Pulmonary Diseases In Children Research Articles

Lung Diseases and Rare Disorders: Is It a Lysosomal Storage Disease? Differential Diagnosis, Pathogenetic Mechanisms and Management.

Pulmonologists may be involved in managing pulmonary diseases in children with complex clinical pictures without a diagnosis. Moreover, they are routinely involved in the multidisciplinary care of children with rare diseases, at baseline and during follow-up, for lung function monitoring. Lysosomal storage diseases (LSDs) are a group of genetic diseases characterised by a specific lysosomal enzyme deficiency. Despite varying pathogen and organ involvement, they are linked by the pathological accumulation of exceeding substrates, leading to cellular toxicity and subsequent organ damage. Less severe forms of LSDs can manifest during childhood or later in life, sometimes being underdiagnosed. Respiratory impairment may stem from different pathogenetic mechanisms, depending on substrate storage in bones, with skeletal deformity and restrictive pattern, in bronchi, with obstructive pattern, in lung interstitium, with altered alveolar gas exchange, and in muscles, with hypotonia. This narrative review aims to outline different pulmonary clinical findings and a diagnostic approach based on key elements for differential diagnosis in some treatable LSDs like Gaucher disease, Acid Sphingomyelinase deficiency, Pompe disease and Mucopolysaccharidosis. Alongside their respiratory clinical aspects, which might overlap, we will describe radiological findings, lung functional patterns and associated symptoms to guide pediatric pulmonologists in differential diagnosis. The second part of the paper will address follow-up and management specifics. Recent evidence suggests that new therapeutic strategies play a substantial role in preventing lung involvement in early-treated patients and enhancing lung function and radiological signs in others. Timely diagnosis, driven by clinical suspicion and diagnostic workup, can help in treating LSDs effectively.

Роль тромбоцитов в патогенезе инфекционно-воспалительных заболеваний легких у детей (обзор литературы)

At present, a subject of scientific interest is the interaction of immune systems and hemostasis. New data on their synergistic effect in various diseases have been obtained in the last decade, which allowed to introduce the concept of "immunothrombosis". Inflammation and thrombosis factors are capable of mutual activation and enhancement. A special role in these processes belongs to platelets, which are classified as cellular effectors of antimicrobial host defence. These cells are among the first to react to the pathogen when it enters the bloodstream. Platelet activation ensures the direct eradication of pathogens, the immune cells involvement, the formation of primary thrombi to prevent the spread of infection, and the coagulation system process start. However, microthrombosis can become uncontrollable and irreversible during continued activation. Platelet dysfunction may be associated with a hyperergic inflammatory response of the body and a severe disease course. Concomitant endothelial dysfunction intensifies hypercoagulation and inflammatory response, increasing the risk of systemic inflammatory processes. The review examines current data on the platelet role in the pathogenesis of infectious and inflammatory pulmonary diseases in children, including destructive ones. KEYWORDS: hemostasis, platelets, immunity, inflammation, pneumonia, children, neutrophil extracellular traps, microthrombosis. FOR CITATION: Tolstova E.M., Besedina M.V., Zaytseva O.V., Kuzina S.R., Lokshina E.E., Haspekov D.V., Turishchev I.V., Belyaeva T.Yu. Platelets in the pathogenesis of infectious and inflammatory pulmonary diseases in children (literature review). Russian Journal of Woman and Child Health. 2024;7(1):58–63 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-9.

Dysanapsis and its role in the occurrence of chronic obstructive respiratory diseases in children and adults: A review

The literature review, written on the basis of world literature data and the results of the authors' own research, is devoted to an important pathogenetic mechanism of development and progression of chronic obstructive pulmonary diseases in children and adults dysanapsis, which is understood as a mismatch in the size or growth of the airways to the volume or growth of the lung parenchyma, while the diameter of the airways is disproportionately smaller than the volume of the lung parenchyma. Modern methods of diagnosis of dysanapsis are based on the use of computed tomography of the chest organs, spirometry (accounting for the volume of forced exhalation in 1 second, forced vital capacity of the lungs, calculation of the coefficient of dysanapsis). Dysanapsis, which has genetic and age-dependent mechanisms of formation, makes an important contribution to the development of bronchial hyperreactivity and bronchial asthma, especially in combination with overweight and obesity, determining the uncontrolled course of asthma. The phenomenon of dysanapsis can be explained by the clinical and functional indicators of the respiratory system (hypoxemia, bronchial obstruction) in premature infants, including patients with bronchopulmonary dysplasia, patients with postinfectious obliterating bronchiolitis. In addition, imbalance is an important pathogenetic component of chronic obstructive pulmonary disease, causing the defeat of patients with this disease, regardless of the presence and length of smoking.

