Presence Of Wheeze Research Articles

Evaluation of the Double-Tracer Gas Single-Breath Washout Test in a Pediatric Field Study

The early life origins of chronic pulmonary diseases are thought to arise in peripheral small airways. Predictors of ventilation inhomogeneity, a proxy of peripheral airway function, are understudied in schoolchildren. Is the double-tracer gas single-breath washout (DTG-SBW) measurement feasible in a pediatric field study setting? What are the predictors of the DTG-SBW-derived ventilation inhomogeneity estimate in unselected schoolchildren? In this prospective cross-sectional field study, a mobile lung function testing unit visited participating schools in Switzerland. We applied DTG-SBW, fraction of exhaled nitric oxide (Feno), and spirometry measurements. The DTG-SBW is based on tidal inhalation of helium and sulfur-hexafluoride, and the phase III slope (SIIIHe-SF6) is derived. We assessed feasibility, repeatability, and associations of SIIIHe-SF6 with the potential predictors of anthropometrics, presence of wheeze (ie, parental report of one or more episode of wheeze in the prior year), Feno, FEV1, and FEV1/FVC. In 1,782 children, 5,223 DTG-SBW trials were obtained. The DTG-SBW was acceptable in 1,449 children (81.3%); the coefficient of variation was 39.8%. SIIIHe-SF6 was independently but weakly positively associated with age and BMI. In 276 children (21.2%), wheeze was reported. SIIIHe-SF6 was higher by 0.049 g.mol.L-1 in children with wheeze compared with those without and remained associated with wheeze after adjusting for age and BMI in a multivariable linear regression model. SIIIHe-SF6 was not associated with Feno, FEV1, and FEV1/FVC. The DTG-SBW is feasible in a pediatric field study setting. On the population level, age, body composition, and wheeze are independent predictors of peripheral airway function in unselected schoolchildren. The variation of the DTG-SBW possibly constrains its current applicability on the individual level. ClinicalTrials.gov; No.: NCT03659838; URL: www. gov.

Bronchiolitis and its Different Ways of Management in Raparin Teaching Hospital, Erbil-Iraq

Background: Despite the prevalence, global impact, financial burden, and mortality and morbidity related to bronchiolitis, clinical management still seems to be difficult.
 Objective: To describe the diversity medical treatment options used to manage bronchiolitis and conclude the safest and most effective way to treat it in order to help the development of an evidence based treatment protocol at Raparin teaching hospital.
 Patients and Methods: This current study design was randomized controlled trial, in which total of 125 children presented with bronchiolitis enrolled in our study, we divided them into five groups (A, B, C, D and E), each of 25 cases. All the groups received supportive treatment in the form of oxygen and intravenous (IV) fluid in addition to specific treatment except group A subjects who received supportive treatment only. The treatments were The study was conducted at the inpatient wards of Raparin teaching hospital in Erbil city-Iraq, from the period of 1st January to 1st August 2022. The infants and children’s age was ranging from 1 to 60 months with clinical diagnosis of bronchiolitis.
 Results: There was non-significant statistical association between treatment groups and presence of wheeze after treatment (p:0.538), while statistically significant association between various treatment modalities (groups) and cough after treatment (p:0.006) in the same way the association was significant with accessory muscle use after treatment (p:0.037). 
 Conclusion: Generally patients in groups B (inhaled bronchodilator) and D (inhaled bronchodilator and intravenous steroids) had better response rates in terms of cough, accessory muscle use, respiratory rate (tachypnea), time to resolution of fever and coryza, duration of IV fluid therapy, oxygen therapy and hospital stay. Which conclude using of inhaled bronchodilator and IV steroid

Bronchiolitis and its Different Ways of Management in Raparin Teaching Hospital, Erbil-Iraq

