History Of Recurrent Wheezing Research Articles

Beyond the Skin: Reduced Lung Function Associated With Atopic Dermatitis in Infants.

Very few studies have examined lung function parameters using tidal breath analysis (TBA) in atopic dermatitis (AD) with its high potential for progression to asthma. To measure lung functions using TBA in infants with AD and in healthy controls (HCs), and to investigate the effects of disease severity, food sensitivity, and history of recurrent wheezing on TBA parameters in infants with AD. Two hundred thirty infants were included in this prospective cross-sectional study, including an AD group (n= 150) and an HC group (n= 80). Food sensitivity was assessed by means of food-specific IgE or the skin prick test. The severity of the disease was evaluated using the SCORing Atopic Dermatitis. Lung function was assessed using TBA. The following TBA parameters were significantly lower in the AD group than in the HC group (P < .05): time to peak tidal expiratory flow, exhaled volume to peak tidal expiratory flow, ratio of time to peak tidal expiratory flow to expiratory time, ratio of exhaled volume to peak tidal expiratory flow to total expiratory volume, expiratory flow when 25% of tidal volume remains in the lungs, respiratory rate, and minute ventilation. No difference was observed in the AD group when TBA parameters were compared according to disease severity, food sensitivity, and history of recurrent wheezing (P > .05). The receiver-operating characteristic curve demonstrated by the ratio of time to peak tidal expiratory flow to expiratory time yielded an area under the curve of 0.826 (CI, 0.772-0.879), with a cutoff value of 31.65 or higher in differentiating AD, with a sensitivity of 78.7% and a specificity of 77.5%. TBA curves can be a useful tool for demonstrating expiratory airway obstruction in AD and for providing objective information for the clinician. Bronchial obstruction was detected in young children with AD irrespective of the severity of the disease, food sensitivity, and history of recurrent wheezing.

Clinical characteristics and differential cytokine expression in hospitalized Taiwanese children with respiratory syncytial virus and rhinovirus bronchiolitis.

Viral bronchiolitis presents a heterogeneous spectrum. In this study, we investigated the clinical characteristics and the cytokines/chemokines profiles among respiratory syncytial virus (RSV), rhinovirus (RV), and their dual infection in Taiwanese children with viral bronchiolitis. This study was conducted between October 2014 and June 2017. Viral etiology was identified using a Luminex respiratory virus panel and blood cytokines were evaluated using a MILLIPLEX MAP Human Cytokine/Chemokine Panel. Cytokine/Chemokine expressions were compared by clinical severity, steroid treatment, and viral entities. A total of 184 patients were evaluated; at least one respiratory virus was identified in 163 (88.6%) patients. RSV and RV were the two leading viral etiologies, with 25.5% and 17.3%, respectively. RV bronchiolitis has a comparable severity to RSV but is more common in children of an older age with a history of recurrent wheezing and blood eosinophilia. Decreased tumor necrosis factor-alpha (TNF-α) and interferon gamma (INF-γ) levels were correlated with clinical severity. Patients infected with RV exhibited higher levels of Interleukin (IL)-22, IL-23, IL-25, IL-31, and IL-33 (p<0.05), whereas those with RSV had higher levels of TNF-α, INF-γ, and IL-10 (p<0.05). Systemic steroid treatment was associated with higher expressions of IL-4, IL-8, IL-13, and MIP-1α levels (p<0.05). Cluster analysis revealed a high correlation of IL-33 and IL-31(R2=0.9731, p<0.0001). Different viral infections elicited the characteristic clinical presentation and immune profiles in bronchiolitis. Our findings also highlight the role of the IL-33/IL-31 axis in the immunopathogenesis of bronchiolitis.

