Airway Disease In Children Research Articles

Study of the role of genes involved in the metabolism of histamine in the development of allergic respiratory diseases

The interaction of genetic, epigenetic and environmental factors underlies the pathogenesis of allergic diseases. Allergic rhinitis and atopic bronchial asthma are closely related and often concurrent respiratory allergic diseases. The chronic recurrent course of these diseases establishes the importance of further and more profound studies of the mechanisms underlying the development of these pathologies. Histamine is one of the most significant inflammatory mediators secreted during allergic reactions. The aim of the research was to study the role of polymorphic variants of AOC1, HRH2, HRH3, ALDH7A1, ADCYAP1, HNMT, PSAP, SCG3, genes involved in the histamine metabolism in the development of different endophenotypes of the allergic airway diseases in individuals living in the Republic of Bashkortostan. DNA samples of 358 individuals with allergic diseases of the respiratory tract of different ethnicity (Russians – 165, Tatars – 143, Bashkirs – 50) and 200 controls with unweighted heredity in allergic diseases (Russians – 75, Tatars – 83, Bashkirs – 42). Genotyping of polymorphic variants was performed by real-time PCR and PCR-RFLP analysis. It was revealed that the rs104979793*CC genotype and the rs104979793*C allele of the AOC1 gene were associated with allergic diseases of the respiratory tract and asthma with concomitant allergic rhinitis in Russians. A significant increase of total IgE level was revealed in Russian patients with allergic diseases of the respiratory tract with the rs1049793*CC genotype of the AOC1 gene compared to carriers of the rs1049793*CG and rs1049793*GG genotypes. The association of the C allele of the rs17525472 polymorphic variant localized near the SCG3 gene with allergic rhinitis in Russians was established. The results revealed that AOC1 and SCG3 genes involved in the metabolism of histamine are related to the development of different endophenotypes of airway diseases in children.

Upper airway obstruction and nocturnal enuresis in children: Why is it important?

Objectives: Nocturnal enuresis (NE) is a common urological complaint among children. The most common cause of obstructive airway disease in children is enlarged tonsils and adenoids. Although the relationship between the presence of NE and sleep disorders is unclear, some studies show that enuresis improves after airway obstruction is resolved. We aimed to investigate the relationship between upper airway obstruction and NE in children. Methods: Between September 2020 and June 2021, 66 pediatric patients diagnosed with persistent NE were included in the study. A total of 57 healthy patients were included in the control group. The presence of snoring and apnea, the presence of Attention-Deficit/Hyperactivity Disorder (ADHD)/social adjustment disorder, academic achievement, and family members’ history of NE were asked through questionnaires filled out by the families. An upper airway examination was done with a flexible nasopharyngoscope. Results: The mean ages of the study patients and healthy controls were 8.32±2.1 and 8.18±2.3 years. The female/male ratio was (25/41) and (33/24), respectively. Of the case group, 62.1% were male, and 78.8% were under nine years old. The frequency of snoring/apnea in children with enuresis was 27.3%, while it was 19.3% in the control group (p=0.299). It was found that more enuresis developed in children with high BMI (p=0.044). Family history was higher in the NE group than in the control group, but it was not statistically significant (p=0.173). Conclusion: Nocturnal enuresis is commonly associated with obstructive sleep apnea. Upper airway obstruction, obesity, and male gender are important risk factors for NE.

Clinical efficacy of bronchoalveolar lavage in the treatment of small airway diseases in children.

