F. Chedevergne

The role of inflammation in childhood asthma

The role of inflammation in adult asthma is well known, involving a cascade of immunological stimulation in which mast cells and eosinophils play pivotal roles. However, the assessment of airway inflammation in children is more difficult as the invasive methods used in adults cannot ethically be used for this purpose alone. Nevertheless, limited data from studies using invasive methodology, and studies using novel non-invasive techniques such as sputum induction and nitrous oxide exhalation, are improving knowledge. The immunopathology in childhood asthma appears to mirror that in adult sufferers. The inflammatory processes are evident at an early age in wheezing infants who later develop asthma, and there are different “wheezing phenotypes” in children with atopic asthma or viral associated wheeze. The mechanisms underlying childhood asthma are dependent not only on increased numbers of inflammatory cells in the airways, but also increased activation of these cells. In vitro data have shown that corticosteroids can inhibit the secretion of proinflammatory compounds from alveolar macrophages, suggesting a potential important role for these agents in halting the development of asthma. Techniques for measuring inflammation in infants need to be refined, in order to provide increased knowledge and accurate monitoring of the disease. It is hoped that this will enable the development of early interventions to minimise the impact of asthma in infants who are identified as being susceptible.

Bioelectrical impedance in young patients with cystic fibrosis: Validation of a specific equation and clinical relevance

BACKGROUND Body composition (BC) analysis based on bioelectrical impedance analysis (BIA) provides conflicting results. The purpose of the study was to validate an equation specific for young patients with cystic fibrosis (CF), describe their BC and investigate its association with lung function. METHODS Fifty-four young CF patients were evaluated by BIA and dual X-ray absorptiometry (DXA). An empirically derived CF-specific equation for fat-free mass (FFM) estimation by BIA was elaborated after stepwise multivariate regression and the agreement between BIA and DXA was assessed by Bland-Altman plots. The association between BC and lung function was investigated by regression analysis. RESULTS The mean difference between the BIA and DXA assessment was close to zero. A total of 22.5% of patients (n=9) presented a FFM z-score≤-2. They had a worse pulmonary function and diaphragmatic impairment. Among these 9 patients, 7 had a normal BMI z-score>-1. CONCLUSIONS BIA, based on a CF-specific equation, is a reliable method for BC assessment and allows the identification of patients at risk of nutritional degradation and bad respiratory prognosis.

Persistent Bordetella bronchiseptica infection in a child with cystic fibrosis: Relationship to bacterial phenotype

Bordetella bronchiseptica is an opportunistic bacteria infecting the respiratory tract of patients with cystic fibrosis. We present a case of B. bronchiseptica chronic pulmonary infection and documentation of some phenotypic attributes of the clinical isolates allowing the microorganism to induce progressive respiratory degradation and chronic sputum colonization. We recommend implementing adequate treatment aiming eradication from the first isolation of this bacterium. We advise for practices that minimize opportunities for zoonotic transmission of B. bronchiseptica from family pets.

142 Immunisation coverage in children with cystic fibrosis: a French multicenter survey

Objectives: To determine platelet aggregation capability for various variants of antigene system AB0 in patients with cystic fibrosis (CF). Methods: 55 CF children (homozygous and heterozygous on F508 del mutation) were enrolled. 46% girls and 54% boys had mild form of CF, 54% girls and 46% boys had severe form. We investigated the function of platelet aggregation with: thrombin, adenosinediphosphate (ADP) and arachidonic acid (AA). Results: Patients with severe form of CF most frequently (29%) had 0 (I); B (III) have not been revealed in this group, meanwhile 22.2% patients with mild form of CF had A (II) and AB (IV) have been revealed. Platelet aggregation with ADP has significant differences between blood groups A (II) and 0 (I), (p = 0.019). Values were ranged 2.5–97.5 percentile in patients with 0 (I) and 2.5−25 percentile in A (II). Data of aggregation with AA did not show significant differences between groups. Significant difference between homozygous F508 del and heterozygous F508 del patients was shown in aggregation with trombin (p = 0.03). There is a tendency to hyperaggregation in heterozygous patients meanwhile homozygous had both hypoaggregation and hyperaggregation. Difference on other tests between homozygous and heterozygous patients is not significant. Conclusion: First results of this study should be interpreted according to system ABO, severity of disease and genotype in patients with CF. These aspects play an important role for individual treatment.