Paula Leiria-Pinto

Lung function and clinical risk factors for asthma in infants and young children with recurrent wheeze

Background: Although several risk factors for asthma have been identified in infants and young children with recurrent wheeze, the relevance of assessing lung function in this group remains unclear. Whether lung function is reduced during the first 2 years in recurrently wheezy children, with and without clinical risk factors for developing subsequent asthma (ie, parental asthma, personal history of allergic rhinitis, wheezing without colds and/or eosinophil level >4%) compared with healthy controls was assessed in this study. Methods: Forced expiratory flows and volumes in steroid naïve young children with ⩾3 episodes of physician confirmed wheeze and healthy controls, aged 8–20 months, were measured using the tidal and raised volume rapid thoracoabdominal compression manoeuvres. Results: Technically acceptable results were obtained in 50 wheezy children and 30 controls using tidal rapid thoracoabdominal compression, and 44 wheezy children and 29 controls with the raised volume technique. After adjustment for sex, age, body length at test and maternal smoking, significant reductions in z scores for forced expiratory volume at 0.5 s (mean difference (95% CI) −1.0 (−1.5 to −0.5)), forced expired flow after 75% forced vital capacity (FVC) has been exhaled (FEF25) (−0.6 (−1.0 to −0.2)) and average forced expired flow over the mid 50% of FVC (FEF25–75) (−0.8 (−1.2 to −0.4)) were observed in those with recurrent wheeze compared with controls. Wheezy children with risk factors for asthma (n = 15) had significantly lower z scores for FVC (−0.7 (−1.4 to −0.04)) and FEF25–75 (−0.6 (−1.2 to −0.1)) than those without such risk factors (n = 29). Conclusions: Compared with healthy controls, airway function is reduced in young children with recurrent wheeze, particularly those at risk for subsequent asthma. These findings provide further evidence for associations between clinical risk factors and impaired respiratory function in early life.

Cystic fibrosis, atopy, asthma and ABPA.

The role of atopy on cystic fibrosis (CF) progression remains unclear but evidence suggests that it may influence the appearance of co-morbid conditions such as CF asthma or allergic bronchopulmonary aspergillosis (ABPA). Recognising asthma in patients with CF is not always easy but the identification of atopic markers favours the diagnosis. Physicians should be aware of this fact in order to achieve a better control of respiratory symptoms in patients with CF. Bronchial mucosa inflammation and abnormal mucus predispose to mould colonisation. These patients are at higher risk of allergic sensitisation, especially when atopic susceptibility is present. In the particular case of A. fumigatus, allergic sensitisation precedes ABPA development, which occurs in up to 10% of CF patients. Progression of lung function deterioration is most strikingly pronounced in patients with ABPA. Therefore, sensitisation with A. fumigatus should be regularly tested in patients with CF, especially those at higher risk. Recombinant allergens constitute an important advance in differentiating Aspergillus sensitisation from ABPA itself.

Bronchodilator responsiveness using spirometry in healthy and asthmatic preschool children

Objective To assess repeatability and reproducibility of spirometry measurements, and bronchodilator responsiveness (BDR), in healthy 3–6-year-old preschool children and those with asthma. Design Spirometry was performed before and 20 minutes after administering either inhaled placebo (for repeatability) or 400 μg salbutamol (for BDR) on two separate occasions (reproducibility) 3–23 days apart in asthmatic preschoolers and healthy controls. Settings Lung Function Laboratory, Hospital de Dona Estefania, Lisbon. Participants Healthy preschool children and those with physician-diagnosed asthma, recruited from local Health Clinics and Outpatient Clinic. Main outcome measures Paired measurements of forced expired volume in 0.75 s (FEV0.75) and forced mid-expiratory flows (FEF25–75). Results Technically successful baseline results were obtained in 86% of children assessed. Paired data were obtained in 43 asthmatic and 22 controls (median (range) age: 5.1 (3.4–6.8) years). Baseline FEV0.75 was significantly lower in asthmatic children (mean (SD): 90 (15)% predicted) than in controls (102 (13) % predicted; p<0.001). Within-occasion coefficient of repeatability following placebo was similar in both groups, being 10.4% in asthma and 13.2% in controls for FEV0.75. Following bronchodilator, FEV0.75 increased significantly more in asthmatic preschoolers (mean (SD): 15.0 (12) %) than in controls (4.5 (5) %; p<0.001), with no significant difference between groups post-bronchodilator. Between-occasion variability was similar to within-day repeatability in controls, but almost twice as high in asthmatic children. Conclusions BDR can be assessed reliably using FEV0.75 in wheezy preschoolers, provided within-subject variability and responsiveness in health are taken into consideration.