Background: Despite the prevalence, global impact, financial burden, and mortality and morbidity related to bronchiolitis, clinical management still seems to be difficult. Objective: To describe the diversity medical treatment options used to manage bronchiolitis and conclude the safest and most effective way to treat it in order to help the development of an evidence based treatment protocol at Raparin teaching hospital. Patients and Methods: This current study design was randomized controlled trial, in which total of 125 children presented with bronchiolitis enrolled in our study, we divided them into five groups (A, B, C, D and E), each of 25 cases. All the groups received supportive treatment in the form of oxygen and intravenous (IV) fluid in addition to specific treatment except group A subjects who received supportive treatment only. The treatments were The study was conducted at the inpatient wards of Raparin teaching hospital in Erbil city-Iraq, from the period of 1st January to 1st August 2022. The infants and children’s age was ranging from 1 to 60 months with clinical diagnosis of bronchiolitis. Results: There was non-significant statistical association between treatment groups and presence of wheeze after treatment (p:0.538), while statistically significant association between various treatment modalities (groups) and cough after treatment (p:0.006) in the same way the association was significant with accessory muscle use after treatment (p:0.037). Conclusion: Generally patients in groups B (inhaled bronchodilator) and D (inhaled bronchodilator and intravenous steroids) had better response rates in terms of cough, accessory muscle use, respiratory rate (tachypnea), time to resolution of fever and coryza, duration of IV fluid therapy, oxygen therapy and hospital stay. Which conclude using of inhaled bronchodilator and IV steroid Keywords: Bronchiolitis, Wheeze, Treatment, Randomized clinical trial, Iraq

Viral Detection Is Associated With Severe Disease in Children With Suspected Community-Acquired Pneumonia.

To evaluate the role of virus detection on disease severity among children presenting to the emergency department (ED) with suspected community-acquired pneumonia (CAP). We performed a single-center prospective study of children presenting to a pediatric ED with signs and symptoms of a lower respiratory tract infection and who had a chest radiograph performed for suspected CAP. We included patients who had virus testing, with results classified as negative for virus, human rhinovirus, respiratory syncytial virus (RSV), influenza, and other viruses. We evaluated the association between virus detection and disease severity using a 4-tiered measure of disease severity based on clinical outcomes, ranging from mild ( discharged from the ED) to severe (receipt of positive-pressure ventilation, vasopressors, thoracostomy tube placement, or extracorporeal membrane oxygenation, intensive care unit admission, diagnosis of severe sepsis or septic shock, or death) in models adjusted for age, procalcitonin, C-reactive protein, radiologist interpretation of the chest radiograph, presence of wheeze, fever, and provision of antibiotics. Five hundred seventy-three patients were enrolled in the parent study, of whom viruses were detected in 344 (60%), including 159 (28%) human rhinovirus, 114 (20%) RSV, and 34 (6%) with influenza. In multivariable models, viral infections were associated with increasing disease severity, with the greatest effect noted with RSV (adjusted odds ratio [aOR], 2.50; 95% confidence interval [CI], 1.30-4.81) followed by rhinovirus (aOR, 2.18; 95% CI, 1.27-3.76). Viral detection was not associated with increased severity among patients with radiographic pneumonia (n = 223; OR, 1.82; 95% CI, 0.87-3.87) but was associated with severity among patients without radiographic pneumonia (n = 141; OR, 2.51; 95% CI, 1.40-4.59). The detection of a virus in the nasopharynx was associated with more severe disease compared with no virus; this finding persisted after adjustment for age, biomarkers, and radiographic findings. Viral testing may assist with risk stratification of patients with lower respiratory tract infections.

Impact of Adjunct Corticosteroid Therapy on Quality of Life for Children With Suspected Pneumonia.

To determine the association between adjunct corticosteroid therapy and quality of life (QoL) outcomes in children with signs and symptoms of lower respiratory tract infection and clinical suspicion for community-acquired pneumonia (CAP) in the emergency department (ED). Secondary analysis from a prospective cohort study of children aged 3 months to 18 years with signs and symptoms of LRTI and a chest radiograph for suspected CAP in the ED, excluding children with recent (within 14 days) systemic corticosteroid use. The primary exposure was receipt of corticosteroids during the ED visit. Outcomes were QoL measures and unplanned visits. Multivariable regression was used to evaluate the association between corticosteroid therapy and outcomes. Of 898 children, 162 (18%) received corticosteroids. Children who received corticosteroids were more frequently boys (62%), Black (45%), had history of asthma (58%), previous pneumonia (16%), presence of wheeze (74%), and more severe illness at presentation (6%). Ninety-six percent were treated for asthma as defined by report of asthma or receipt of ß-agonist in the ED. Receipt of corticosteroids was not associated with QoL measures: days of activity missed (adjusted incident rate ratio [aIRR], 0.84; 95% confidence interval [CI], 0.63-1.11) and days of work missed (aIRR, 0.88; 95% CI, 0.60-1.27). There was a statistically significant interaction between age (>2 years) and corticosteroids receipt; the patients had fewer days of activity missed (aIRR, 0.62; 95% CI, 0.46-0.83), with no effect on children 2 years or younger (aIRR, 0.83; 95% CI, 0.54-1.27). Corticosteroid treatment was not associated with unplanned visit (odds ratio, 1.37; 95% CI, 0.69-2.75). In this cohort of children with suspected CAP, receipt of corticosteroids was associated with asthma history and was not associated with missed days of activity or work, except in a subset of children aged older than 2 years.