This study aimed to evaluate the efficacy of bronchoalveolar lavage (BAL) in the treatment of children with small airway diseases. Children [n = 112; boys: 76, girls: 36 (ratio 2.1:1); age range: 1 month-10 years; median age: 12 months] with small airway diseases diagnosed by high-resolution computed tomography (HRCT) were enrolled in this study. The patients were assigned to either the BAL group (BAL and conventional therapy) or the control group (conventional therapy only). The duration of cough, fever, wheezing, hospitalization duration, disease course before admission, treatment cost, HRCT recovery time, and re-hospitalization rate were compared between the two groups. The median disease course before admission of the BAL group patients was longer than that of the controls (p = 0.006). The duration of cough and wheezing in the BAL group was significantly longer than that in the control group (p = 0.012 and p = 0.001, respectively). The recovery time of cough, the re-hospitalization rate, and the total expenditure incurred for the BAL group were lower than those for the control group (p = 0.027, p = 0.026, and p = 0.000, respectively). At 2 months after discharge, the small airway lesions were found to be absorbed in 86.2% of BAL group patients vs. 64.1% of control group patients. At 6 months after discharge, the lesions were not fully absorbed in 3.4% of the BAL group patients compared to 20.5% in the control group patients. BAL is suitable for patients with a long disease course before admission, a long duration of coughing, and recurrent wheezing. BAL treatment of small airway diseases in children can promote the disappearance of clinical symptoms, accelerate the improvement of imaging, reduce the rate of re-hospitalization, and reduce the cost of treatment.

The relationship between changes in peak expiratory flow and asthma exacerbations in asthmatic children

BackgroundAsthma is one of the most common chronic airway diseases in children. Preventing asthma exacerbation is one of the objectives of all asthma action plans. In patients with poor perception, it is difficult to identify acute asthma exacerbations by clinical asthma score, asthma control test or asthma control questionnaire. The aim of this study is to analyze whether children with asthma have changes in peak expiratory flow(PEF)before an acute asthma exacerbation and to evaluate the relationship between PEF and asthma exacerbation.MethodsBasic information (including sex, age, atopy, etc.) and clinical information of asthmatic children who registered in the Electronic China Children’s Asthma Action Plan (e-CCAAP) from 1 September 2017 to 31 August 2021 were collected. Subjects with 14 consecutive days of PEF measurements were eligible. Subjects in this study were divided into an exacerbation group and a control group. We analyzed the relationship between changes in PEF% pred and the presence of asthma symptoms.ResultA total of 194 children with asthma who met the inclusion criteria were included, including 144 males (74.2%) and 50 females (25.8%), with a male-to-female ratio of 2.88:1. The mean age of the subjects was 9.51 ± 2.5 years. There were no significant differences in sex, age, allergy history or baseline PEF between the two groups. In children with and without a history of allergy, there was no significant difference between the variation in PEF at 14 days. Patients who only had a reduced in PEF but no symptoms of asthma exacerbation had the greatest reduction in PEF compared to the other groups. The most common cause of acute exacerbations of asthma is upper respiratory tract infection. Among the causes of acute exacerbations of asthma, the variation in PEF caused by air pollution was significantly higher than that of other causes (P < 0.05). In acute exacerbations, the decrease in PEF was significantly greater in the exacerbation group than in the control group. In children with asthma symptoms, there was a decrease in PEF approximately 1.34 days before the onset of symptoms.ConclusionChildren with asthma show a decrease in PEF 1.34 days before the onset of asthma symptoms. We recommend that asthmatic children who show a decrease in PEF should step-up asthma therapy. The most common cause of acute exacerbations of asthma was upper respiratory tract infections, and the variation in PEF caused by air pollution was significantly higher than that caused by other factors.

Biomarkers Reflecting the Severity of Bronchial Asthma in Children.

