Asthma-like Symptoms Research Articles

Prevalence of asthma-like symptoms by ISAAC video questionnaire in Mozambican schoolchildren

The International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire was developed to overcome the language and cultural differences in the assessment of asthma-like symptoms. 27 schools were included in the Maputo Asthma and Allergies in childhood Study (MAPAAS) using ISAAC methods, and a video questionnaire (VQ) was administered to 1614 adolescents 13-14 years old of 20 schools located in urban, suburban and semi-rural areas of Maputo (Mozambique). Simultaneously, they also replied to the ISAAC written questionnaire (WQ). According to the video questionnaire, the prevalence of current asthma was 11.9% (compared with 13.3% using the written questionnaire). Wheezing after exercise in the last year was reported by about 21%. Females reported more frequent wheezing after exercise than males (p < .001). The prevalence of nocturnal cough in the last year was 24.7%, and was more frequent in the suburban area (p < .001). "Severe attacks of asthma" was reported by 11.9% of the individuals. Teenagers instructed in the suburban schools reported more severe asthma-like symptoms than others (p < .05). There was a poor correlation between the WQ and the AVQ3.0 (kappa coefficients varied from 0.09 to 0.24). The lowest agreement was observed for the question regarding severe attacks of asthma. Agreement was better in terms of specificity than in terms of sensitivity. In spite of the poor agreement between the written and the video questionnaires, the prevalence of asthma symptoms estimated using the video questionnaire confirms that asthma is an important public health problem in Maputo.

Association of FEF25-75% Impairment with Bronchial Hyperresponsiveness and Airway Inflammation in Subjects with Asthma-Like Symptoms

Background: Forced expiratory flow at 25 and 75% of the pulmonary volume (FEF_25-75%) might be considered as a marker of early airway obstruction. FEF_25-75% impairment might suggest earlier asthma recognition in symptomatic subjects even in the absence of other abnormal spirometry values. Objectives: The study was designed in order to verify whether FEF_25-75% impairment in a cohort of subjects with asthma-like symptoms could be associated with the risk of bronchial hyperresponsiveness (BHR) and with airway inflammation expressed as fractional exhaled nitric oxide (Fe<smlcap>NO</smlcap>) and eosinophil counts in induced sputum. Methods: Four hundred adults with a history of asthma-like symptoms (10.5% allergic) underwent spirometry, determination of BHR to methacholine (PD₂₀FEV₁), Fe<smlcap>NO</smlcap> analysis and sputum induction. FEF_25-75% <65% of predicted or <-1.64 z-score was considered abnormal. Results: All subjects had normal FVC, FEV₁ and FEV₁/FVC, while FEF_25-75% was abnormal in 27.5% of them. FEF_25-75% (z-score) was associated with PD₂₀FEV₁ (p < 0.001), Fe<smlcap>NO</smlcap> (p < 0.001) and sputum eosinophils (p < 0.001). Patients with abnormal FEF_25-75% showed higher levels of Fe<smlcap>NO</smlcap> and eosinophils in induced sputum than did patients with normal FEF_25-75% (p < 0.01 and p < 0.01, respectively). Subjects with abnormal FEF_25-75% had an increased probability of being BHR positive (OR = 13.38; 95% CI: 6.7-26.7; p < 0.001). Conclusions: Our data show that abnormal FEF_25-75% might be considered an early marker of airflow limitation associated with eosinophilic inflammation and BHR in subjects with asthma-like symptoms, indicating a role for FEF_25-75% as a predictive marker of newly diagnosed asthma.

The risk of respiratory symptoms on allergen exposure increases with increasing specific IgE levels.

The relation between IgE sensitization and allergic respiratory symptoms has usually been evaluated by dichotomizing specific IgE levels. The aim of this study was to evaluate the association between specific IgE levels and risk of symptoms on allergen-related exposure, with special reference to allergen-related asthma-rhinitis comorbidity. We considered 6391 subjects enrolled within the European Community Respiratory Health Survey 2, having information on cat/grass/D. pteronyssinus IgE levels and symptoms on exposure to animals/pollen/dust. The risk of oculonasal/asthmalike/both symptoms was evaluated by a multinomial logistic model. A clear positive association was observed between specific IgE levels to cat/grass/mite and the risk of symptoms on each allergen-related exposure (test for trend with P < 0.001). This trend was particularly pronounced when considering the coexistence of asthmalike and oculonasal symptoms. Compared to non-sensitized subjects, subjects with specific IgE to cat >= 3.5 kU/l presented relative risk ratios of 11.4 (95% CI 6.7-19.2), 18.8 (8.2-42.8), and 55.3 (30.5-100.2) when considering, respectively, only oculonasal symptoms, only asthmalike symptoms, or both. A similar pattern was observed when considering specific IgE to grass/mite and symptoms on exposure to pollen/dust. Also the proportion of people using inhaled medicines or visiting a general practitioner for breathing problems in the previous year increased with increasing sum of specific IgE to cat/grass/mite. Specific IgE level is the most important predictor of allergen-related symptoms. The risk of both oculonasal/asthmalike symptoms increases with specific IgE levels, suggesting that specific IgE contributes to the 'united airways disease'.