Automatic wheeze segmentation using harmonic-percussive source separation and empirical mode decomposition.

Wheezes are adventitious respiratory sounds commonly present in patients with respiratory conditions. The presence of wheezes and their time location are relevant for clinical reasons, such as understanding the degree of bronchial obstruction. Conventional auscultation is usually employed to analyze wheezes, but remote monitoring has become a pressing need during recent years. Automatic respiratory sound analysis is required to reliably perform remote auscultation. In this work we propose a method for wheeze segmentation. Our method starts by decomposing a given audio excerpt into intrinsic mode frequencies using empirical mode decomposition. Then, we apply harmonic-percussive source separation to the resulting audio tracks and get harmonic-enhanced spectrograms, which are processed to obtain harmonic masks. Subsequently, a series of empirically derived rules are applied to find wheeze candidates. Finally, the candidates stemming from the different audio tracks are merged and median filtered. In the evaluation stage, we compare our method to three baselines on the ICBHI 2017 Respiratory Sound Database, a challenging dataset containing various noise sources and background sounds. Using the full dataset, our method outperforms the baselines, achieving an F1 of 41.9%. Our method's performance is also better than the baselines across several stratified results focusing on five variables: recording equipment, age, sex, body-mass index, and diagnosis. We conclude that, contrary to what has been reported in the literature, wheeze segmentation has not been solved for real life scenario applications. Adaptation of existing systems to demographic characteristics might be a promising step in the direction of algorithm personalization, which would make automatic wheeze segmentation methods clinically viable.

Prevalence of childhood cough in epidemiological studies depends on the question used: findings from two population-based studies

Epidemiological studies use different questions to assess recurrent cough in children. In two independent population-based studies, we assessed how prevalence estimates of cough vary depending on the questions parents are asked about their child's cough and how answers to the different questions overlap. We analysed cross-sectional data from two population-based studies on respiratory health:LuftiBus in the School(LUIS), conducted in 2013-2016 among 6- to 17-year-school children in the Canton of Zurich, Switzerland, and the 1998Leicester Respiratory Cohort(LRC) study, UK where we used data from 6- to 8-year-old children from the 2003 follow-up survey. Both studies used parental questionnaires that included the same three questions on the child's cough, namely cough without a cold, dry cough at night and coughing more than others. We assessed how the prevalence of cough varied depending on the question and how answers to the different questions on cough overlapped. We also assessed how results were influenced by age, sex, presence of wheeze and parental education. We included 3457 children aged 6-17 years from LUIS and 2100 children aged 6-8 years from LRC. All respiratory outcomes - cough, wheeze and physician-diagnosed asthma - were reported twice as often in the LRC as in LUIS. We found large differences in the prevalence of parent-reported cough between the three cough questions. In LUIS, 880 (25%) parents reported cough without a cold, 394 (11%) dry night cough, and 159 (5%) reported that their child coughed more than other children. In the LRC, these numbers were 1003 (48%), 527 (25%) and 227 (11%). There was only partial overlap of answers, with 89 (3%) answering yes to all questions in LUIS and 168 (8%) in LRC. Prevalence of all types of cough and overlap between the cough questions was higher in children with current wheeze. In both population-based studies prevalence estimates of cough depended strongly on the question used to assess cough with only partial overlap of responses to different questions. Epidemiological studies on cough can only be compared if they used exactly the same questions for cough.