Bronchial asthma, the most prevalent chronic inflammatory airway disease in children, exhibits a concerning rise in both incidence and prevalence. Asthma biomarkers hold promise for stratifying patients into distinct clinical phenotypes, paving the way for targeted and personalized treatment approaches. This study aimed to evaluate the association between novel and non-established semi-invasive circulating and well-known exhaled inflammatory biomarkers in two distinct pediatric asthma populations stratified by disease severity. Forty-four asthmatic children aged 8-12 years meeting inclusion criteria were recruited from hospitalized patients. The first group (n=15, mean age 9.8 years) consisted of patients with mild persistent asthma who did not require regular inhaled corticosteroids (ICS). The second group (n=29, mean age 9.8 years) consisted of children with moderate to persistent asthma who received regular ICS treatment. Serum levels of interleukins (IL-13, IL-1β), eosinophil-derived neurotoxin (EDN), and surfactant protein D (SPD) were measured by ELISA in all participants. In addition, exhaled nitric oxide (FeNO) and blood eosinophil counts were evaluated. No significant differences were observed in the baseline plasma concentrations of inflammatory markers (IL-13, IL-1β, SPD, and EDN) or exhaled FeNO between the ICS-treated and non-ICS-treated groups. Further inter-individual analysis confirmed significant positive correlations between IL-13, SPD, and IL-1β (Pearson's r = 0.591-0.781) in both groups of patients. Interestingly, the ICS-treated group compared to the nontreated group showed an exclusive moderate negative correlation between FeNO and IL-1β. In contrast, FeNO exhibited a positive correlation with EDN and a strong association with eosinophil count in all the study groups. Our findings highlight the complex and unresolved role of asthma biomarkers in routine clinical practice for the management of childhood asthma, particularly in predicting exacerbations. By comparing the relationships of carefully selected biomarkers, we can achieve a greater clinical predictive value.

Impact of Acute Exercise Challenge on Airway Dynamics in Children and Young Adults with Sickle Cell Anemia

Background Sickle cell anemia (SCA) complications such as frequent pain, chronic anemia, and acute and chronic organ damage lead to reduced physical functioning and cardiopulmonary fitness in affected individuals. Limited data support the safety of maximal cardiopulmonary exercise testing (CPET) in SCA, yet the safety of submaximal, longer-duration exercise at moderate to high intensity in SCA is unclear. The Sickle Cell Pro-Inflammatory Response to Interval Testing Study (SPRINTS) was a multicenter, prospective study that evaluated the impact of longer, submaximal exercise, which mimics the physical activity patterns of children better than CPET, on the acute inflammatory response and airway dynamics in children and young adults with SCA. In this analysis, we defined the effect of moderate to vigorous exercise on forced expiratory volume in 1 second (FEV1) and acute bronchoconstriction. We hypothesized the risk of exercise-induced bronchoconstriction (EIB) in children with SCA is greater than in controls. Methods SPRINTS was approved by the Lurie Children's central Institutional Review Board. Subjects 10-21 years old with hemoglobin (Hb) SS or S/β0 thalassemia and race-matched controls without SCA or sickle cell trait were enrolled across 4 institutions. Subjects were excluded for 1) inability to perform exercise, 2) receiving chronic transfusions, 3) history of exercise-related arrhythmia/syncope, 4) physician-diagnosed asthma, 5) history of EIB, or 6) history of cardiac disease precluding exercise testing. Participants performed maximal CPET on a cycle ergometer using a standardized Godfrey protocol. At least 2 weeks later, participants performed a controlled intensity interval test (CIIT) consisting of 8 bouts of constant workload cycling randomized to either 50% (moderate intensity) or 70% (vigorous intensity) of peak workload achieved during CPET. Exercise bouts were 2 min each with 1-min rest intervals between bouts. Spirometry was performed pre/post (5, 10, 15, and 30 min) CPET and CIIT. EIB was defined as a drop in FEV1 ≥10% from baseline to the lowest FEV1 recorded. Bivariable comparisons were performed, and logistic regression models analyzed the association between EIB and covariables (age, sex, SCA status, max workload, exercise intensity (CIIT only), baseline FEV1 % predicted, FEV1/FVC % predicted) using IBM ® SPSS ® Statistics. Results Available data from 64 subjects (48% F, 73% on hydroxyurea, mean 13.8±2.8 years) and 40 controls (45% F, mean 15.4±2.9 years) were analyzed. Baseline Hb (8.5±1.2 vs. 13±1.4 g/dL, p &amp;lt; 0.001) and maximal workload achieved during CPET (85±26 vs. 135±45 watts, p &amp;lt; 0.001) were lower in subjects vs. controls. The percentage of participants who completed CIIT did not differ between subjects and controls, and no respiratory-related adverse events, including need for bronchodilator therapy, occurred. At baseline, FEV1 and FEV1 % predicted and other parameters (FVC and FVC % predicted, MMEF and MMEF % predicted) were significantly lower in subjects vs. controls (Table 1). However, there was no between-group difference in baseline FEV1/FVC % predicted. Post-exercise, the percentage of participants who met criteria for EIB did not differ between subjects and controls after CPET (21 vs. 26%, p = 0.537) or CIIT (32 vs. 17%, p = 0.126). There was also no significant between-group difference in the greatest drop in FEV1 from baseline to any post-exercise timepoint (mean value or as % of baseline) after CPET or CIIT. In logistic regression models, SCA status, age, sex, maximal workload during CPET, exercise intensity (CIIT only), baseline FEV1 % predicted and FEV1/FVC % predicted were not associated with EIB after CPET or CIIT (Table 2). Conclusion Compared to controls, children and young adults with SCA and no history of asthma or EIB had lower baseline values on all spirometry parameters except FEV1/FVC % predicted. EIB was not more common in subjects with SCA vs. controls after maximal CPET or a submaximal exercise challenge of longer duration at moderate or vigorous intensity. No independent factors were associated with development of EIB after acute exercise. Despite concerns that undiagnosed lower airways disease in children with SCA is common, our results suggest the risk of EIB in SCA is low and underscore the safety of moderate to vigorous exercise toward developing evidence-based exercise guidelines in non-asthmatic children and young adults with SCA.