Lung lavage inflammatory patterns and pathogen profiles in preschool children with problematic wheeze

Practicing clinicians regularly encounter the preschool child with intermittent episodes of wheeze. Preschool wheezing episodes account for a large burden of unscheduled ambulatory care visits and hospitalizations across the globe. Recurrent episodes of acute wheeze are often referred to as “problematic.” However, guidelines to treat these children are not based on solid evidence. There are few clinical trials applicable to real-world practice to direct treatment of problematic wheeze. 1 Bacharier LB Guilbert TW Mauger DT Boehmer S Beigelman A Fitzpatrick AM et al. Early administration of azithromycin and prevention of severe lower respiratory tract illnesses in preschool children with a history of such illnesses: a randomized clinical trial. JAMA. 2015; 314: 2034-2044 Crossref PubMed Scopus (193) Google Scholar , 2 Fitzpatrick AM Jackson DJ Mauger DT Boehmer SJ Phipatanakul W Sheehan WJ et al. Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol. 2016; 138 (1608-1618.e12) Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar , 3 Wallace A Sinclair O Shepherd M Neutze J Trenholme A Tan E et al. Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial. Arch Dis Child. 2021; 106: 339-344 Crossref PubMed Scopus (4) Google Scholar A helpful study by Bacharier et al 1 Bacharier LB Guilbert TW Mauger DT Boehmer S Beigelman A Fitzpatrick AM et al. Early administration of azithromycin and prevention of severe lower respiratory tract illnesses in preschool children with a history of such illnesses: a randomized clinical trial. JAMA. 2015; 314: 2034-2044 Crossref PubMed Scopus (193) Google Scholar found that a burst of azithromycin given early during an episode of virus-triggered wheeze in preschool children with a history of recurrent wheeze was effective in preventing the progression of symptoms. Azithromycin treatment was effective in not only the first but subsequent wheeze episodes over 1 year. Although guidelines on the management of preschool wheeze have been published, inconsistencies prevail as to the endorsement of azithromycin to treat acute exacerbations.

Food-induced anaphylaxis in infants, as compared to toddlers and preschool children in Turkey.

The literature includes scarce data on infants with food-induced anaphylaxis (FIA). Medical records of the patients diagnosed with FIA aged 0-6years between 2015 and 2020 were retrospectively analyzed. During the study period, there were 451 instances of FIA in 314 patients, of which 175 (38.8%) occurred in 160 infants (50.9%). The median (IQR) age of infants was 7 months (6-9 months) with a male predominance (67.5%), of which 7.5% had multiple instances (≥2) and 60% atopic dermatitis. The most common triggers were cow's milk (51.4%), tree nuts (16.6%), and hen's egg (15.4%), whereas tree nut was the most common trigger in toddlers (35.8%) and preschool children (35.2%). Skin and neurologic symptoms, and nausea-vomiting occurred more frequently (P=.003, P≤.001, and P=.003, respectively), whereas respiratory symptoms occurred less commonly in infants compared to toddlers and preschool children (P≤.001). In infants, 65 (37.1%) mild, 92 (52.6 %) moderate, and 18 (10.3%) severe episodes of anaphylaxis were detected. History of recurrent wheezing (OR: 6.837 [95% CI: 1.940-24.097], P=.003) and tree nut allergy (OR: 2.849 [95% CI: 1.056-7.688], P=.039) were found to be independent risk factors for moderate-to-severe anaphylactic reactions. 40.6% of the infants receivedadrenaline, which was lower than the toddlers (49.7%) and preschool children (57.6%) (P=.005). There is no doubt thatfood-induced anaphylaxis is a medical emergency, specifically in young children. Pediatricians should be aware of the distinct features of infant anaphylaxis, particularly gastrointestinal and neurologic symptoms to provide effective treatment as soon as possible.

A randomized, placebo-controlled, double-blinded, single-centre, phase IV trial to assess the efficacy and safety of OM-85 in children suffering from recurrent respiratory tract infections