Early-life weight gain is associated with non-atopic asthma in childhood

BackgroundPrevious studies suggest the association between early-life weight gain and asthma. It remains unclear whether early-life weight gain is associated with atopic or non-atopic asthma. This study aimed to investigate whether early-life weight gain is associated with atopic or non-atopic asthma. MethodsIncluded in this study were 1343 singleton-birth children (761 boys, 57%) born between January 2010 and December 2011 participating in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort were evaluated by a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and interviewed by pediatricians between July 1, 2016 and May 31, 2018 at the mean age of 6.4 years. Weight gain z-scores during the first 6, 12, and 18 months of life were classified into 4 groups: slow (below −0.67), on track (−0.67 to 0.67), rapid (0.67 to 1.28), and extremely rapid (above 1.28). The main outcomes were atopic and non-atopic asthma. Asthma was defined as having physician-diagnosed asthma and the presence of wheeze or asthma exacerbations in the last 12 months. Atopy was determined by Phadiatop Infant. ResultsThe extremely rapid weight gain group of children during the first 6, 12, and 18 months of life was significantly associated with an increased risk of non-atopic asthma (adjusted odd ratio [AOR], 2.14, 95% confidence interval [CI], 1.01–4.53 for the first 6 months; AOR, 2.86, 95% CI, 1.34–6.14 for the first 12 months; AOR, 3.26, 95% CI 1.49–7.15 for the first 18 months) compared with the on track group. No significant association was found in atopic asthma. A sex-stratified analysis revealed the association of early-life weight gain with non-atopic asthma was statistically significant only in boys (AOR, 4.24, 95% CI, 1.44–12.50). ConclusionExtremely rapid weight gain during the first 6–18 months of life was significantly associated with 2.1- to 3.3-fold increased risk of non-atopic asthma, with a more pronounced risk found in boys.

Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study

RationaleOscillometry is an emerging technique that offers some advantages over spirometry as it does not require forced exhalation and may detect early changes in respiratory pathology. Obstructive lung disease disproportionately impacts people experiencing homelessness with a high symptoms burden, yet oscillometry is not studied in this population.ObjectivesTo assess lung disease and symptom burden using oscillometry in people experiencing homelessness or at-risk of homelessness using a community-based participatory action research approach (The Bridge Model™).MethodsOf 80 recruited, 55 completed baseline oscillometry, 64 completed spirometry, and all completed patient-reported outcomes with demographics, health, and respiratory symptom related questionnaires in the Participatory Research in Ottawa: Management and Point-of-Care for Tobacco Dependence project. Using a two-tail t-test, we compared mean oscillometry values for airway resistance (R5–20), reactance area under the curve (Ax) and reactance at 5 Hz (X5) amongst individuals with fixed-ratio method (FEV1/FVC ratio < 0.70) and LLN (FEV1/FVC ratio ≤ LLN) spirometry diagnosed chronic obstructive pulmonary disease (COPD). We compared mean oscillometry parameters based on participants’ COPD assessment test (CAT) scores using ANOVA test.ResultsThere was no significant difference between the pre- and post- bronchodilator values of R5–20 and Ax for the fixed ratio method (p = 0.63 and 0.43) and the LLN method (p = 0.45 and 0.36). There was a significant difference in all three of the oscillometry parameters, R5–20, Ax and X5, based on CAT score (p = 0.009, 0.007 and 0.05, respectively). There was a significant difference in R5–20 and Ax based on the presence of phlegm (p = 0.03 and 0.02, respectively) and the presence of wheeze (p = 0.05 and 0.01, respectively). Oscillometry data did not correlate with spirometry data, but it was associated with CAT scores and correlated with the presence of self-reported symptoms of phlegm and wheeze in this population.ConclusionsOscillometry is associated with respiratory symptom burden and highlights the need for future studies to generate more robust data regarding the use of oscillometry in systematically disadvantaged populations where disease burden is disproportionately higher than the general population.TrialRegistration: ClinicalTrails.gov—NCT03626064, Retrospective registered: August 2018, https://clinicaltrials.gov/ct2/show/NCT03626064

Predicting Mortality and Use of RISC Scoring System in Hospitalized Under-Five Children Due to WHO Defined Severe Community Acquired Pneumonia