P195 Prospective longitudinal evaluation of the lung clearance index (LCI) in the clinical setting

Lung clearance index (LCI) is recognized of great value as an endpoint for CF clinical trials, particularly among young children. However, there are still gaps in the information required to understand its role in the clinical care setting. We conducted a longitudinal study to evaluate the potential of LCI as a clinical decision tool. We enrolled 55 children with CF (mean age 10.9 + 3.6 years) and followed for 2 years LCI, FEV1 and other clinical parameters during quarterly routine visits. Reported symptoms, findings of exacerbation and changes in therapies were recorded for each visit. LCI was significantly increased from the previous visit in the presence of new respiratory symptoms reported (p = 0.0006), as well as being associated with changes in respiratory regimen (p = 0.0008), but not with prescription for antibiotics (p > 0.2). In contrast, FEV1 did not change significantly under any of these conditions (p > 0.2). A significant increase in LCI was noted for children diagnosed at the visit with a pulmonary exacerbation (1.3 vs 0.005 units, p = 0.04), this was not the case with FEV1 (+0.7 vs –2.4%-pred., p = 0.26). Most exacerbations were mild and treated as an outpatient, only 2 led to hospitalization. In addition, a mild decline in lung function with age during the study period was noted, with an increase of LCI by 0.32 units per year (p = 0.002) and a drop in FEV1 of –1.12%-pred. per year (p = 0.02). The decline in FEV1 was associated with LCI, with a drop of –2.0%-pred./year for every unit of increase in LCI (p < 0.0001). Further, there was a strong correlation between the change in FEV1 between visits and the change in LCI (p < 0.0001). We are conducting additional sensitivity analyses to evaluate cut-offs for minimal clinically important difference (MCID) considerations. We conclude that LCI has high sensitivity to progression of CF airway disease in children with what could be considered as well preserved lung function based on FEV1 criteria alone.