Reversible airway obstruction in cystic fibrosis: Common, but not associated with characteristics of asthma

BackgroundAs asthma-like symptoms are common in CF, we evaluated reversible airway obstruction and associated characteristics. MethodsRetrospective analysis of charts including spirometry and bronchodilator response. ResultsOf 190 CF patients (103 at Schneider's, 87 at Hadassah), aged 14.4 (4–76) years, median (range), 39% had reversible obstruction (ΔFEV1% predicted ≥12%), associated with younger age (p=0.01) and severe genotype (p=0.02). There was no association with family history of asthma, serum IgE, blood eosinophils, pancreatic status, FEV1<40% predicted, Aspergillus or pseudomonas infection. Of patients with reversible obstruction, 74% were on bronchodilator and 68% on inhaled corticosteroid therapy but 54% and 57% respectively receiving these therapies did not have reversible obstruction. ConclusionsReversible airway obstruction is common in CF, more frequent in younger patients and with severe genotype, with no correlation to markers of atopy or CF clinical severity. Bronchodilator and inhaled corticosteroid therapies are commonly prescribed even without reversible obstruction.

Exploration of the effects of classroom humidity levels on teachers' respiratory symptoms.

Previous studies indicate that teachers have higher asthma prevalence than other non-industrial worker groups. Schools frequently have trouble maintaining indoor relative humidity (RH) within the optimum range (30-50%) for reducing allergens and irritants. However, the potential relationship between classroom humidity and teachers' health has not been explored. Thus, we examined the relationship between classroom humidity levels and respiratory symptoms among North Carolina teachers. Teachers (n=122) recorded daily symptoms, while data-logging hygrometers recorded classroom RH levels in ten North Carolina schools. We examined effects of indoor humidity on occurrence of symptoms using modified Poisson regression models for correlated binary data. The risk of asthma-like symptoms among teachers with classroom RH >50% for 5days was 1.27 (95% Confidence Interval (CI)0.81, 2.00) times the risk among the referent (teachers with classroom RH 30-50%). The risk of cold/allergy symptoms among teachers with classroom RH >50% for 5days was 1.06 (95% CI0.82, 1.37) times the risk among the referent. Low RH (<30%) for 5days was associated with increased risk of asthma-like [risk ratio (RR) = 1.26 (95% CI0.73, 2.17)] and cold/allergy symptoms [RR = 1.11 (95% CI0.90, 1.37)]. Our findings suggest that prolonged exposure to high or low classroom RH was associated with modest (but not statistically significant) increases in the risk of respiratory symptoms among teachers.

Obesity and asthma: co-morbidity or causal relationship?

There is substantial evidence that obesity and asthma are related. "Obese asthma" may be a unique phenotype of asthma, characterized by decreased lung volumes, greater symptoms for a given degree of lung function impairment, destabilization or lack of asthma control, lack of eosinophilic inflammation and a different response to controller medication. Whether this relationship between obesity and asthma is causal or represents co-morbidity due to other factors is unclear. In previous reviews concerning the relationship between obesity and asthma, five hypotheses were put forth. One of these hypotheses is that a low grade systemic inflammation caused by adipokines from the fat tissue causes or enhances bronchial inflammation. In animal models, there is an increasing amount of evidence for the role of adipokines derived from fat tissue in the relationship between obesity and asthma. The data are conflicting in humans. Since obesity is a component of the metabolic syndrome and the metabolic syndrome is also a form of systemic inflammation, it is to be expected that there is a relationship between metabolic syndrome and asthma. The few data that are available show that there is no relationship between metabolic syndrome and asthma, but there is one between the metabolic syndrome and asthma-like symptoms. Further research is needed to confirm the relationship between obesity and asthma in humans, where a rigorous approach in the diagnosis of asthma is essential.