Pneumonia acquired in the community is a leading cause of hospitalization and death in under-five children. Predicting mortality in children remains a challenge. There is a need of consolidated scoring system to predict mortality in under-five children in developing nations. This is a hospital-based prospective nested case-control study, conducted in a tertiary care teaching hospital of north India. Included were under-five hospitalized children due to WHO defined severe community acquired pneumonia (CAP). Those who did not survive were categorized as cases, while those who were discharged were categorized as controls. The mortality rate among the recruited 180 hospitalized children with severe CAP was 9.4%. The mortality in under-five children was higher among infants, children who resided in rural areas and were unimmunized or partially immunized for the present age. Mortality was also statistically significantly higher among under-five children with weight for age and weight for length/height below -2Z score; SpO2 < 90% at room air at admission, cyanosis, convulsion, high C-reactive protein (CRP), blood culture positive sepsis and end point consolidation. These predictors were found to be independent risk factors for the mortality after analyzing in multivariate model while presence of wheeze and exclusive breast feeding for first six months of life were found to be protective. The receiver operating characteristic (ROC) curve for respiratory index of severity in children (RISC) score has area under curve (AUC) 0.91 while AUC of RISC score with King George's Medical University (KGMU) modification has 0.88 for prediction of mortality. At the cut-off level of 3, the sensitivity of the RISC score in predicting mortality was 94.1% while the specificity was 73.6%. However, the sensitivity of the RISC score with KGMU modification in predicting mortality at cut-off level of 3 was 88.4% with a specificity of 74.8%. Various predictors for mortality under-five children are young age, malnutrition, cyanosis, high CRP, blood culture positive sepsis and end point consolidation. It is also possible to predict mortality using RISC score which comprises simple variables and can be easily used at centers of periphery. Similar accuracy had been also found through the use of an age independent modified score (RISC score with KGMU modification).Lay summaryPneumonia is a primary cause of hospitalization as well as death among the children under the age of five. A variety of severity or mortality predicting scores have been produced for adults, but such scores for children are scarce. Furthermore, their utility in developing nations has not been proven. This is a hospital-based prospective study. Included were children under five (2 to 59 months) hospitalized due to severe community acquired pneumonia (CAP) defined as per World Health Organization (WHO) and were not hospitalized in last 14 days elsewhere. Those who did not survive were classified as cases while those who were discharged were classified as controls. A total of 200 consecutively hospitalized children with severe CAP based on WHO were screened and 180 children were recruited. Among recruited children, the percentage of mortality was 9.4% while 90.6% were discharged. The mortality was higher among children younger than 12 months, those belonged to rural area and were unimmunized or partially immunized for the present age. Mortality was also higher among under-five children with severe malnutrition, anemia, SpO2 < 90% at room air at admission, cyanosis, convulsion, thrombocytopenia, high CRP, blood culture positive sepsis and end point consolidation. After assessing in a multivariate model, these predictors were determined to be independent risk factor for death, while wheezing and exclusive breast feeding throughout the first six months of life were found to be protective. The receiver operating characteristic (ROC) curve for respiratory index of severity in children (RISC) score has an area under curve (AUC) of 0.91 while AUC of RISC score with King George's Medical University (KGMU) modification was 0.88 for the prediction of death in under-five children hospitalized due to severe CAP.

Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children.

The diagnosis of pneumonia in children is challenging, given the wide overlap of many of the symptoms and physical examination findings with other common respiratory illnesses. We sought to derive and validate the novel Pneumonia Risk Score (PRS), a clinical tool utilizing signs and symptoms available to clinicians to determine a child's risk of radiographic pneumonia. We prospectively enrolled children 3 months to 18 years in whom a chest radiograph (CXR) was obtained in the emergency department to evaluate for pneumonia. Before CXR, we collected information regarding symptoms, physical examination findings, and the physician-estimated probability of radiographic pneumonia. Logistic regression was used to predict the presence of radiographic pneumonia, and the PRS was validated in a distinct cohort of children with suspected pneumonia. Among 1181 children included in the study, 206 (17%) had radiographic pneumonia. The PRS included age in years, triage oxygen saturation, presence of fever, presence of rales, and presence of wheeze. The area under the curve (AUC) of the PRS was 0.71 (95% confidence interval [CI]: 0.68-0.75), while the AUC of clinician judgment was 0.61 (95% CI: 0.56-0.66) (P < 0.001). Among 2132 children included in the validation cohort, the PRS demonstrated an AUC of 0.69 (95% CI: 0.65-0.73). In children with suspected pneumonia, the PRS is superior to clinician judgment in predicting the presence of radiographic pneumonia. Use of the PRS may help efforts to support the judicious use of antibiotics and chest radiography among children with suspected pneumonia.