Computational phenotyping of obstructive airway diseases: protocol for a systematic review

BackgroundOver the last decade, computational sciences have contributed immensely to characterization of phenotypes of airway diseases, but it is difficult to compare derived phenotypes across studies, perhaps as a result of the different decisions that fed into these phenotyping exercises. We aim to perform a systematic review of studies using computational approaches to phenotype obstructive airway diseases in children and adults.Methods and analysisWe will search PubMed, Embase, Scopus, Web of Science, and Google Scholar for papers published between 2010 and 2020. Conferences proceedings, reference list of included papers, and experts will form additional sources of literature. We will include observational epidemiological studies that used a computational approach to derive phenotypes of chronic airway diseases, whether in a general population or in a clinical setting. Two reviewers will independently screen the retrieved studies for eligibility, extract relevant data, and perform quality appraisal of included studies. A third reviewer will arbitrate any disagreements in these processes. Quality appraisal of the studies will be undertaken using the Effective Public Health Practice Project quality assessment tool. We will use summary tables to describe the included studies. We will narratively synthesize the generated evidence, providing critical assessment of the populations, variables, and computational approaches used in deriving the phenotypes across studiesConclusionAs progress continues to be made in the area of computational phenotyping of chronic obstructive airway diseases, this systematic review, the first on this topic, will provide the state of the art on the field and highlight important perspectives for future works.Ethics and disseminationNo ethical approval is needed for this work is based only on the published literature and does not involve collection of any primary or human data.Registration and reportingSystematic review registrationPROSPERO CRD42020164898

Standardization of Reporting Obstructive Airway Disease in Children: A National Delphi Process

Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways, and there is no consensus for standardized reporting. We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting. We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (eg, asthma) and features (eg, triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting. Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label "asthma" for children older than 5 years and "obstructive bronchitis" or "suspected asthma" for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception. We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.

Macrophage PD-1 associates with neutrophilia and reduced bacterial killing in early cystic fibrosis airway disease

BackgroundMacrophages are the major resident immune cells in human airways coordinating responses to infection and injury. In cystic fibrosis (CF), neutrophils are recruited to the airways shortly after birth, and actively exocytose damaging enzymes prior to chronic infection, suggesting a potential defect in macrophage immunomodulatory function. Signaling through the exhaustion marker programmed death protein 1 (PD-1) controls macrophage function in cancer, sepsis, and airway infection. Therefore, we sought to identify potential associations between macrophage PD-1 and markers of airway disease in children with CF. MethodsBlood and bronchoalveolar lavage fluid (BALF) were collected from 45 children with CF aged 3 to 62 months and structural lung damage was quantified by computed tomography. The phenotype of airway leukocytes was assessed by flow cytometry, while the release of enzymes and immunomodulatory mediators by molecular assays. ResultsAirway macrophage PD-1 expression correlated positively with structural lung damage, neutrophilic inflammation, and infection. Interestingly, even in the absence of detectable infection, macrophage PD-1 expression was elevated and correlated with neutrophilic inflammation. In an in vitro model mimicking leukocyte recruitment into CF airways, soluble mediators derived from recruited neutrophils directly induced PD-1 expression on recruited monocytes/macrophages, suggesting a causal link between neutrophilic inflammation and macrophage PD-1 expression in CF. Finally, blockade of PD-1 in a short-term culture of CF BALF leukocytes resulted in improved pathogen clearance. ConclusionTaken together, these findings suggest that in early CF lung disease, PD-1 upregulation associates with airway macrophage exhaustion, neutrophil takeover, infection, and structural damage.

Acute Upper Airway Disease in Children With the Omicron (B.1.1.529) Variant of SARS-CoV-2—A Report From the US National COVID Cohort Collaborative

This cohort study uses data from the US National COVID Cohort Collaborative to evaluate upper airway infections in children during the surge of the Omicron (B.1.1.529) variant of SARS-CoV-2 in the US.

A Meta-Analysis of Probiotics for the Treatment of Allergic Airway Diseases in Children and Adolescents.

