Angela Zacharasiewicz

Symptoms suggestive of atopic rhinitis in children aged 6–9 years and the indoor environment

Background: We aimed to investigate the influence of indoor factors on the prevalence of symptoms suggestive of atopic rhinitis in children aged 6–9 years in Upper Austria.

Noninvasive monitoring of airway inflammation and steroid reduction in children with asthma.

Purpose of review Management of pediatric asthma is currently based on symptoms (often a second-hand report from parents) and lung function. Inhaled steroids are the mainstay of asthma management targeted at controlling airway inflammation. They should be used in the lowest possible doses. A number of noninvasive methods to assess inflammation have been developed in an effort to optimize anti-inflammatory treatment. Recent findings The first longitudinal studies have been published demonstrating an improvement in asthma control in children by adding noninvasive monitoring of inflammation into the clinical management. New methods include exhaled nitric oxide measurements, induced sputum and markers in exhaled breath condensate. Summary Further studies will show the practicability of including these measurement methods into everyday clinical practice. Their addition to the conventional assessment of asthma control appears promising. Using these methods to evaluate the current inflammatory state seems obligatory in research into new asthma therapeutics and management strategies. Managing asthma in children in specialist practice relying only on symptoms and lung function is no longer state of the art.

Diagnosis and management of asthma – Statement on the 2015 GINA Guidelines

SummaryThis statement was written by a group of pulmonologists and pediatric pulmonologists belonging to the corresponding professional associations ÖGP (Austrian Society for Pulmonology) and ÖGKJ (Austrian Society for pediatric and adolescent medicine) to provide a concise overview of the latest updates in the 2015 GINA Guidelines and to include aspects that are specific to Austria.

Konsensuspapier zur Evaluation und Therapie des chronischen Hustens in der Pädiatrie

ZusammenfassungHintergrundBisher existieren im deutschsprachigen Raum keine Leitlinien zur Evaluation und Therapie des chronischen Hustens.Ziel dieser Arbeit ist nach Literatur-Suche zu relevanten Publikationen und Leitlinien zum Thema „chronischer Husten beim Kind“ eine aktuelles Statement der Österreichischen Gesellschaft für Kinder- und Jugendheilkunde und der Österreichischen Gesellschaft für Pneumologie zu Evaluation und Therapie des chronischen Hustens beim Kind sowie einen praktischer Algorithmus zu geben. Ziel ist auch chronischen Husten deutlich von obstruktiven Atemwegserkrankungen abzugrenzen und die möglichen Differenzialdiagnosen anhand wesentlicher anamnestischer und klinischer Merkmale zu beschreiben und einen Überblick über die therapeutischen Möglichkeiten zu geben. Die subjektive Komponente des Symptoms und die schwierige Objektivierung werden diskutiert.MethodenEine Cochrane und Medline Suche wurde durchgeführt und die relevante Literatur bis Mai 2013 inkludiert.ErgebnisseKindlicher chronischer Husten wird definiert als Husten täglich über 4 Wochen. Bei einer Dauer von 3-8 Wochen Husten kann man auch von prolongiertem subakutem Husten sprechen. Chronischer Husten kann spezifische Ursachen haben und sich als Symptom einer Grunderkrankung darstellen. Diese gilt es herauszufinden und adäquat zu behandeln. Daneben existiert der nicht spezifische Husten, der erst nach Ausschluss jeder anderen spezifischen Ursache diagnostiziert werden kann. Jeglicher Therapieversuch bei chronischem Husten muss re-evaluiert und die Wirksamkeit überprüft werden.Wichtig bei der Diagnostik sind auch das elterliche Verständnis der Ätiologie des Hustens im Allgemeinen und der Zusammenhang von Umwelteinflüssen und chronischem Husten beim Kind.SchlussfolgerungChronischer Husten bedarf einer detaillierten Aufarbeitung, um möglichen Ursachen adäquat zu begegnen; bei Fehlen einer Diagnose und Fortbestehen der Beschwerden empfiehlt sich dringend eine Abklärung in einem auf Pädiatrische Pneumologie spezialisierten Zentrum.SummaryBackgroundCurrently no consensus guidelines on the evaluation and therapy of chronic cough in children have been published in German.Aim of this study was therefore, after a literature search on all relevant publications and guidelines concerning chronic cough in children, to publish a Statement of the Austrian Society of Pediatrics and The Austrian Society of Pneumology on the evaluation and therapy of chronic childhood cough and to publish a practice based approach. Aim was also to differentiate cough clearly from obstructive airway diseases and to summarize all relevant differential diagnosis using relevant patient history and clinical characteristics and give an overview of therapeutical approaches. The subjective component of cough and the difficulty to assess cough in an objective manner is discussed.MethodsA Cochrane and Medline Search were performed on all relevant literature until Mai 2013.ResultsChronic cough in children is defined as daily cough for more than 4 weeks. Duration of 3 to 8 weeks is sometimes called prolonged or sub-acute cough. Chronic cough may have specific cause and may be a symptom of an underling disease, which needs to be found and treated adequately. Unspecific cough may only be diagnosed after exclusion of all other causes. Any therapeutical approach needs to be re- evaluated and efficacy needs to be reviewed. Parental understanding of the etiology of cough in general and the influence of environmental exposures is essential for diagnosis.ConclusionChronic cough needs a detailed history and various differential diagnoses need to be taken in consideration. Children with persistent complaints without a proper diagnosis need to be seen in a center specialized in Pediatric Respiratory Medicine.BACKGROUND Currently no consensus guidelines on the evaluation and therapy of chronic cough in children have been published in German. Aim of this study was therefore, after a literature search on all relevant publications and guidelines concerning chronic cough in children, to publish a Statement of the Austrian Society of Pediatrics and The Austrian Society of Pneumology on the evaluation and therapy of chronic childhood cough and to publish a practice based approach. Aim was also to differentiate cough clearly from obstructive airway diseases and to summarize all relevant differential diagnosis using relevant patient history and clinical characteristics and give an overview of therapeutical approaches. The subjective component of cough and the difficulty to assess cough in an objective manner is discussed. METHODS A Cochrane and Medline Search were performed on all relevant literature until Mai 2013. RESULTS Chronic cough in children is defined as daily cough for more than 4 weeks. Duration of 3 to 8 weeks is sometimes called prolonged or sub-acute cough. Chronic cough may have specific cause and may be a symptom of an underling disease, which needs to be found and treated adequately. Unspecific cough may only be diagnosed after exclusion of all other causes. Any therapeutical approach needs to be re- evaluated and efficacy needs to be reviewed. Parental understanding of the etiology of cough in general and the influence of environmental exposures is essential for diagnosis. CONCLUSION Chronic cough needs a detailed history and various differential diagnoses need to be taken in consideration. Children with persistent complaints without a proper diagnosis need to be seen in a center specialized in Pediatric Respiratory Medicine.

