Annabelle Quizon

Probiotic administration in early life, atopy, and asthma: a meta-analysis of clinical trials.

BACKGROUND AND OBJECTIVE: Probiotics may reduce the risk of atopy and asthma in children. However, results from clinical trials have been conflicting, and several of them may have been underpowered. We performed a meta-analysis of randomized, placebo-controlled trials to assess the effects of probiotic supplementation on atopic sensitization and asthma/wheeze prevention in children. METHODS: Random-effects models were used to calculate pooled risk estimates. Meta-regression was conducted to examine the effect of potential factors on probiotics efficacy. RESULTS: Probiotics were effective in reducing total immunoglobulin E (IgE) (mean reduction: –7.59 U/mL [95% confidence interval (CI): –14.96 to –0.22]; P = .044). Meta-regression showed that the reduction in IgE was more pronounced with longer follow-up. Probiotics significantly reduced the risk of atopic sensitization when administered prenatally (relative risk: 0.88 [95% CI: 0.78 to 0.99]; P = .035 for positive result on the skin prick test and/or elevated specific IgE to common allergens) and postnatally (relative risk: 0.86 [95% CI: 0.75 to 0.98]; P = .027 for positive result on skin prick test). Administration of Lactobacillus acidophilus, compared with other strains, was associated with an increased risk of atopic sensitization (P = .002). Probiotics did not significantly reduce asthma/wheeze (relative risk: 0.96 [95% CI: 0.85 to 1.07]). CONCLUSIONS: Prenatal and/or early-life probiotic administration reduces the risk of atopic sensitization and decreases the total IgE level in children but may not reduce the risk of asthma/wheeze. Follow-up duration and strain significantly modified these effects. Future trials for asthma prevention should carefully select probiotic strain and consider longer follow-up.

Macrolides for the long-term management of asthma - a meta-analysis of randomized clinical trials.

Macrolide antibiotics, which have anti‐inflammatory and immune modulatory effects, have been studied as adjuncts for the management of asthma. However, results have been contradictory and trials underpowered. We therefore sought to conduct a meta‐analysis of randomized controlled trials (RCT).

Obliterative lower airway lesions in childhood: Bronchoscopic diagnosis and clinical spectrum

Previous reports have described structural airway abnormalities in children with non‐cystic fibrosis chronic supportive lung disease as well as obliterative membranes in the major bronchi of cystic fibrosis patients. The putative paradigm proposed in the evolution of these membranes invokes intense inflammation resulting in granulation tissue and neovascularization with the formation of pyogenic granuloma and eventually fibrosis.

Special considerations in pediatric asthma.

Asthma is the most common chronic illness in childhood with challenges that revolve around interventions that can potentially alter the course of the disease and concerns regarding the safety of regular use of controller medications. Recent studies suggest that the use of inhaled corticosteroids in very young children with frequent wheezing episodes and at high risk for asthma, while effective, does not alter the eventual progression to asthma. As a controller medication, the safety of inhaled corticosteroids as regards efficacy and risk are reviewed. The use of as-needed ICS as a strategy to reduce risk of adverse events can be explored in children with mild persistent asthma. The key to risk reduction is to titrate the dose of steroids to the lowest dose needed to achieve asthma control. Aside from inhaled corticosteroids, other controller medications are described within the framework of the updated asthma guidelines released by the NIH-National Asthma Education and Prevention Program in 2007. Other interventions that may attenuate asthma risk and severity include environmental measures towards allergen avoidance and attention to the increasing prevalence of obesity. The use of age-appropriate delivery systems for inhaled medications is also important for asthma control.

On the nature of pleural involvement in necrotizing pneumonia: A report of two cases of life threatening late complications

Suppurative complications of pneumonia such as empyema, lung abscess, pyopneumothorax, and necrotizing pneumonia (NP) are uncommon in children. Over the last decade an increasing incidence of NP has been reported. Streptococcus pneumoniae continues to be the predominant causative organism of NP, and while sporadic cases were reported prior to routine administration of heptavalent pneumococcal vaccine, a marked increase in NP appears to relate to replacement pneumococcal strains. Pleural involvement is almost universal in NP, and the course of pleural disease often determines its duration and outcome, particularly as it relates to complication of bronchopleural fistula. Cavities are formed in NP within the lung parenchyma and in the pleural space as the fibrosing pleural process organizes. The similarity of the radiologic appearance of parenchymal and pleural space cavities often makes the differentiation of pneumatocele versus residua of loculated pneumothorax challenging. The prevailing perception from most reports on childhood NP is of a favorable outcome with conservative approach. We report two pediatric cases with pneumonia who presented with prolonged fever despite antibiotic treatment, eventually diagnosed with NP. After stabilization on prolonged IV antibiotics, and weeks after discharge, they presented with unexpected acute respiratory failure due to a life‐threatening tension air collection. In this article we discuss the nature of NP, its typical presentation, benign course and outcome, albeit its potential to cause serious late complications in the light of our recent experiences. Increasing awareness of such complications will result in more careful follow‐up and in providing appropriate recommendations to parents of patients recovering from NP. Pediatr Pulmonol. 2014; 49:E90–E95.

Treatment of Disorders Characterized by Reversible Airway Obstruction in Childhood: are Anti-cholinergic Agents the Answer?