Allergic airway disease is a chronic airway allergic inflammatory disease including allergic rhinitis (AR) and allergic asthma which is common in children and adolescents. Recently the probiotics has been becoming a supplementary or alternative therapy to allergic diseases, however the effect of them has not been clearly established. The purpose of the present meta-analysis was to evaluate the effectiveness of probiotics on allergic airway disease including AR and allergic asthma in children and adolescents. We performed a comprehensive search on PubMed, Cochrane Library, EMBASE for relevant publications from 1 Jan 2000 to 1 July 2021. Physical examinations, Pediatric Rhinoconjunctivitis Quality of Life Questionnaires (PRQLQs), Total Nasal Symptom Score (TNSS), Nasal or Eye Symptom Score (NSS or ESS), serum allergen-specific IgE, and eosinophil were used as evaluating indicators for AR and allergic asthma in children and adolescents. The meta-analysis was performed using Review Manager (RevMan, Version 5.3). 15 randomized controlled trials (RCTs) with a total of 1388 participants were included for the meta-analysis. Among them, 729 patients treated with probiotics served as the probiotics group, and 659 patients with placebo as control group. Significantly greater reduction in PRQLQs from baseline to endpoint (SMD = -2.57, 95% CI [ - 4.66, -0.48] P < 0.01), NSS (SMD = -1.43, 95% CI [ - 1.63, - 1.23], P < 0.01) and ESS (total MD = -1.67, 95% CI [ - 1.79, - 1.55], P < 0.01) were observed in probiotics group compared to control group. Probiotics have no significant effect to serum IgE and eosinophils (P > 0.01). The results of this meta-analysis indicated that probiotics treatment may reduce PRQLQs, NSS, ESS in patients with allergic airway disease. More research involving the mechanism of probiotics are needed to clarify the role of probiotics in AR and allergic asthma in children and adolescents.

Nasal upregulation of CST1 in dog-sensitised children with severe allergic airway disease.

The clinical presentation of children sensitised to dog dander varies from asymptomatic to severe allergic airway disease, but the genetic mechanisms underlying these differences are not clear. The objective of the present study was to investigate nasal transcriptomic profiles associated with dog dander sensitisation in school children and to reveal clinical symptoms related with these profiles. RNA was extracted from nasal epithelial cell brushings of children sensitised to dog dander and healthy controls. Blood sample analyses included IgE against dog dander, dog allergen molecules, other airborne and food allergens, basophil activation and white blood cell counts. Clinical history of asthma and rhinitis was recorded, and lung function was assessed (spirometry, methacholine provocation and exhaled nitric oxide fraction). The most overexpressed gene in children sensitised to dog dander compared to healthy controls was CST1, coding for Cystatin 1. A cluster of these children with enhanced CST1 expression showed lower forced expiratory volume in 1 s, increased bronchial hyperreactivity, pronounced eosinophilia and higher basophil allergen threshold sensitivity compared with other children sensitised to dog dander. In addition, multi-sensitisation to lipocalins was more common in this group. Overexpression of CST1 is associated with more severe allergic airway disease in children sensitised to dog dander. CST1 is thus a possible biomarker of the severity of allergic airway disease and a possible therapeutic target for the future treatment of airborne allergy.

Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary.

Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.

A new dimension of success in the management of airway disease in children with neurological deficit