Tabakrauchexposition von Kindern und Jugendlichen

ZusammenfassungEs wird versucht, in möglichst prägnanter Form die wesentlichen Schadwirkungen durch Tabakrauchexposition auf die Gesundheit von Kindern und Jugendlichen zu beschreiben, Präventionsstrategien vorzuschlagen, um diese vor den Auswirkungen des Tabakrauchs zu schützen, und die wichtige Rolle des Pädiaters hierbei hervorzuheben. Passivrauchexposition, „third hand smoking“ und aktives Rauchen bedrohen in vielfältiger Weise die Gesundheit von Kindern und Jugendlichen. Präpartale Schädigungen im Sinne des fetalen Tabaksyndroms werden ebenso wie die postpartalen Folgen beschrieben. Präventionsmaßnahmen für Jugendliche sind von entscheidender Bedeutung, um den besonders gefährlichen frühen Einstieg zu verhindern. Schutz unserer Patienten vor Tabakrauch muss ein fester Bestandteil der Aufklärung von Eltern und Erziehungsberechtigten sein. Der Stellenwert des Pädiaters bei der Tabakprävention kann dabei nicht deutlich genug hervorgehoben werden.AbstractThe aim is to describe the main detrimental effects of tobacco exposure on the health of children and adolescents in a concise manner, to suggest prevention strategies to protect children and adolescents against these effects and to stress the important role of pediatricians regarding protection from these harmful effects. Secondary and tertiary smoke exposure as well as active smoking threaten the health of children and adolescents in many different ways. Prenatal damage, such as the fetal tobacco syndrome and postnatal effects are described. Smoking prevention strategies for adolescents are crucial especially in order to prevent the particularly dangerous early start of smoking. Protection from tobacco exposure for patients has to be a permanent part of every consultation with parents and caregivers. The pediatrician plays a key role in tobacco prevention.

Habit‐tic cough: Presentation and outcome with simple reassurance

The paper on habittic cough by Wright M et al. addresses a specific diagnosis for chronic cough in children which has received little attention in the past and this paper is therefore both timely and important. The main outcome of this retrospective study of the practice of an experienced respiratory pediatrician is that a diagnosis of habit-tic cough can be made and simple reassurance may be given − all in a single consultation. Most of the children reported in this paper had already been on trials of ineffective therapy for the cough and the authors rightly highlight that if habit-tic cough had not been thought of as a diagnosis then the children would likely have continued to cough and continued to be given ineffective treatments. These results are interesting and while the paper provides us with important new data it also leaves open questions especially with respect to definition, naming, diagnosis and treatment of the habit-tic cough or what others have labelled psychogenic coughing or more recently the somatic cough syndrome.