BackgroundOver many years, OM-85, a lysate of 21 common bacterial respiratory pathogens, has been demonstrated to prevent respiratory recurrences in children. However, further studies are needed to explore the true importance of OM-85 in the prevention of respiratory tract infections (RTIs) in children. This study was planned to further contribute to the evaluation of the role played by OM-85 in prevention of recurrent RTIs in children.MethodsThis study was a randomized (3:3:1), placebo-controlled, double-blind, single-centre, phase IV trial carried out in Italy to assess the efficacy of OM-85 (Broncho-Vaxom®; Vifor Pharma; Meyrin 2/Geneva, Switzerland) in reducing the number of new RTI episodes in 288 children aged 1 to 6 years with a history of recurrent RTIs and to compare the efficacy of the standard 3-month regimen with that of administration of OM-85 for 6 months during a 6-month study period.ResultsThe number of RTIs and of children who experienced at least one RTI were significantly lower among patients receiving OM-85 for 3 months than among those given placebo (33% vs 65.1%, p < 0.0001). Differences were statistically significant for upper RTIs (i.e., common cold/viral pharyngitis and acute otitis media; p < 0.0001 and p = 0.006, respectively). Days of absence from day-care for children and working days lost by parents were significantly lower in the group with children treated with OM-85 for 3 months than in the placebo group (p = 0.007 and p = 0.004, respectively). No difference was seen between children who received OM-85 for 3 and those who received OM-85 for 6 months. The prevalence of atopy as well as the history of recurrent wheezing and age of the study child did not influence the results. Benefit was maximally evident among children with a history of frequent recurrences. OM-85 was well tolerated and safe, even in children who received an influenza vaccination.ConclusionsThe use of OM-85 for 3 months in 3 series of 10 consecutive days each time reduces the risk of recurrent RTIs in children, with a favourable safety profile. The greater effect observed in children prone to several respiratory episodes than in non-prone children seems to indicate that this lysate should be administered especially to children with a proven high susceptibility to RTIs.

Live attenuated influenza vaccine use and safety in children and adults with asthma

BackgroundLive attenuated influenza vaccine (LAIV) might increase the risk of wheezing in persons with asthma or children younger than 5 years with a history of recurrent wheezing. ObjectiveTo describe the use and assess the safety of LAIV in persons with asthma in the Vaccine Safety Datalink population. MethodsWe identified persons with asthma using diagnosis codes and medication records in 7 health care organizations over 3 influenza seasons (2008–2009 through 2010–2011) and determined their influenza vaccination rates. Using the self-controlled risk interval method, we calculated the incidence rate ratio of medically attended respiratory events in the 14 days after LAIV compared with 29 to 42 days after vaccination in persons 2 through 49 years old. ResultsIn our population of 6.3 million, asthma prevalence was 5.9%. Of persons with asthma, approximately 50% received any influenza vaccine but less than 1% received LAIV. The safety study included 12,354 LAIV doses (75% in children; 93% in those with intermittent or mild persistent asthma). The incidence rate ratio for inpatient and emergency department visits for lower respiratory events (including asthma exacerbation and wheezing) was 0.98 (95% confidence interval 0.63–1.51) and the incidence rate ratio for upper respiratory events was 0.94 (95% confidence interval 0.48–1.86). The risk of lower respiratory events was similar for intermittent and mild persistent asthma, across age groups, and for seasonal trivalent LAIV and 2009 H1N1 pandemic monovalent LAIV. ConclusionLAIV use in asthma was mostly in persons with intermittent or mild persistent asthma. LAIV was not associated with an increased risk of medically attended respiratory adverse events.

First Cluster of Acute Flaccid Myelitis Related to Enterovirus D-68 in Argentinean Children