THE CORRELATION OF SYMPTOMS AND OBJECTIVE WHEEZE IN ASTHMATICS

Objective: To determine the correlation between symptoms and objective wheeze in asthmatics.&#x0D; Study Design: A cross sectional study.&#x0D; Place and Duration of Study: Medicine department, Combined Military Hospital Lahore, from Jul to Dec 2019.&#x0D; Methodology: Two hundred patients of asthma were selected reporting in Medicine department, CMH Lahore.Patients were interviewed regarding their primary chest symptom and it was correlated with the clinical examination for wheeze to find which particular symptom correlated most with the presence of wheeze. The 130 symptomatic cases were subjected to spirometry to assess their lung functions tests.&#x0D; Results: Two hundreds patients of asthma were interviewed of whom 130 patients were symptomatic. Out of 130 patients, 59 (45.3%) complained of difficulty in breathing, 40 (30.7%) complained of shortness of breath, 20 (15.3%) had wheezing, 7 (5.3%) had cough and 4 (3%) had chest pain. Eighty five (65.3%) patients when examined had wheeze. The distribution of objective wheezing in the above cases were 100% for wheezing patient, 66.1% for Difficulty in breathing, 57.5% for shortness of breath 28.5% for cough and 25% for chest pain. The FEV1/FVC ratio was lowest for wheezing patients at 0.55 and highest for cough at 0.70.&#x0D; Conclusion: Difficulty in breathing was the commonest symptom in symptomatic asthmatics being presentin 66.1% of patients. The symptom which correlated best with the presence of wheeze was wheezy chest anddifficulty in breathing and was also associated with lowest FEV1/FVC ratio.

An Unidentified Monster in the Bed – Assessing Nocturnal Asthma in Children

Nocturnal asthma (NA) is increasing in prevalence, affecting millions of people worldwide. In addition to being associated with increased mortality, NA is associated with a decreased quality of life. NA associated sleep disturbances and increased daytime sleepiness are especially important in children due to the accompanying behavioral and developmental difficulties. As diurnal spirometry is not a practical tool for the diagnosis and monitoring of NA, self or parental reports are used. Children underreport and underestimate their NA symptoms and parents are not fully aware of their child's NA indicators. In addition, there is the lack of physician familiarity regarding the assessment and treatment of NA. Therefore, NA is chronically underreported. The development of a non-invasive, objective, home-based diagnostic tool is crucial in diagnosing and monitoring children with NA. The presence of wheeze during sleep has been successfully employed as a tool to measure NA in children. This review discusses the increasing prevalence of NA, current diagnostic tools and the consequences of undiagnosed NA in children. In conclusion, this paper suggests that an automated wheeze detective device is an objective and practical tool to aid the diagnosis and monitoring of NA.

Randomised controlled trial of paracetamol or ibuprofen, as required for fever and pain in the first year of life, for prevention of asthma at age 6 years: paracetamol or ibuprofen in the primary prevention of asthma in Tamariki (PIPPA Tamariki) protocol

IntroductionAsthma is one of the most common diseases in the world and is a global public health burden. There is an urgent need for research that leads to evidenced-based primary...

Oral amoxicillin versus intravenous ampicillin for chest indrawing pneumonia in children aged 3–59 months: A randomized control trial

