Eva Mantzouranis

Monitoring asthma in children

The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence. ERS statement summarising and discussing the available literature on monitoring children with asthma http://ow.ly/H01NG

Increased sensitization in urban vs. rural environment--rural protection or an urban living effect?

In a population‐based longitudinal cohort study, we tested the hypothesis that children growing up in a high‐traffic polluted urban area (UA) in the Athens’ basin have higher prevalence of allergies and sensitization when compared with those growing up in a Greek provincial rural area (RA). We recruited 478 and 342 children aged 8–10 living in the UA and the RA, respectively. Respiratory health was assessed by a parent‐completed questionnaire in three phases: 1995–96 (phase 1), 1999–2000 (phase 2), 2003–04 (phase 3) and skin‐prick testing to common indoor and outdoor aeroallergens was performed at phases 1 and 2. Reported asthma and eczema did not differ between the two areas, whereas reported hay fever was persistently more prevalent in the UA than in the RA (16.5%, 17.0%, 18.2% vs. 7.0%, 8.3%, 9.6%, respectively). Sensitization was more prevalent in the UA at both phases (19.0% vs. 12.1% in phase 1, 20.0% vs. 14.1% in phase 2). Residential area contributed independently to sensitization to ≥1 aeroallergens (OR: 0.29; 95% CI: 0.13–0.66; p = 0.003) and to polysensitization (OR: 0.28; 95% CI: 0.10–0.82; p = 0.020) in phase 1. These associations were independent of farming practices. No significant contributions were found in phase 2. Our results suggest that long‐term exposure to urban environment is associated with a higher prevalence of hay fever but not of asthma or eczema. The negative association between rural living and the risk of atopy during childhood, which is independent of farming practices, implies that it is mainly driven by an urban living effect.

Taking your child's breath away--the extension of asthma's global reach.

Although asthma is considered a disease of the Westernized world, in low-income countries all over the world, asthma is now occurring at increasing rates. Dr. Eva Mantzouranis writes that changes in the environment seem to be key factors in this epidemiologic shift.

Asthma Symptoms and Airway Narrowing in Children Growing up in an Urban versus Rural Environment

The development of asthma and allergy appears to be the result of gene-environment interaction. Potential environmental risk factors such as outdoor and indoor air pollution, infections, allergen exposure, diet, and lifestyle patterns may trigger respiratory symptoms and compromise lung function in children. Specific features of urban and rural lifestyle may constitute distinct risk factors but may also coexist within certain socioeconomic levels. Children of rural environments are at lower risk for asthma and aeroallergen sensitization. The protective effect has been associated with close contact with large animals, but the genetic factor also plays a contributory role. Children with prolonged exposure to urban environment are at increased risk of reduced lung function and those that reside in polluted areas exhibit slower lung growth. It is possible that polluted urban environment per se facilitates subclinical small airway disease. Evidence to date supports a strong relation between residential area as a potential risk factor for childhood asthma symptoms and airway obstruction and a western type of socioeconomic development.

Polyomyositis and myocarditis associated with acquired toxoplasmosis in an immunocompetent girl

BackgroundAcquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents with primary infection are generally asymptomatic, but symptoms may include malaise, fever, and lymphadenopathy. By contrast, immunocompromised patients may experience severe manifestations including encephalitis and multisystem organ failure.Case presentationWe report a case of polymyositis and myocarditis in a 13-year old immunocompetent girl with toxoplasmosis. The patient presented with proximal muscle weakness, dysphagia, palms and soles rash and elevated serum levels of muscle enzymes, with liver and myocardial involvement. The diagnosis of toxoplasmosis was confirmed by serology. The patient was treated with prednisolone and had an excellent outcome. During a follow-up period of four years no relapses occurred and antibody levels to the T. gondii significantly decreased.ConclusionsAlthough several previous cases of toxoplasmosis occuring in association with polymyositis have been described in the literature such a wide spectrum of acute toxoplasmosis is rather unusual in immunocompetent adolescents. The relationship between T. gondii and polymyositis remains obscure. Appropriate investigation should be performed in every case of polymyositis not only for the appropriate treatment but also for further elucidation of this relationship.

Different effects of sensitization to mites and pollens on asthma symptoms and spirometric indices in children: a population-based cohort study

BACKGROUND We have previously shown that long-term exposure of children to a highly polluted urban compared with a rural environment is associated with subclinical airway narrowing and increased prevalence of atopy. OBJECTIVE To test the hypothesis that sensitization to indoor perennial, compared with seasonal, aeroallergens has distinct effects on asthma symptoms and/or spirometric indices. METHODS We evaluated the respiratory health of 478 and 342 children aged 8 to 10 years living in an urban and a rural area, respectively, during a period of 8 years. Children were evaluated by parental questionnaire in 3 phases, 1995 to 1996 (phase 1), 1999 to 2000 (phase 2), and 2003 to 2004 (phase 3), and by spirometry and skin prick testing to 9 common local aeroallergens in phases 1 and 2. RESULTS Sensitization to pollens was associated with current wheezing in phase 1 of the study (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.71 to 6.62; P < .001) but not with spirometric indices. Sensitization to mites was negatively associated with forced expiratory volume in 1 second (95% CI, -7.26 to -0.90; P = .01) and forced expiratory flow at 50% of forced vital capacity (95% CI, -10.80 to -1.33; P = .01) in study phase 1 but not in phase 2. CONCLUSIONS Our results indicate that sensitization to mites is associated with insidious involvement of large and small airways, whereas sensitization to pollens is associated with childhood wheezing at the age of 8 to 10 years. Subsequent loss of these associations implies that risk factors other than allergy influence airway disease at a later age.

A boy with recurrent pneumonia

In the previous issue of Breathe , the case of a 6-yr-old boy who had been admitted to the paediatric department of the University of Heraklion was introduced. After diagnosis of pneumonia and treatment, he was discharged and returned to normal life. 12 months later, the patient was readmitted with fever (38.5°C), dyspnoea and cough for 2 days. He appeared ill. His body temperature was 36.7°C, respiratory rate was 26 breaths·min−1, pulse was 108 beats·min−1 and O2 saturation was 93%. On chest auscultation, he had decreased breath sounds over the right hemi-thorax. S1 and S2 cardiac sounds were normal with no murmur and …