of pregnant women registered in JECS were collected using self-administered questionnaires during the second/third trimester and 1 month after delivery. Childbirth records were completed by the doctors. Similarly, wheezing in infants was evaluated using self-administered questionnaires 1 year after birth. Logistic regression analysis was used to determine the primary outcome.ResultsIn total, 75,731 infants, excluding those with unknown gender, who were not singleton infants, and who relocated during pregnancy and the first month of life, were examined in this study. Renovation during pregnancy increased the prevalence of wheezing (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.20–1.48) and recurrent wheezing (OR: 1.22, 95% CI: 1.00–1.48) in the first year of life. The relationship between new construction during pregnancy and wheezing in infants was insignificant (OR: 0.98, 95% CI: 0.90–1.06).ConclusionsRenovation during pregnancy may be a risk factor for wheezing in infants, and should be avoided.     

A US postmarketing evaluation of the frequency and safety of live attenuated influenza vaccine use in nonrecommended children younger than 5 years: 2009-2010 season

The 2007 US approval for use of Ann Arbor strain live attenuated influenza vaccine (LAIV) in children aged 24 through 59 months included precautions against use in (1) children <24 months and children aged 24 through 59 months with (2) asthma, (3) recurrent wheezing, and (4) altered immunocompetence. Results from the third season (2009-2010) of a 3-year study postmarketing commitment to monitor LAIV vaccination rates and frequency of hospitalizations or emergency department visits within 42 days after LAIV are reported here. As in the first 2 seasons, LAIV usage in cohorts 1, 2, and 4 were low relative to those in LAIV-recommended populations. The only numerically increased risk observed was for respiratory events in children aged <24 months administered LAIV, compared to those administered trivalent inactivated influenza vaccine (TIV). The number of children vaccinated with LAIV was small and precluded precise quantification of rare event.