Asthma-like symptoms, diagnostic tests, and asthma medication use in children and adolescents: a population-based nationwide survey

Objective: This study aimed to estimate the prevalence of asthma-like symptoms, current asthma (CA), asthma diagnostic tests, and inhaled medication use in a nationwide pediatric population (<18 years). Methods: Pediatric-specific data from a cross-sectional, population-based telephone survey (INAsma study) in Portugal were analyzed. CA was defined as lifetime asthma and (1) wheezing, (2) waking with breathlessness, or (3) asthma attack in the previous 12 months, and/or (4) taking asthma medication at the time of the interview. Results: In total, 716 children were included. The prevalence of asthma-like symptoms was 39.4% [95% confidence interval (95% CI): 35.7–43.3]. The most common symptoms were waking with cough (30.9%) and wheezing (19.1%). The prevalence of CA was 8.4% (95% CI: 6.6–10.7). Among children with CA, 79.9% and 52.9% reported prior allergy testing and pulmonary function testing (PFT), respectively. Inhaled medication use in the previous 12 months was reported by 67.6% (reliever inhalers, 40.1%; controller inhalers, 41.5%). Those who only used inhaled reliever medications experienced more asthma attacks [odds ratio (OR): 2.69]. Significantly fewer children with CA living in rural areas than those living in urban areas had undergone PFT or used inhaled medication (OR: 0.06 for PFT, 0.20 for medication]. Conclusions: The prevalence of CA in the Portuguese pediatric population was 8.4%. Only half of children with CA had ever undergone PFT; more than half did not use controller inhalers, and those who only used reliever inhalers reported more asthma attacks. These findings suggest that asthma management has been substandard, mainly in rural areas.

Systemic inflammation and higher perception of dyspnea mimicking asthma in obese subjects

There are a variable number of obese subjects with self-reported diagnosis of asthma but without current or previous evidence of airflow limitation, bronchial reversibility, or airway hyperresponsiveness (misdiagnosed asthma). However, the mechanisms of asthma-like symptoms in obesity remain unclear. We sought to evaluate the perception of dyspnea during bronchial challenge and exercise testing in obese patients with asthma and misdiagnosed asthma compared with obese control subjects to identify the mechanisms of asthma-like symptoms in obesity. In a cross-sectional study we included obese subjects with asthma (n = 25), misdiagnosed asthma (n = 23), and no asthma or respiratory symptoms (n = 27). Spirometry, lung volumes, exhaled nitric oxide levels, and systemic biomarker levels were measured. Dyspnea scores during adenosine bronchial challenge and incremental exercise testing were obtained. During bronchial challenge, patients with asthma or misdiagnosed asthma reached a higher Borg-FEV1 slope than control subjects. Moreover, maximum dyspnea and the Borg-oxygen uptake (V'O2) slope were significantly greater during exercise in subjects with asthma or misdiagnosed asthma than in control subjects. The maximum dyspnea achieved during bronchial challenge correlated with IL-1β levels, whereas peak respiratory frequency, ventilatory equivalent for CO2, and IL-6 and IL-1β levels were independent predictors of the Borg-V'O2 slope during exercise (r(2) = 0.853, P < .001). A false diagnosis of asthma (misdiagnosed asthma) in obese subjects is attributable to an increased perception of dyspnea, which, during exercise, is mainly associated with systemic inflammation and excessive ventilation for metabolic demands.

Epidemiology of bronchial asthma in school children (10-16 years) in Srinagar.