Background: Pneumonia is one of the leading causes of under-five mortality. There is lack of consistency in treatment guidelines issued by various organizations. Objective: The primary objective of the study was to compare the efficacy of oral amoxicillin against intravenous (IV) ampicillin in children aged 3–59 months with chest retraction pneumonia. The secondary objective was to identify the risk factors associated with the absence of clinical improvement at the end of 48 h of treatment. Materials and Methods: This was a non-blinded randomized controlled, non-inferiority trial of oral amoxicillin 80 mg/kg/day in two divided doses and IV ampicillin 200 mg/kg/day in three divided doses in children aged 3–59 months with chest retraction pneumonia. The study was conducted in the pediatric wards of a tertiary care facility from November 2016 to September 2017. The children were followed up after 48 h and 5 days for the clinical improvement. The primary outcome considered was absence of improvement or deterioration in the study children at the end of 48 h of initiation of therapy and was expressed as risk difference between the two treatment groups. Multivariate regression analysis was performed to determine the predictors of poor outcome of the disease. Results: Risk difference of treatment failure between both groups was -3.7% (95% confidence interval [CI] ?16.8%–9.4%). The presence of wheeze and X-ray findings of pneumonia was significant independent risk factors for poor outcome at the end of 48 h. Conclusion: Oral amoxicillin is not inferior to IV penicillin in the treatment of chest retraction pneumonia in children aged 3–59 months. The presence of wheeze and X-ray findings suggestive of pneumonia can be used as prognostic indicators in children.

Impact of swimming school attendance in 3-year-old children with wheeze and rhinitis at age 5 years: A prospective birth cohort study in Tokyo

BackgroundIn Japan, swimming school attendance is promoted as a form of therapy or as a prophylactic measure against asthma in young children. However, the putative beneficial effects have not been sufficiently verified.ObjectiveThe aim of the present study was to clarify whether or not swimming school attendance at age 3 years affects the onset and/or improvement of wheeze and rhinitis at age 5 years.MethodsThis study was a single-center, prospective, general, longitudinal cohort study (T-CHILD Study). Between November 2003 and December 2005, 1776 pregnant women were enrolled, and their offspring were followed up until age 5 years. Swimming school attendance at age 3 years and the presence of wheeze and/or rhinitis in the previous one year were examined using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The relationship between swimming school attendance and wheeze and/or rhinitis was analyzed using multivariable logistic regression analysis.ResultsData on the 1097 children were analyzed. At age 3 years, 126 (11.5%) children attended a swimming school, and at age 5 years, the prevalence of wheeze was 180 (16.4%) while that of rhinitis was 387 (35.3%). Swimming school attendance at age 3 showed no significant relationship with the development of either wheeze (aOR 0.83, 95% CI (0.43–1.60) or rhinitis (aOR 0.80, 95% CI (0.43–1.60) at age 5.ConclusionsSwimming school attendance at age 3 years showed neither a preventive nor therapeutic effect on wheeze or rhinitis at age 5 years. There is thus no scientific evidence yet that swimming school attendance has a positive impact on the development of childhood wheeze or rhinitis.

The prevalence of asthma and allergic rhinitis in Nigeria: A nationwide survey among children, adolescents and adults.

PurposeAsthma is an important cause of morbidity and mortality worldwide and information on the prevalence of asthma in Nigeria is inconsistent. Nationally representative data, important for health planning is unavailable. We aimed to determine the current prevalence of asthma and allergic rhinitis in Nigeria.Materials and methodsA cross-sectional population survey conducted between June 2017 and March 2018 across five cities representing five geo-political zones in Nigeria. Validated screening questionnaires were used to identify persons with asthma and allergic rhinitis respectively. Asthma was defined as physician diagnosed asthma, clinical asthma and by presence of wheeze in the last 12 months respectively. Socio-demographic information, tobacco smoking, sources of household cooking fuel were also obtained.ResultsA total of 20063 participants from 6024 households were screened. The prevalence (95% confidence interval) of physician diagnosed asthma, clinical asthma and wheeze was 2.5% (2.3–2.7%), 6.4% (6.0–6.64%) and 9.0% (8.6–9.4%) respectively. The prevalence of allergic rhinitis was 22.8% (22.2–23.4%). The prevalence of asthma and rhinitis increased with age (prevalence of clinical asthma: 3.1% (2.8–3.4%), 9.8% (9.1–10.5) and 10.7% (9.4%-12.0) among 6–17 years, 18–45 years and >45 years respectively). Prevalence also varied across different cities with the highest prevalence of clinical asthma occurring in Lagos (8.0%) and the lowest in Ilorin (1.1%). The frequency of allergic rhinitis among persons with clinical asthma was 74.7%. Presence of allergic rhinitis, family history of asthma, current smoking and being overweight were independent determinants of current asthma among adults.ConclusionThe prevalence of asthma and allergic rhinitis in Nigeria is high with variabilities across regions and age groups. The number of persons with clinical asthma in Nigeria (approximately 13 million) is likely to rank among the highest in Africa. This warrants prioritization by stakeholders and policy makers to actively implement risk reduction measures and increase investment in capacity building for the diagnosis and treatment of asthma and allergic rhinitis.

