Don S. Urquhart

Statement on Exercise Testing in Cystic Fibrosis.

This statement summarizes the information available on specific exercise test protocols and outcome parameters used in patients with cystic fibrosis (CF) and provides expert consensus recommendations for protocol and performance of exercise tests and basic interpretation of results for clinicians. The conclusions were reached employing consensus meetings and a wide-band Delphi process. Although data on utility are currently limited, standardized exercise testing provides detailed information on physiological health, allows screening for exercise-related adverse reactions and enables exercise counselling. The Godfrey Cycle Ergometer Protocol with monitoring of oxygen saturation and ventilatory gas exchange is recommended for exercise testing in people 10 years and older. Cycle ergometry only with pulse oximetry using the Godfrey protocol or treadmill exercise with pulse oximetry - preferably with measurement of gas exchange - are second best options. Peak oxygen uptake, if assessed, and maximal work rate should be reported as the primary measure of exercise capacity. The final statement was reviewed by the European Cystic Fibrosis society and revised based on the comments received. The document was endorsed by the European Respiratory Society.

‘They said it was bronchiolitis; is it going to turn into asthma doctor?’

Acute bronchiolitis is a common paediatric disease of infancy. Its association with subsequent asthma development has puzzled clinicians and epidemiologists for decades. This article reviews the current state of knowledge regarding the role of acute bronchiolitis in the inception of asthma. There is little doubt that acute bronchiolitis is associated with an increased risk of recurrent wheezing throughout the primary school years although the direction of causality—i.e. whether bronchiolitis in infancy leads to asthma or it merely represents the first clinical presentation of predisposition to asthma—is uncertain. Existing evidence suggests that both host factors (e.g. prematurity, atopic predisposition) and acute viral infection characteristics (e.g. type of virus, severity) are operating in this relationship, perhaps with variable involvement in different individuals. Further clarification of these issues will help paediatricians provide evidence‐based information regarding the long‐term prognosis of this common disease to the families, and at the same time, it will facilitate prophylactic approaches and therapeutic strategies.

The curious incident of groaning in the night-time

Catathrenia (from the Greek kata, meaning “below”, and threnia, meaning “to lament”) is a rare sleep disorder with very few cases reported in children [1]. The principal feature of catathrenia is a monotonic expiratory groaning noise that may or may not be associated with an altered respiratory pattern. It is now classified amongst the sleep-related breathing disorders [2]. The first report of catathrenia in a child who has been symptomatic from birth http://ow.ly/XcY830bevOH