Increased severity of respiratory syncytial virus airway infection due to passive smoke exposure

Aim of this study was to analyze whether children with objectively measured second‐hand cigarette smoke (SHS) exposure suffer from a more severe course of disease when hospitalized with lower respiratory tract infection (LRTI) due to respiratory syncytial virus (RSV).

Severity of respiratory syncytial virus bronchiolitis is increased in children with passive smoking exposure

Background: Respiratory syncytial virus (RSV) bronchiolitis is one of the most common causes for hospitalization in the first year of life. Second-hand cigarette smoke (SHS) has been shown to increase the severity of respiratory illnesses and as a major metabolite of Nicotine, urinary Cotinine has been shown to be a reliable marker for SHS exposure. Aim of this study was to compare severity of RSV bronchiolitis in children with and without increased urinary Cotinine levels. Methods: A prospective study was performed including children aged below 12 months hospitalized with RSV bronchiolitis in Wilhelminen-Hospital Vienna. RSV infection was confirmed with nasopharyngeal swab and RSV enzyme-immuno-assay and urinary Cotinine levels (measured by chromatography tandem mass spectography) were assessed as indicator for SHS. Main outcome, assessing clinical severity, was oxygen (O2)-saturation (%) at rest on admission. Secondary outcomes were “Clinical severity score at admission” (CSSA) and “Disease severity score“ (DSS) combining different respiratory parameters. Results: Eighty-one patients with a mean age of 106 days (SD: ± 80) were included. Results of 13 (16%) patients with SHS (urinary cotinine ≥ 7ng/dl) and 68 (84%) without SHS exposure were analyzed. Mean O2-saturation for patients with and without SHS exposure was 95.1 % and 96,6 %, respectively (p U-test =0.045). Mean CSSA and DSS for patients with and without SHS exposure was 3.1 versus 2.5,(p=0.014) and 1.6 versus 2.4 (n.s.). Conclusions: The data show, that children hospitalized for RSV bronchiolitis with SHS exposure have significantly lower 02-saturation and a worse CSSA than children without SHS exposure.

Chronischer Husten beim Kind

ZusammenfassungKindlicher chronischer Husten ist definiert als Husten täglich über mehr als vier Wochen. Bei einer Dauer von drei bis acht Wochen kann man auch von prolongiertem subakutem Husten sprechen. Chronischer Husten kann sich als Symptom einer Grunderkrankung darstellen und unterschiedlichste Ursachen haben. Diese müssen diagnostiziert und dann adäquat behandelt werden. Das Verständnis der Ätiologie und der Zusammenhang von Umwelteinflüssen wie Tabakrauchbelastung und anderer inhalativer Noxen und dem chronischem Husten ist wesentlich für die Diagnose. Jeglicher Therapieversuch bei chronischem Husten muss reevaluiert und die Wirksamkeit überprüft werden. Chronischer Husten bedarf jedenfalls einer detaillierten Aufarbeitung, bei Fehlen einer Diagnose und Fortbestehen der Beschwerden empfiehlt sich dringend eine Abklärung in einem auf Pädiatrische Pneumologie spezialisierten Zentrum.

Neue internationale Referenzwerte für die Spirometrie – Implikation für die Praxis anhand einer vergleichenden Analyse eines pädiatrischen Patientenkollektivs

BACKGROUND The new lung function reference values of the global lung initiative (GLI) are recommended by most health societies. The aim of this study was to analyze FEV1- and FEV1/FVC-values from a German and Austrian patient group applying old and new reference values. RESULTS A total of 215 Caucasian children (aged 5-17 years) were included. FEV1-values were significantly lower applying GLI reference values compared to Zapletal values (median 96.9 % pred. (87.3-105.2) versus 100.6 % pred. (quartile 91.5-111.4), p = 0.000), the median difference was 4.9 % (range -12.9 to 27.5) % pred. Differences correlated significantly with age and FEV1 in % predicted (Zapletal), p = 0.000 17/70 (24 %) patients with cystic fibrosis had FEV1-values <80% pred. applying Zapletal, in 25 (36 %) patients FEV1 was abnormal (z-score <1645) using GLI values; 3/145 asthmatics (2 %) had FEV1-Werte <80 % d.S. (Zapletal), 7/145 (5 %) z-scores <1645 (GLI). CONCLUSION Differences between GLI-and Zapletal-reference values were considerable in pediatric asthma and CF-patients.