BackgroundAcute flaccid Myelitis(AFM) related to enterovirus D68(EVD68) has been reported as sporadic cases worldwide since the outbreak of respiratory illness in USA in 2014. Objective: To describe the first cluster of AFM by EVD68 in Argentina.Methodsprospective-observational study in children admitted to Hospital de Niños “Ricardo Gutiérrez” by Acute Flaccid Paralysis(AFP) from April-August 2016. AFM was defined as AFP with MRI lesions affecting the gray matter of the spinal cord as defined by CDC. RT-PCR was used to identify EVD68 in NPS, CSF, stool samplesResultsNineteen children were admitted by AFP. Six confirmed as AFM: age 40(±22.6) months; 66% female, 50% had history of recurrent wheezing. Prodrome: 100% Upper Respiratory Tract Infection(URTI); 4/6(66%) fever; 1/6(16%) vomiting and abdominal pain. Neurological symptoms appeared 5.2(±6) days after prodrome. All children had acute progressive asymmetric limbs weakness, areflexia, intact sensitivity and severe muscles pain; 5/6(83%) had neck muscles weakness; 3/6(50%) had severe respiratory failure: 2 mechanical ventilation and 1 noninvasive ventilatory assistance; 3/6(50%) needed feeding support; 2/6(33.3%) had cranial nerve dysfunction. None had cognitive disability. CFS findings: 5/6 mononuclear pleocytosis; 2/6 increase of proteins and 1/6 albuminocytological dissociation. Spinal cord lesions in MRI was observed in all patients. EMG showed early signs of denervation and low motor neuron in 5/5 patient. Virology: enterovirus could be identified by RT-nested – PCR and genomic sequencing from nasopharyngeal-swab in 5/6(83%); 4/5 typified as EVD68, in 1/5 viral charge was low for typing. Stool samples: EVD68 was identified in 2/6(33%). CSF samples were negative. Treatment: IV immunoglobulin 5/6(83%) patient; 2/6(33%) systemic corticosteroids; 3/6(50%) required ICU admission. All patients had neurologic motor sequelae; 2/6 remain with chronical ventilatory assistance after 6 months of follow-up. None patient dye.Conclusionthis is the first cluster reported from South America and support evidence for the association of EVD68 and AFM in children.Disclosures All authors: No reported disclosures.

Novel Mutation of Interferon-γ Receptor 1 Gene Presenting as Early Life Mycobacterial Bronchial Disease.

Mendelian susceptibility to mycobacterial diseases (MSMD) are a spectrum of inherited disorders characterized by localized or disseminated infections caused by atypical mycobacteria. Interferon-γ receptor 1 (IFNGR1) deficiency was the first identified genetic disorder recognized as MSMD. Mutations in the genes encoding IFNGR1 can be recessive or dominant and cause complete or partial receptor deficiency. We present the case of a 2½-year-old boy with a history of recurrent wheezing, diagnosed with endobronchial mycobacterial infection. Immunological workup revealed a homozygous nonsense mutation in the IFNGR1 gene, a novel mutation predicted in silico to cause complete IFNGR1 deficiency. This case demonstrates that (a) Interferon-γ receptor deficiency can present resembling common disorders of the lung; (b) mycobacterial infections should be suspected when parenchymal lung disease, hilar lymphadenopathy, and endobronchial disease are present; and (c) high index of suspicion for immunodeficiency should be maintained in patients with disseminated nontubercular mycobacterial infection.

Bronchodilator response in wheezing infants assessed by the raised volume rapid thoracic compression technique

BackgroundBronchodilator response (BDR) analyzed by the raised volume rapid thoracic compression (RVRTC) in wheezing infants is not yet well described, although bronchodilators (BD) are routine in the treatment of this population. ObjectiveTo evaluate BDR by RVRTC technique in infants with recurrent wheezing and compare to control group. MethodCross sectional study, 45 infants, age 56 weeks (38–67 weeks). Two groups: wheezing group (WG: history of recurrent wheezing) and control group (CG). RVRTC was evaluated, FVC, FEV0.5, FEF50, FEF75, FEF85, FEF25–75 were measured. Salbutamol was delivered to infants and RVRTC evaluated again. BDR was determined by the increase greater than two standard deviation from the mean change in the CG. ResultsIn WG (n = 32) lung function was worse than in CG (n = 13): FEV0.5: 0.0(−0.9–0.9z score) vs 0.8(0.2–1.4z score); FEF50: 0.2(−0.3–1.1z score) vs 0.9(0.5–1.4z score); and FEF25–75: 0.2(−0.5–1.1z score) vs 1.1(0.6–1.6z score), respectively, p < 0.05. Both groups had similar increase after BD. In WG 11 patients (34%) were responder and these had worse lung function compared to nonresponder (n = 21) (p < 0.05). The increase in lung function after BD in responder was higher than in nonresponder: FEV0.5: 6.5(2.1–7.1%) vs −0.5(−2.5–0.7%), FEF50: 5.1(2.7–11.7%) vs 0.4(−1.1–2.8%), FEF75: 20.7(4.7–23.6%) vs −1.3(−6.4–3.9%), FEF25–75: 9.9(3.8–16.4%) vs 0.0(−1.5–1.0%), respectively, p < 0.05. Conclusion34% WG showed BDR measured by the RVRTC. The best variables to detect BDR were FEF75, FEF25–75 and FEV0.5. Patients with worse lung function showed better response to BD.