Objectives:To assess the epidemiological profile of asthma in school going children in Srinagar, Kashmir.Study design:Cross-sectional study.Setting:Thirty-one schools with proportionate representation from both government and private schools as well as from primary, middle, and high schools.Participants:School children aged 10–16 years with equal representation of sex and all ages.Main Outcome Measure:Prevalence of current and past asthma.Methods and Results:After administering a modified pretested questionnaire, peak expiratory flow measurement was carried. Children who had asthma-like symptoms or positive family history of asthma or physician-labeled asthma were subjected to spirometry and bronchodilator reversibility. Out of 806 children, bronchial asthma was seen in 60 (prevalence of 7.4%) which included 34 boys and 26 girls. Majority of asthmatic children (78.3% [n = 47]) had probable asthma; 6.7% (n = 4) had definite asthma; and 15% (n = 9) had physician-diagnosed asthma. Majority of children had intermittent asthma (78.3% [n = 47]). Mild persistent asthma was seen in 12.7% (n = 7) and 10% (n = 6) had moderate persistent asthma. None of the children had severe persistent asthma. The prevalence of current asthma was 3.2% (n = 26). On univariate analysis, the factors found to be statistically significant were family history of asthma (odds ratio [OR] =8.174; confidence interval [CI] =4.403–15.178), seasonal cough (OR = 4.266; CI = 2.336–7.791), allergic rhinitis (OR = 2.877; CI = 1.414–5.852), atopic dermatitis (OR = 6.597; CI = 2.72–16.004), and obesity (OR = 6.074; CI = 2.308–18.034). On multivariate analysis, family history, seasonal cough, allergic rhinitis, atopic dermatitis, and obesity were found to be significant independent risk factors.Conclusions:Srinagar qualifies as a low prevalence area for bronchial asthma in the age group of 10–16 years. Majority of children had mild intermittent asthma resulting in under diagnosis and wrong treatment.

Meta-analysis of the prevalence of asthma-like symptoms and asthma in Russia (according to the results of ISAAC)

The representative data of the results of epidemiological surveys (the International Study of Asthma and Allergies in Childhood, ISAAC) were selected during a meta-analysis of the 1994–2013 published investigations estimating the prevalence of asthmalike and asthma among 7–8- and 13–14‑year-old children in Russia. Phase I ISAAC was conducted in 1993 to 2000, which covered 96241 schoolchildren (57185 children aged 13–14 years and 39056 ones aged 7–8 years) from 17 regional centers of Russia. The prevalence of asthma-like symptoms in Russia in 1993–2000 in both groups was comparable with the worldwide average and northeast European rates. According to the results of Phase II ISAAC, the prevalence of asthma in Russia averaged 5,3% in 13–14‑year-old adolescents and 4,7% in 7–8‑year-old first formers. Phase III ISAAC was performed in 2001 to 2008. Group 3A included studies done in the Novosibirsk center only. Over 6 years, the old age group showed a steady-state trend for an annual increment in asthma-like symptoms, such as severe attacks with speaking-related dyspnea by 0,15% per year, as well as nocturnal cough by 0,42% per year. The parents of the first formers more frequently reported that their children were diagnosed with asthma (an annual increase of 0,15%). Both age groups displayed average annual reductions of 0,5 and 0,37% in bronchospasm symptoms in response to exercise. Based on the results of Phase 3B study, it is pertinent to note that there is a slight change in the prevalence of asthma-like symptoms and asthma in Russia’s children in the past 20 years.

Epidemiology and Prevention of Allergy in Children

In this paper we present 94 children affected with atopic dermatitis (AD), aggravated by respiratory allergy, asthma and/or allergic rhinitis (AR). AD is a common disorder, frequently complicated by asthma-like symptoms, we debate either disorder and conclude that both AR and asthma can afflict most babies with AD, especially when both parents smoke. We confirm our previous statistics, according to which little children not fed breast milk may react to smallest doses of allergens.

Storage, handling, and potential health risks of household cleaning substances in Sulaimani City, Iraq

Background: Household cleaning substances are complex mixtures of chemicals including acidic and basic compounds; these products are of potential health hazards and vary widely in their toxic potential. Acids cause more caustic burns than alkalis, and the damage is worse in cases of intentional ingestion. Objective: To investigate indoor threats of household cleaning substances in Sulaimani city and to observe safety measurement, storage, and ventilation status of those substances used by the women in the area. Materials and Methods: A prospective descriptive study was carried out between February and April 2015 on 40 women who were responsible for cleaning chores in their households in Sulaimani city. Two research tools were used for conducting this study; first, a questionnaire based on the previous studies was developed as required by the study design. The second tool is a checklist prepared to inspect the labels of the household cleaning substance. Result: The result of this study showed that all participants were using more than one type of cleaning substance. A total 42% of the participants did not store household cleaners out of children’s reach and 90% of them had no locked storage spaces. Most of the women disposed the unused cleaning substances in the toilet; moreover, the study showed that 38% of respondents did not use household cleaners in a ventilated area, 72% did not use personal protective equipment, 95% of respondents mixed different types of household cleaners, and 88% did not read the instruction labels that were written on the containers. Other findings of the study revealed that 8% of respondents experienced accidental poisoning and 88%, 48%, 42%, and 10% experienced asthma-like symptoms; ear, nose, and throat irritation; skin problems; and nasal congestion, respectively. Conclusion: This study concluded that handling, utilization, and storage of household cleaning products by women in Sulaimani city were improper, which, consequently, resulted in many severe clinical harmful effects.