Release of acetylcholine from parasympathetic nerves in the airways activates postjunctional muscarinic receptors present on smooth muscle, submucosal glands and blood vessels. This triggers bronchoconstriction, muscle hypertrophy, mucus secretion, and vasodilatation, respectively. The release of acetylcholine from parasympathetic nerves in lungs is induced by a variety of stimuli and downregulated by the inhibitory activity of neuronal M2 muscarinic receptors via a feedback mechanism. Increased parasympathetic nerve activity occurs in a variety of airway diseases in childhood, including viral-induced wheeze and asthma. Common to these conditions are reversible airway obstruction, mucus hypersecretion, vasodilation and enhanced vascular permeability. In animal models of airway hyperreactivity similar findings of increased acetylcholine release resulting in enhanced supply of this neurotransmitter to the postjunctional smooth muscles, submucosal glands and airway vessels, were demonstrated. While the number and function of postjunctional muscarinic receptors in the airways are unchanged in such airway disorders, inhibitory activity on the parasympathetic nerves appears to be impaired. Specifically, M2 muscarinic receptor dysfunction has been demonstrated in models of bronchial hyperreactivity induced by a variety of triggers, including viruses, atmospheric pollutants and allergens. The mechanisms leading to impairment of neuronal M2 muscarinic receptor function and their putative relevance to the pathogenesis and the treatment of airway disease in childhood are described. Finally, the available data on the activity of ipratropium bromide, a short-acting anticholinergic drug, in the most common pediatric airway disease are reported and the possible therapeutic efficacy of tiotropium bromide, a more recently introduced long-acting, selective anticholinergic compound, is discussed.

Anticholinergics as treatment for childhood asthma

• Respiratory viruses isolated in the upper airway are commonly found in the lower airway [6]. • Viral typing has shown that viruses do not colonise the airway. A new group of HRV was found about five years ago and several studies have now shown that this group, HRV-C, is responsible for up to 60% of acute asthma exacerbations in children. Some of these studies have also shown that HRV-C causes more severe exacerbations that other HRV groups or other viruses [2]. Further evidence of the increased pathogenicity of HRV-C compared with other viral groups comes from the observation that HRV-C isolation rates in children with more severe acute exacerbations are much higher than in control children. Other viral groups, particularly other HRV groups, show smaller differences in isolation rates between exacerbation and control children. HRV-C appears to be more of a problem in younger children, as isolation rates are lower in adults with acute asthma exacerbations. In summary, acute virus infections are now established as the cause of the majority of acute asthma exacerbations in children and a newly-discovered viral group, HRV-C, is the most common viral cause of more severe asthma exacerbations.

Life threatening complications of necrotizing pneumonia: a report of two cases

Introduction: Acute Bronchiolitis is a common seasonal lower respiratory disease in infants. Syncytial respiratory virus is responsible for more than 50 percent of bronchiolitis events. The treatment is usually supportive. This study was done to examine the efficacy of nebulizer magnesium sulfate in the treatment of acute bronchiolitis. Methods: This study was a double blind clinical trial in which 60 patients admitted with acute bronchiolitis in our hospitals in Isfahan, Iran during 2010 and 2011. Patients were randomly divided into two groups, A and B. Group A were treated by nebulizer of magnesium sulfate, epinephrine and normal saline nebulizer and group B were treated only by the epinephrine and normal saline nebulizer. Severity of symptoms was estimated by measuring the temperature, SPO2, pulse rate (PR), respiratory rate (RR) and respiratory distress assessment instrument (RDAI) index, at the beginning of study to 3 days after treatment by follow-up questionnaires. Data were analyzed by Student t-test and repeated measure ANOVA. Results: The mean of temperature, SPO2, PR, RR and RDAI at admission and during hospital stay was not significantly different between two groups. After removing the confounding effect of different arrival, RDAI in second and third days in group A was significantly less than group B (P < 0.01). Conclusion: According to this study, treatment with magnesium sulfate nebulizer has no effect on symptoms of acute bronchiolitis. Magnesium sulfate can reduce RDAI only in the second and third days of hospitalization.

The Relationship Between Asthma, Sleep Apnea, and Other Respiratory Disorders and Childhood Metabolic Syndrome

Introduction: Obesity and the metabolic syndrome are associated with increased morbidity from chronic respiratory diseases such as asthma and sleep-disordered breathing, as well as increased risk of perioperative respiratory complications.

Abnormal Venous Drainage

Congenital pulmonary venous anomalies, which arise from abnormal embryonic venous development, occur in a diverse spectrum in the pediatric population. Although echocardiography with pulsed Doppler remains the initial investigation of choice in evaluation of the pulmonary venous developmental anomalies particularly in infants and young children, noninvasive imaging studies such as Magnetic Resonance Imaging and Multidetector Computed Tomography are currently playing increasing roles in the initial diagnosis and further characterization of this group of disorders. In this chapter, we review (1) embryology; (2) epidemiology; (3) anatomy; (4) clinical presentation; (5) preoperative imaging evaluation; (6) management; and (7) postoperative imaging evaluation of congenital pulmonary venous anomalies in the pediatric population. Disorders of the lymphatic system encompass a number of entities that may lead to chronic and serious pulmonary disease and manifest with a range of clinical presentations. Congenital errors in lymphatic development are rare and their diagnoses and management are difficult.