Opportunistic screening for COPD in primary care: a pooled analysis of 6,710 symptomatic smokers and ex-smokers.

ObjectiveTo investigate the prevalence and predictors of COPD in a large cohort of symptomatic smokers and ex-smokers in a primary care setting.MethodsGeneral practitioners (n=390) consecutively recruited individuals ≥35 years, with current or previous tobacco exposure, at least one respiratory symptom, and no previous diagnosis of obstructive airways disease; and obtained data on tobacco exposure, body mass index (BMI), and dyspnea (Medical Research Council dyspnea scale). All individuals with airflow obstruction, ie, FEV1/FVC <0.70 at initial lung function test, had diagnostic spirometry, including bronchodilator reversibility test. COPD was defined as respiratory symptom(s), tobacco exposure, and nonreversible airflow limitation.ResultsOf the 6,710 at-risk individuals screened with spirometry (52% male sex, mean age 58 years [SD 10.9]), 1,185 were diagnosed with COPD (17.7%). Apart from age and pack-years, multivariate logistics regression analysis, adjusted for FEV1, revealed that BMI <25 kg/m2 (OR 4.2, 95% CI 3.0–5.9, p<0.001), BMI 35+ kg/m2 (OR 1.6, 95% CI 1.2–2.3), self-reported dyspnea (OR 1.2, 95% CI 1.1–14, p=0.04), wheeze (OR 1.3, 95% CI 1.1–1.6, p=0.001), phlegm (OR 1.4, 95% CI 1.1–1.6, p<0.001), and MRC ≥3 (OR 1.6, 95% CI 1.2–2.0, p=0.001) were associated with a significantly higher likelihood of being diagnosed with COPD. No association was found between sex, cough, and recurrent respiratory tract infections and a diagnosis of COPD.ConclusionThe prevalence of COPD is high among smokers and ex-smokers with one or more respiratory symptoms seen in primary care, and the presence of wheeze, phlegm and dyspnea, together with both low BMI and obesity identify a subgroup with an even higher likelihood of COPD.

Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis

There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and2012. A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC< 0.7). Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n= 220), 37.7%had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9%in low- to middle-income countries to 4.9%in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7%reported current use of respiratory medication. Excluding patients with reported asthma, 34.4%of those with normal spirometry still used a respiratory medication. False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.

Prevalence and factors associated with adult bronchial asthma in Aseer region, Southwestern Saudi Arabia.

BACKGROUND:Bronchial asthma (BA) is one of the most common chronic respiratory diseases in Saudi Arabia (SA). Most of the studies investigating the prevalence of BA in SA have focused on children and its exact prevalence in adults is unknown.OBJECTIVES:The objective of this study is tto investigate the prevalence and factors associated with adult BA in Aseer region, southwestern SA.METHODS:A cross-sectional study was conducted on a representative sample of adults who attended primary health care centers. A validated Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire was used. The presence of wheeze in the past 12 months was used as a proxy for BA.RESULTS:The study included 960 adults. The prevalence rate of BA was 19.2% (95% confidence interval [CI]: 16.72–21.80). In a multivariable analysis, the following factors were significantly associated with BA in adults; living in low-altitude areas (adjusted odds ratio [aOR] = 1.51, 95% CI: 1.04–2.21), being in rural areas (aOR = 1.58, 95% CI: 1.12–2.23), using analgesics (aOR = 1.52, 95% CI: 1.06–2.20), residing near heavy trucks traffics (aOR = 1.67, 95% CI: 1.13–2.46), having cats in the house (aOR = 2.27, 95% CI: 1.30–5.94), and being aged 55–64-year-old (aOR = 1.94, 95% CI: 1.02–3.69).CONCLUSION:The prevalence of BA was high, affecting one-fifth of adults in Aseer region. The study revealed some modifiable factors significantly associated with BA in adults. There is a need to improve asthma control programs at the primary health-care level, particularly at rural and at low-altitude areas, and more focus should address the elders. In addition, enhancing community-based health promotion programs tackling the identified modifiable factors of BA are required.