Airway hyperreactivity is frequent in non-asthmatic children with sickle cell disease.

Asthma is associated with poorer outcomes in sickle cell disease (SCD). Whether AHR can exist in SCD as a distinct entity, separate and independent of asthma, is unknown. Our goal was to elucidate the prevalence of AHR, as measured by a methacholine challenge test (MCT), in children with SCD who did not have concomitant asthma or any recent history of acute chest syndrome (ACS). To determine if AHR was associated with asthma-like symptoms, we compared the results of the MCT to a validated asthma questionnaire. We also examined if a correlation between AHR and inflammatory markers exists. AHR was identified with a positive MCT defined as a provocation concentration (PC20 ) < 4 mg/ml. The children and/or their parents completed the ISAAC (International Study of Asthma and Allergies in Children) questionnaire. We obtained blood, urine, and exhaled breath condensate samples. We measured cysteinyl leukotriene levels in urine and exhaled breath condensate via enzyme immunoassay. Twenty-nine of forty children (72.5%) had a positive MCT. Nine (31.0%) also reported asthma-like symptoms on questionnaire. Inflammatory markers did not correlate with AHR. Among MCT positive subjects, those on hydroxyurea had significantly less severe AHR as quantified by PC20 (P = 0.014). In children with SCD, there is a high prevalence of AHR that is not associated with asthma-like symptoms. AHR may be a distinct entity in children with SCD, existing in the absence of concomitant asthma. Hydroxyurea therapy might lessen the severity of AHR in affected individuals. Pediatr Pulmonol. 2016; 51:950-957. © 2015 Wiley Periodicals, Inc.

Azithromycin for episodes with asthma-like symptoms in young children aged 1–3 years: a randomised, double-blind, placebo-controlled trial

SummaryBackgroundBacteria and viruses are equally associated with the risk of acute episodes of asthma-like symptoms in young children, suggesting antibiotics as a potential treatment for such episodes. We aimed to assess the effect of azithromycin on the duration of respiratory episodes in young children with recurrent asthma-like symptoms, hypothesising that it reduces the duration of the symptomatic period.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited children aged 1–3 years, who were diagnosed with recurrent asthma-like symptoms from the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort; a birth cohort consisting of the general Danish population of Zealand, including Copenhagen. Exclusion criteria were macrolide allergy, heart, liver, neurological, and kidney disease, and, before each treatment, one or more clinical signs of pneumonia (respiratory frequency of ≥50 breaths per min; fever of ≥39°C; C-reactive protein concentration of ≥476·20 nmol/L [≥50 mg/L]). Each episode of asthma-like symptoms lasting at least 3 days was randomly allocated to a 3-day course of azithromycin oral solution of 10 mg/kg per day or placebo after thorough examination by a study physician at the Copenhagen Prospective Studies on Asthma research unit. Each episode was randomly allocated independently of previous treatment from a computer-generated list of random numbers in blocks of ten (generated at the Pharmacy of Glostrup). Investigators and children were masked until the youngest child turned 3 years of age and throughout the data validation and analysis phases. The primary outcome was duration of the respiratory episode after treatment, verified by prospective daily diaries and analysed with Poisson regression. Analyses were per protocol (excluding those without a primary outcome measure or who did not receive treatment). This trial is registered with ClinicalTrials.gov, number NCT01233297.FindingsBetween Nov 17, 2010, and Jan 28, 2014, we randomly allocated 158 asthma-like episodes in 72 children (79 [50%] to azithromycin and 79 [50%] to placebo). The mean duration of the episode after treatment was 3·4 days for children receiving azithromycin compared with 7·7 days for children receiving placebo. Azithromycin caused a significant shortening of the episode of 63·3% (95% CI 56·0–69·3; p<0·0001). The effect size increased with early initiation of treatment, showing a reduction in episode duration of 83% if treatment was initiated before day 6 of the episode compared with 36% if initiated on or after day 6 (p<0·0001). We noted no differences in clinical adverse events between the azithromycin (18 [23%] of 78 episodes included in final analysis) and placebo (24 [30%] of 79) groups (p=0·30), but we did not investigate bacterial resistance patterns after treatment.InterpretationAzithromycin reduced the duration of episodes of asthma-like symptoms in young children, suggesting that this drug could have a role in acute management of exacerbations. Further research is needed to disentangle the inflammatory versus antimicrobial aspects of this relation.FundingLundbeck Foundation, Danish Ministry of Health, Danish Council for Strategic Research, Capital Region Research Foundation.

