Warren Lenney

Health care utilisation of infants with chronic lung disease, related to hospitalisation for RSV infection

AIMS To compare the use of health care resources and associated costs between infants with chronic lung disease (CLD) who had or had not an admission with a proven respiratory syncytial virus (RSV) infection. METHODS Review of community care, outpatient attendances, and readmissions in the first two years after birth. Patients: 235 infants (median gestational age 27 weeks) evaluated in four groups: 45 infants with a proven RSV admission (RSV proven); 24 with a probable bronchiolitis admission; 60 with other respiratory admissions; and 106 with non-respiratory or no admissions. RESULTS The RSV proven compared to the other groups required more frequent and longer admissions to general paediatric wards and intensive care units, more outpatient attendances and GP consultations for respiratory related disorders, and had a higher total cost of care. CONCLUSION RSV hospitalisation in patients with CLD is associated with increased health service utilisation and costs in the first two years after birth. Key message Prematurely born CLD infants who are hospitalised with RSV infection have an increased health service utilisation in the first two years after birth

Prevention of viral induced asthma attacks using inhaled budesonide.

Thirty two preschool children were entered into a double blind, placebo controlled study using intermittent budesonide to treat viral induced wheeze. Active treatment was either 800 micrograms twice a day via a spacer or 1600 micrograms twice a day via a spacer and facemask in those children too young to use a mouthpiece. Treatment was started at the onset of an upper respiratory tract infection and continued for seven days or until symptoms had resolved for 24 hours. Each child remained in the study until they had completed using one pair of budesonide and placebo inhalers in random order without the need for additional oral prednisolone. Twenty five children completed 28 treatment pairs. All 25 families were asked to express a preference after completing their first treatment pair: 12 preferred budesonide and six preferred placebo; seven had no preference. Symptom scores were compared in 17 treatment pairs that were completed without the need for oral prednisolone. Mean day and night time wheeze in the first week after infection were significantly lower in those receiving budesonide. Intermittent inhalation of budesonide can modify the severity of wheezing in preschool children developing asthma after viral respiratory infections but improvements were modest with the doses used in this study.

The burden of pediatric asthma

Childhood asthma is common and its prevalence is increasing in most countries of the world. Large‐scale studies indicate that approximately one‐third of children with asthma have had five or more episodes of wheezing in the previous 12 months. Such frequency of symptoms leads to a significant number of days lost from school, interference with physical exercise, and underfunctioning at school because of interrupted sleep. In cases of more severe asthma, the more frequent school absences may affect the individuals education and, possibly, choice of career. In addition to the extensive individual burden of asthma, the burden on the family is substantial. Additional housework may be required to reduce the childs exposure to potential environmental triggers. Time “off work” may be required to take care of a sick child. In cases of severe asthma, children regularly wake at night, and 50% of parents indicate limitation of their social life. Sibling studies show that sometimes siblings who do not have asthma are neglected and that parents may have insufficient time to devote to them. Mortality in pediatric asthma is low, but there has been little reduction in recent years. When viewed as potential life‐years lost, the burden is considerable in social and economic terms. In the United States, the mean annual cost per patient has been estimated at in excess of US

Hydrogen cyanide as a biomarker for Pseudomonas aeruginosa in the breath of children with cystic fibrosis

1,000. In Australia, the cost ranges from A

Health care utilisation of prematurely born, preschool children related to hospitalisation for RSV infection

85 to A

Use of budesonide in severe asthmatics aged 1-3 years.

884 per patient, depending on asthma severity. In the United Kingdom the estimated annual costs of childhood asthma to the Health Service are between £100 million and £150 million. To reduce the burden to patients, their families, and health care services, improved understanding of the basic pathophysiology of asthma is necessary. Environmental issues need to be addressed as does delivery of care using appropriate devices and effective therapeutic medications. Pediatr. Pulmonol. 1997; Supplement 15:13–16.

Home oxygen status and rehospitalisation and primary care requirements of infants with chronic lung disease

Hydrogen cyanide (HCN) is emitted by Pseudomonas aeruginosa (PA) in vitro. We hypothesized that exhaled HCN could be measured using Selected Ion Flow Tube Mass Spectrometry (SIFT‐MS) and that concentrations would be higher in children with cystic fibrosis (CF) and PA infection than in children with asthma.

Isoprene levels in the exhaled breath of 200 healthy pupils within the age range 7–18 years studied using SIFT-MS

Background: In prematurely born infants with chronic lung disease (CLD), RSV hospitalisation is associated with increased health service utilisation and costs in the first two years after birth. Aims: To determine whether RSV hospitalisation in the first two years was associated with chronic respiratory morbidity during the preschool years in prematurely born children who had had CLD. Methods: Retrospective review of readmissions, outpatient attendances, and community care in years 2–4 and, at age 5 years, assessment of the children’s respiratory status and their health related quality of life. Comparison was made of the results of children who had had at least one hospitalisation in the first two years after birth for RSV infection (RSV group) to those of the rest of the cohort. Participants were 190 of an original cohort of 235 infants with CLD and a median gestational age 27 (range 22–33) weeks. Results: The 33 children in the RSV group, compared to the rest of the cohort, had a greater duration of hospital stay and more outpatient appointments. The RSV group had required more prescriptions for all treatments and respiratory medications, and more had used an inhaler. The cost of care of the RSV group was higher (median £2630 [€4000, US

Concentrations of some metabolites in the breath of healthy children aged 7–18 years measured using selected ion flow tube mass spectrometry (SIFT-MS)

4800], range £124–18 091 versus £1360 [€2500, US

Variation in hydrogen cyanide production between different strains of Pseudomonas aeruginosa

3000], range £5–18 929) and their health related quality of life was lower. Conclusion: In prematurely born children who had developed CLD, RSV hospitalisation in the first two years was associated with chronic respiratory morbidity and increased cost of care.