Risk Factors of Transient Early Wheezing in Infants below 2 years in Fayoum City

The three different phenotypes of wheezing in infants and children are transient early wheezing, non-atopic preschool wheezing and atopic or asthmatic wheezing. Early transient wheezers suffer from wheezing only during the first two years of life due to small airways caliber being more likely to narrow and obstruct. The main phenomena are the absence of personal history and/or family of atopy, so they are born with lung deficiency. Transient early wheezing to represent about 60% among children. There are many risk factors, which predispose to transient early wheezing such as: maternal complications during pregnancy, type of delivery, type of feeding during infancy, overweight infants, passive smoking and day care attendance during infancy. The previous risk factors were studied well in many developed countries but not in our communities including Egypt. Study these risk factors among infants between two months and two years of age and this is the first study done for this common problem among Egyptian children. The study included 160 infants between 2 months and two years, 80 of them were diagnosed as TEW (group 1) and another 80 healthy infants as a control group. Infants were subjected to the following: Detailed history with special emphasize on gestational age -infant gender-infant weight-prenatal and natal history- history of smoking in family- type of delivery -type of feeding. History of recurrent wheezing, need for hospitalization. Full Clinical Examination 3-Investigations: chest x ray and Laboratory tests: Full picture analysis and IgE total enzyme assay. The study revealed that TEW was encountered with large percentage among infants with history of: maternal disease during pregnancy (diabetes, hypertension and urinary tract infection), caesarian section delivery, over weight infants, family history of smoking, artificial feeding, consuming cow milk during first year of life and attendance to daycare during infancy. Overweight is a new risk factor that was observed in our study. Most of the noted risk factors are similar to that reported in studies done in developed countries in addition to overweight infants are associated.

Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study

Study question How safe is live attenuated influenza vaccine (LAIV), which contains egg protein, in young people with egg allergy?Methods In this open label, phase IV intervention study, 779 young...

Exhaled Biomarkers and Gene Expression at Preschool Age Improve Asthma Prediction at 6 Years of Age

EMM Klaassen, KDG van de Kant, Q Jobsis. Am J Respir Crit Care Med. 2015;191(2):201–207 The objective of this study was to assess whether exhaled biomarkers, expression of inflammation genes, and early lung function measurements can improve early asthma prediction in the wheezing preschool child when used in conjunction with the Asthma Predictive Index (API). The study included 202 children, aged 2 to 4 years, with history of recurrent wheeze who were prospectively followed up yearly until 6 years of age. At age 6, a diagnosis of asthma or transient wheeze was determined on the basis of symptoms, use of asthma medication, and lung function features. At initial recruitment, researchers collected exhaled breath condensate, measuring exhaled volatile organic compounds (VOCs) and …

Prevalence and molecular characterizations of enterovirus D68 among children with acute respiratory infection in China between 2012 and 2014.