Chronic respiratory diseases and quality of life in elderly nursing home residents

Few studies have assessed the quality of life (QOL) related to chronic respiratory diseases in the elderly. In the framework of the geriatric study on the health effects of air quality in elderly care centers (GERIA) study, a questionnaire was completed by elderly subjects from 53 selected nursing homes. It included various sections in order to assess respiratory complaints, QOL (World Health Organization QOL (WHOQOL)-BREF), and the cognitive and depression status. The outcome variables were the presence of a score lower than 50 (<50) in each of the WHOQOL-BREF domains (physical health, psychological health, social relationships, and environmental health). Chronic bronchitis, frequent cough, current wheezing, asthma, and allergic rhinitis were considered as potential risk factors. The surveyed sample was (n = 887) 79% female, with a mean age of 84 years (SD: 7 years). In the multivariable analysis, a score of <50 in the physical domain was associated with wheezing in the previous 12 months (odds ratio (OR): 2.03, confidence interval (CI): 1.25–3.31) and asthma (OR: 1.95, CI: 1.12–3.38). The psychological domain was related with a frequent cough (OR: 1.43, CI: 0.95–2.91). A score of <50 in the environmental domain was associated with chronic bronchitis (OR: 2.89, CI: 1.34–6.23) and emphysema (OR: 3.89, CI: 1.27–11.88). In view of these findings, the presence of respiratory diseases seems to be an important risk factor for a low QOL among elderly nursing home residents.

Environment and Health in Children Day Care Centres (ENVIRH) – Study rationale and protocol☆

Abstract Background Indoor air quality (IAQ) is considered an important determinant of human health. The association between exposure to volatile organic compounds, particulate matter, house dust mite, molds and bacteria in day care centers (DCC) is not completely clear. The aim of this project was to study these effects. Methods – study design This study comprised two phases. Phase I included an evaluation of 45 DCCs (25 from Lisbon and 20 from Oporto, targeting 5161 children). In this phase, building characteristics, indoor CO2 and air temperature/relative humidity, were assessed. A childrens respiratory health questionnaire derived from the ISAAC (International Study on Asthma and Allergies in Children) was also distributed. Phase II encompassed two evaluations and included 20 DCCs selected from phase I after a cluster analysis (11 from Lisbon and 9 from Oporto, targeting 2287 children). In this phase, data on ventilation, IAQ, thermal comfort parameters, respiratory and allergic health, airway inflammation biomarkers, respiratory virus infection patterns and parental and child stress were collected. Results In Phase I, building characteristics, occupant behavior and ventilation surrogates were collected from all DCCs. The response rate of the questionnaire was 61.7% (3186 children). Phase II included 1221 children. Association results between DCC characteristics, IAQ and health outcomes will be provided in order to support recommendations on IAQ and childrens health. A building ventilation model will also be developed. Discussion This paper outlines methods that might be implemented by other investigators conducting studies on the association between respiratory health and indoor air quality at DCC.

Effect of indoor air quality of day care centers in children with different predisposition for asthma

Scarce information is available about the relationships between indoor air quality (IAQ) at day care centers (DCC), the estimated predisposition for asthma, and the actual wheezing susceptibility.

Food Allergy and Anaphylaxis in Infants and Preschool-Age Children

Food allergy (FA) prevalence data in infants and preschool-age children are sparse, and proposed risk factors lack confirmation. In this study, 19 children’s day care centers (DCC) from 2 main Portuguese cities were selected after stratification and cluster analysis. An ISAAC’s (International Study of Asthma and Allergies in Childhood) derived health questionnaire was applied to a sample of children attending DCCs. Outcomes were FA parental report and anaphylaxis. Logistic regression was used to explore potential risk factors for reported FA. From the 2228 distributed questionnaires, 1217 were included in the analysis (54.6%). Children’s median age was 3.5 years, and 10.8% were described as ever having had FA. Current FA was reported in 5.7%. Three (0.2%) reports compatible with anaphylaxis were identified. Reported parental history of FA, personal history of atopic dermatitis, and preterm birth increased the odds for reported current FA. A high prevalence of parental-perceived FA in preschool-age children was identified. Risk factor identification may enhance better prevention.

Spirometry and bronchodilator responsiveness in wheezing preschool children

Methods We carried out a retrospective analysis of incentive spirometry tests in recurrent wheezing children, aged 2-5 years, from our center, performed between September 2012 and March 2014. Lung function was assessed before and after 400 mg of inhaled salbutamol using a Jaeger spirometer v.4.65 (CareFusion). Wheezing symptoms, parental asthma, prematurity, passive smoking exposure, atopy and controller medication use were evaluated. Categorical frequency analysis and non-parametric tests were used.

Leguminous allergy in a sample of children attending an outpatient allergy clinic.

Results The median age of onset of the allergic reaction was 3.9 ± 2.2 years. The leguminous most commonly responsible for allergy were the peas involved in 5 reactions, followed by chickpeas and beans, each involved in three reactions. All children were allergic to more than one leguminous, with a median of two leguminous involved in allergic reactions. All reactions except for one were immediate with a mild to severe degree of severity. Regarding the clinical findings of the allergic reactions, the mucocutaneous, gastrointestinal and respiratory symptoms occurred with similar frequency. Oral allergy syndrome was seen in one reaction. Two of these reactions fulfilled anaphylaxis criteria. All children except for one were allergic to at least another class of food besides the leguminous. Concomitant allergic rhinitis was also seen in all patients except for one. SPT, namely prick to prick tests, were performed and confirmed the allergy in all patients.