Geo-climatic heterogeneity in self-reported asthma, allergic rhinitis and chronic bronchitis in Italy

BackgroundSeveral studies highlighted a great variability, both between and within countries, in the prevalence of asthma and chronic airways diseases. AimTo evaluate if geo-climatic variations can explain the heterogeneity in the prevalence of asthma and respiratory diseases in Italy. MethodsBetween 2006 and 2010, a postal screening questionnaire on respiratory health was administered to 18,357 randomly selected subjects, aged 20–44, living in 7 centers in northern, central, and southern Italy. A random-effects meta-analysis was fitted to evaluate the between-centers heterogeneity in the prevalence of asthma, asthma-like symptoms, allergic rhinitis, and chronic bronchitis (CB). A principal component analysis (PCA) was performed to synthetize the geo-climatic information (annual mean temperature, range of temperature, annual rainfalls, global solar radiations, altitude, distance from the sea) of all the 110 Italian province capital towns. The associations between these geo-climatic components obtained with PCA and the prevalence of respiratory diseases were analyzed through meta-regression models. Results10,464 (57%) subjects responded to the questionnaire. There was a significant between-centers heterogeneity in the prevalence of asthma (I2=59.5%, p=0.022) and CB (I2=60.5%, p=0.019), but not in that of asthma-like symptoms or allergic rhinitis. Two independent geo-climatic components explaining together about 80% of the overall geo-climatic variability were identified: the first principally summarized the climatic variables; the second the topographic ones. Variations in the prevalence of asthma across centers were significantly associated with differences in the climatic component (p=0.017), but not with differences in the topographic one. ConclusionsOur findings suggest that climate play a role in determining the between-center heterogeneity in the prevalence of asthma in Italy, with higher prevalence in dry-hot Mediterranean climates, and lower in rainy-cold northern climates.

"Health consequences associated with frequent wheezing in adolescents without asthma diagnosis." K. Yeatts, K. Johnston Davis, D. Peden and C. Shy. Eur Respir J 2003; 22: 781-786.

Statement from the editor : In November 2003, the European Respiratory Journal published an article entitled “Health consequences associated with frequent wheezing in adolescents without asthma diagnosis” [1]. It was subsequently brought to our attention that another article by two of the same authors, “Health consequences for children with undiagnosed asthma-like symptoms,” had been published in the Archives of Pediatric and Adolescent Medicine (now JAMA Pediatrics ) [2]; the National Library of Medicine has decided that these two articles represent duplicate publication, and both articles have …

A Case with Reactive Airway Dysfunction Syndrome Accompanied by Non-Cardiogenic Pulmonary Edema

Reactive airway dysfunction syndrome (RADS) is a disease that causes bronchial hyper-reactivity with asthma-like symptoms within 24 hours, and it causes high-level irritant exposure in patients who did not have any previous lung disease. In general, the patient’s radiological findings are normal, although some changes are often seen. Pulmonary edema is rarely seen radiologically. In a 43-year-old female patient’s thorax computed tomography (CT) scan after the inhalation of a mixture of hydrochloric acid and sodium hypochloride, ground glass opacities, which implies bilaterally pulmonary edema, are detected. This case is presented because RADS is rarely accompanied by pulmonary edema.

Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm.

BackgroundThis study aims to evaluate the children with chronic cough and to analyze their etiological factors according to the age groups.MethodFive hundred sixty-three children with chronic cough were included. The last diagnosis were established and were also emphasized according to the age groups.ResultsThe mean age was 5.4 ± 3.8 years (2-months–17-years) and 52 % of them were male. The most common final diagnosis from all the participants were: asthma (24.9 %), asthma-like symptoms (19 %), protracted bacterial bronchitis (PBB) (11.9 %), and upper airway cough syndrome (9.1 %). However, psychogenic cough was the second most common diagnosis in the subjects over 6 years of age.ConclusionAsthma and asthma-like symptoms were the most common diagnosis in children. Different age groups in children may have a different order of frequencies. Psychogenic cough should be thought of in the common causes especially in older children.

Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper.

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.

Asthma-like symptoms in homeless children in the Greater Paris area in 2013

Asthma-like symptoms in homeless children in the Greater Paris area in 2013