EV-D68 is associated with respiratory tract infections (RTIs). Since its first isolation, EV-D68 has been detected sporadically. However, the US and Canada have experienced outbreaks of EV-D68 infections between August and December 2014. This study aimed to investigate the molecular epidemiology and clinical characteristics of EV-D68 in Chongqing, Southwestern China. From January 2012 to November 2014, 1876 nasopharyngeal aspirate specimens (NPAs) were collected from hospitalized children with RTIs. Among the 1876 NPAs, EV-D68 was detected in 19 samples (1.0%, 19/1876). Of these, 13 samples were detected in September and October 2014 (9.8%, 13/132). Phylogenetic analysis showed that all 13 strains detected in the 2014 Chongqing had high homology with the main strains of the 2014 US outbreak. Among the children with EV-D68 infection, 13 (68%) had a history of recurrent wheezing. A total of 13 children had a discharge diagnosis of asthma. Of these, 11 children were diagnosed with acute asthma exacerbation. EV-D68 was the predominant pathogen that evoked asthma exacerbation in September and October 2014. In conclusion, our results found that a history of recurrent wheezing may be a risk factor for the detection of EV-D68 and viral-induced asthma exacerbation may be a clinical feature of EV-D68 infection.

Predictors of severe disease in a hospitalized population of children with acute viral lower respiratory tract infections.

Although predictors of severe viral acute lower respiratory infections (ALRIs) in children have been reported, there have been few research studies performed in low- and middle-income countries (LMIC). The aim of the present study was to determine predictors of disease severity in a population of Colombian children <5 years of age with ALRI. In a prospective cohort study, we determined independent predictors of severe ALRI in a hospitalized population of children under 5 years old with ALRI during a 1-year period. We included both underlying disease conditions and the infecting respiratory viruses as predictor variables of severe disease. We defined severe disease as the necessity of pediatric intensive care unit admission. Of a total of 1,180 patients admitted with a diagnosis of ALRI, 416 (35.3%) were included because they were positive for any kind of respiratory virus. After controlling for potential confounders, it was found that a history of pulmonary hypertension (RR 3.62; CI 95% 2.38-5.52; P < 0.001) and a history of recurrent wheezing (RR 1.77; CI 95% 1.12-2.79; P = 0.015) were independent predictors of severe disease. The present study shows that respiratory viruses are significant causes of ALRI in infants and young children in Colombia, a typical tropical LMIC, especially during the rainy season. Additionally, the results of the present study show that clinical variables such as a history of pulmonary hypertension and a history of recurrent wheezing are more relevant for predicting ALRI severity than the infecting respiratory viruses.

An update on the efficacy of oral corticosteroids in the treatment of wheezing episodes in preschool children.

Traditionally, oral corticosteroids (OCSs) have been the mainstay of treatment for acute wheezing episodes among preschool children with a history of recurrent wheezing. Although there is substantial evidence for the efficacy of OCSs as a treatment for asthma exacerbations in school-aged children and adolescents, recent clinical studies questioned the benefits of OCSs as a treatment for acute wheezing in preschool children. This review summarizes the current evidence on the efficacy of OCSs as a treatment for acute wheezing episodes among preschool age children with episodic wheezing, focusing on studies performed in three different settings: OCS treatment initiated by parents in the outpatient setting, OCS treatment initiated in the emergency department (ED), and OCS treatment among hospitalized preschool children. The results of most studies reviewed in this paper do not support the efficacy of OCS treatment among preschool children with recurrent wheezing. The heterogeneity of early childhood wheezing and asthma might be part of the explanation for lack of efficacy of this intervention noted in multiple studies.

Decreased Levels of Lipoxin A4 and Annexin A1 in Wheezy Infants

Objective: Wheezing is a common and challenging health issue in infancy and early childhood. Asthma diagnosis is frequent in patients with a history of recurrent wheezing. A relationship has been reported between asthma and anti-inflammatory mediators such as lipoxin A4 and annexin A1. However, this remains uncertain in wheezy infants. The aim of the present study was to determine lipoxin A4 and annexin A1 levels in wheezy infants. Materials and Methods: Eighty-seven patients aged 6-36 months were included in this study. Demographic characteristics, clinical features, laboratory data, clinical diagnoses, and treatments, if present, were recorded. Patients were divided into 2 groups: patients with wheezing (n = 59) and healthy controls (n = 28). Blood samples were taken and lipoxin A4 and annexin A1 levels were evaluated by ELISA. Results: Lipoxin A4 and annexin A1 levels were significantly lower in the wheezing group than in the control group (p < 0.05). A significant correlation was found between the serum total immunoglobulin E (IgE) level and the percentage and absolute number of eosinophils (p < 0.05). No significant correlation was found in terms of lipoxin A4 and annexin A1 levels, the serum total IgE level, and the percentage and absolute number of eosinophils among groups (p > 0.05). Conclusion: This is the first study to assess lipoxin A4 and annexin A1 levels in wheezy infants. The levels of lipoxin A4 and annexin A1 were found to be low in wheezy infants. We hope that these results will lead to novel therapeutic options for asthma in cases where an optimal treatment modality is lacking.