ObjectivesAnomalies of the larynx and trachea can cause respiratory distress in infants and older children. Depending on its nature, degree and extent of the disease invasive open surgery is indicated. Non-airway-related co-morbidities increase the challenges in its treatment. Neurological deficit poses a great challenge as it is associated with hypotonia and causes diminished laryngeal coordination. The definition of success in treatment of laryngotracheal disease has always focused on the post-operative functional outcomes: breathing, voice swallowing. The aim of this study is to describe a new dimension of success in the management of laryngotracheal disease in children with moderate neurological deficit, where the expected functional gain is less than in otherwise healthy children. MethodsThis retrospective observational study includes all patients who have undergone open reconstructive airway surgery between 2012 and 2017. Control patients without neurological deficit and cases with moderate neurological deficit were included. Functional outcome data was obtained from clinical records and two questionnaires were filled in by the parents of the children: one the pediatric voice-handicap index (pVHI) and a quality of life questionnaire. ResultsThirty-two children were included of which ten had moderate neurological deficit. Both groups revealed post-operatively an improvement in the functional outcomes: breathing, voice and swallowing, however, as expected, a trend was observed towards less functional improvement in children with neurological deficit. Both groups reveal a remarkable gain in quality of life (QoL). ConclusionIndicating the QoL to be an unidentified, dimension of success in the management of laryngotracheal disease in children with moderate neurological deficit.

Investigating The Effect of Prescribing Vitamin C on Improving the Clinical Symptoms of Asthma in 2-12-Year-Old Children Hospitalized in the Pediatric Ward of Ghaem and Dr. Sheikh Hospitals, Mashhad, Iran

Background Asthma is the most common chronic airway disease in children. We aimed to investigate the effect of vitamin C supplementation on improving the asthma symptoms in children. Materials and Methods: In a double-blind clinical trial: sixty 2-12-year-old children hospitalized with the diagnosis of asthma attack in the Ghaem and Dr. Sheikh hospitals, Mashhad, Iran were randomly assigned into two groups: intervention (receiving vitamin C tablets 500 mg every 12 hours, n=29), and control (receiving placebo, n=31). In each group, at the beginning and end of the hospitalization, one blood sample (3ml) was taken to evaluate the serum level of vitamin C and for other necessary tests. A pediatric resident recorded clinical symptoms at the beginning and every 6 hours until discharged including tachypnea, wheezing, retraction, and hypoxia every six hours until discharge from the hospital. Eventually, the data in the two groups were compared. Results: The mean age of the hospitalized patients was 33±24 months. There was a significant difference between the intervention and control groups regarding the serum level of vitamin C at the beginning of hospitalization and at the time of discharge. A significant difference was found in tachypnea of the hospitalized patients of both groups at 24, and 36 hours post hospitalization. Existence of wheezing in the patients of the intervention and control groups had a significant difference at 18, 36, and 66 hours post-hospitalization (p <0.05). Conclusion According to the results, oral vitamin C prescription in patients with acute asthma symptoms leads to improved respiratory status (tachypnea and wheezing) in 2-12-year-old children. Also, it is effective in reducing the duration of hospitalization of these children.

Hyaluronic acid for the treatment of airway diseases in children: Little evidence for few indications.

Hyaluronic acid (HA) is major physiological component of the extracellular matrix, which, in its high molecular weight form (HMW-HA) has anti-inflammatory properties. The diffusion of many different medical devices for inhalation therapy containing HA has led to an increase in their prescription, also in children. Here, we systematically review the published evidence on the efficacy and safety of HA for the treatment of upper and lower airway diseases in childhood. Relevant published studies (randomized controlled trials) for the efficacy of HA inhalation in children with upper airways diseases, asthma, cystic fibrosis (CF), and non-CF bronchiectasis were searched in Pubmed, Scopus, and Web of Knowledge databases by combining the adequate Medical Subject Headings terms and keywords, with no limit for the year of publication. We identified seven relevant publications for upper airways diseases, one for asthma, and five for CF, while we found no clinical trial including children with non-CF bronchiectasis. Meta-analysis was not conducted due to the heterogeneity of the included studies. The evidence of HA efficacy in the treatment of the upper and lower airways is still limited in children. Available data suggest that inhaled HMW-HA could be useful in the treatment of recurrent upper respiratory infections and chronic or recurrent inflammation of the middle ear and adenoids as well as of the lower airways in cystic fibrosis in association with hypertonic saline solution. Studies on larger populations and on the different formulations and nebulization methods, especially in pediatric age, are urgently needed.