Impacto da técnica de expiração lenta e prolongada na mecânica respiratória de lactentes sibilantes

OBJECTIVE: To evaluate changes in respiratory mechanics and tidal volume (VT) in wheezing infants in spontaneous ventilation after performing the technique known as the prolonged, slow expiratory (PSE) maneuver. METHODS: We included infants with a history of recurrent wheezing and who had had no exacerbations in the previous 15 days. For the assessment of the pulmonary function, the infants were sedated and placed in the supine position, and a face mask was used and connected to a pneumotachograph. The variables of tidal breathing (VT and RR) as well as those of respiratory mechanics-respiratory system compliance (Crs), respiratory system resistance (Rrs), and the respiratory system time constant (prs)-were measured before and after three consecutive PSE maneuvers. RESULTS: We evaluated 18 infants. The mean age was 32 ± 11 weeks. After PSE, there was a significant increase in VT (79.3 ± 15.6 mL vs. 85.7 ± 17.2 mL; p = 0.009) and a significant decrease in RR (40.6 ± 6.9 breaths/min vs. 38.8 ± 0,9 breaths/min; p = 0.042). However, no significant differences were found in the variables of respiratory mechanics (Crs: 11.0 ± 3.1 mL/cmH2O vs. 11.3 ± 2.7 mL/cmH2O; Rrs: 29.9 ± 6.2 cmH2O • mL−1 • s−1 vs. 30.8 ± 7.1 cmH2O • mL−1 • s−1; and prs: 0.32 ± 0.11 s vs. 0.34 ±0.12 s; p > 0.05 for all). CONCLUSIONS: This respiratory therapy technique is able to induce significant changes in VT and RR in infants with recurrent wheezing, even in the absence of exacerbations. The fact that the variables related to respiratory mechanics remained unchanged indicates that the technique is safe to apply in this group of patients. Studies involving symptomatic infants are needed in order to quantify the functional effects of the technique.

The Role ofMycoplasma pneumoniaeInfection in Asthma

The Role of<i>Mycoplasma pneumoniae</i>Infection in Asthma

P82 Episodic viral wheeze and multitrigger wheeze: are they really different phenotypes?

IntroductionEpisodic viral wheeze (EVW) and multitrigger wheeze (MTW) are thought to be distinct recurrent wheezing phenotypes in preschool children. Here we tested the hypothesis that there are detectable physiological differences...

Vaccination coverage and risk factors for incomplete vaccination in children with recurrent wheeze

Aim To determine the possible impact of recurrent wheeze on immunisation status in the first three years of life. Method A cross-sectional case control study of 288 children less than three years of age with a history of recurrent wheezing, hospitalised at a single centre for wheeze; and a control group of 190 children with no prior history of wheezing .Vaccination charts of all children were analysed according to the National Immunisation Schedule. Additionally, some associated data were collected through a questionnaire to the parents. Results Children with recurrent wheezing during the first three years of life were less likely to be vaccinated against BCG (Bacillus-Calmette-Guerin), hepatitis B, Hib (Haemophilus influenza type B), and MMR (Measles, Mumps, Rubella) (p < 0.001). A significant inverse association was also found between the number of wheezy episodes and the number of vaccine doses received. The odds ratio of incomplete vaccination in children with recurrent wheeze was 10.6 (95% CI, 2.96 to 38.1). Conclusion Children under three years of age with recurrent wheeze run a high risk of incomplete immunisation. Efforts should be therefore made to insure that such children receive adequate vaccination.