Imaging of Acute Pulmonary and Airway Diseases in Children

소아의 다양한 응급질환 중 급성 폐질환 또는 급성 기도질환은 영상의학과 의사가 자주 대하게 되는 임상 상황이며, 일차적으로 시행되는 영상검사는 흉부 방사선사진이다. 따라서 다양한 임상 상황에서의 감별진단과 영상 소견을 숙지하는 것이 중요하다. 본 종설에서는 급성 폐질환의 다양한 원인과 폐렴을 알아보고, 폐렴과 감별해야 하는 급성 폐질환을 생각해보았다. 급성 기도질환으로는 크룹, 급성 후두염, 기관연화증, 천식, 감염 후 폐쇄세기관지염, 그리고 이물 흡인을 검토하였다. 이렇게 소아에서 고려해야 할 질환들의 영상 소견을 검토하여 진단과 치료에 도움을 줄 수 있길 바란다.

First Occurrence of Saffold Virus in Sewage and River Water Samples in Karaj, Iran.

Saffold virus as a newly discovered virus, which seems to be related to acute gastroenteritis as with other enteric viruses and to human airway diseases in children belongs to Cardiovirus genus in picornaviridae family with 11 genotypes. Saffold virus initially was detected in America from infant stool sample. Saffold virus has also been detected in environmental water samples. Until now, two reports have demonstrated that sewage water sources are contaminated with Saffold viruses. Molecular detection of Saffold virus mostly depended on reverse transcription PCR methods and RT-qPCR, which had targeted 5'UTR region of the viral genome. The present study aims to evaluate the molecular detection and quantity of Saffold virus in sewage water and river water specimens by RT-qPCR assay in Karaj, Iran. Fifty samples collected from environmental waters containing treated and untreated sewage water and river water samples were included in this study. After viral RNA extraction, the Real-time PCR was developed to amplify the 5'UTR sequence of Saffold virus genome and viral load was assessed. Out of the 50 samples tested (consisting 28 river water samples and 22 sewage water samples), the Saffold virus genomic RNA was identified in 10/28 (35.7%) of river water samples and in 4/12 (33.3%) of treated and 4/10 (40%) of untreated sewage samples. The maximum viral load was 6.8 × 106 copies/l in untreated sewage water sample in December, and the lower viral load was 1.2 × 106 copies/l related to treated sewage water taken in October. Our results for the first time indicate that Saffold virus has apparently been circulating among Iranian peoples. Also, the viral prevalence of Saffold virus in each of the three sets of tested samples was within moderate to high in range.

Measurement of nitric oxide and assessment of airway diseases in children: an update.

Nitric oxide (NO) is a gas synthesized by the inducible NO synthase enzyme in airway cells and it is thought to make important functions in the airway inflammation of several respiratory diseases. This current study is a review of the literature from 1990 to present about NO and its use in clinical practice. The databases used were PubMed, Scopus, and Cochrane Library. At the respiratory level there are three different measurements sites of NO: nNO (nasal nitric oxide), FeNO (exhaled fraction of nitric oxide), CaNO (alveolar nitric oxide). Each of them is produced at different levels of the respiratory tract and is involved in various diseases. nNO finds its use, principally, in the allergic rhinitis in fact it can be used as a measure of therapeutic efficacy, but not for the evaluation of the severity; also in primary ciliary dyskinesia (PCD), where high levels exclude the disease, and in chronic rhinosinusitis, but it is not currently used as a diagnostic or prognostic marker. FeNO has a greatest use in bronchial asthma, particularly, it is considered a non-invasive biomarker to identify and to monitor airway inflammation but currently, there is not a consensus on the use of the FeNO in the management of asthma treatment. Finally, CaNO is the least used in clinical practice, because lack of standardization of measurement techniques. Nitric oxide is a sensitive indicator of the presence of airway inflammation and ciliary dysfunction, although some studies have shown varying or conflicting results.