P099 Inhaled tobramycin solution hypersensitivity in patients with cystic fibrosis at the Centre for Cystic Fibrosis, Institute for Pulmonary Diseases in Children in North Macedonia

P099 Inhaled tobramycin solution hypersensitivity in patients with cystic fibrosis at the Centre for Cystic Fibrosis, Institute for Pulmonary Diseases in Children in North Macedonia

Chronic bronchopulmonary diseases in children with bronchial obstruction syndrome

Introduction. The results of long-term observations of children with chronic bronchopulmonary diseases occurring with bronchoobstructive syndrome and poorly responding to standard therapy are presented. To optimize treatment, it is necessary to accurately determine the nosological variant of the pathology, to identify the main causes of the formation of dysontogenetic disorders.Aim. To study the main nosological options and clinical and diagnostic criteria for chronic obstructive pulmonary diseases in children to justify an individual approach to treatment and follow-up.Materials and methods. 148 children with chronic bronchopulmonary diseases occurring with bronchial obstruction syndrome (excluding bronchial asthma and cystic fibrosis) were exаmined according to the differential diagnostic algorithm developed by us, including anamnestic, clinical, X-ray, functional and morphological methods.Results. The main group of 148 cases consisted of 73 children (49,3%) with lung malformations with insufficiency of the muscular-elastic and cartilaginous framework of the trachea and bronchi, local malformations, with impaired lung growth and development, causing bronchial obstruction. Acquired variants of chronic obstructive pulmonary diseases in children were noted by us in the form of chronic obstructive bronchitis (25.2%) and in the outcome of bronchopulmonary dysplasia (11.5%), chronic obliterating bronchiolitis (6.1%), gastroesophageal reflux disease (0.7%). Acquired local forms of obstruction (foreign object, scar stenosis, tumors) were noted in 4.5% of cases. Hereditary lung diseases, including primary ciliary dyskinesia, were detected in 2.7% of cases.Conclusion. Chronic obstructive pulmonary diseases are diseases of various etiology and pathogenesis that occur at an early age in children with perinatal disorders against the background of various lung malformations, bronchial dysplasia, lung tissue malformations and are the pathomorphological basis for the further formation of chronic obstructive pulmonary disease in adult patients.

Classification of Lung Disease in Children by Using Lung Ultrasound Images and Deep Convolutional Neural Network.

Bronchiolitis is the most common cause of hospitalization of children in the first year of life and pneumonia is the leading cause of infant mortality worldwide. Lung ultrasound technology (LUS) is a novel imaging diagnostic tool for the early detection of respiratory distress and offers several advantages due to its low-cost, relative safety, portability, and easy repeatability. More precise and efficient diagnostic and therapeutic strategies are needed. Deep-learning-based computer-aided diagnosis (CADx) systems, using chest X-ray images, have recently demonstrated their potential as a screening tool for pulmonary disease (such as COVID-19 pneumonia). We present the first computer-aided diagnostic scheme for LUS images of pulmonary diseases in children. In this study, we trained from scratch four state-of-the-art deep-learning models (VGG19, Xception, Inception-v3 and Inception-ResNet-v2) for detecting children with bronchiolitis and pneumonia. In our experiments we used a data set consisting of 5,907 images from 33 healthy infants, 3,286 images from 22 infants with bronchiolitis, and 4,769 images from 7 children suffering from bacterial pneumonia. Using four-fold cross-validation, we implemented one binary classification (healthy vs. bronchiolitis) and one three-class classification (healthy vs. bronchiolitis vs. bacterial pneumonia) out of three classes. Affine transformations were applied for data augmentation. Hyperparameters were optimized for the learning rate, dropout regularization, batch size, and epoch iteration. The Inception-ResNet-v2 model provides the highest classification performance, when compared with the other models used on test sets: for healthy vs. bronchiolitis, it provides 97.75% accuracy, 97.75% sensitivity, and 97% specificity whereas for healthy vs. bronchiolitis vs. bacterial pneumonia, the Inception-v3 model provides the best results with 91.5% accuracy, 91.5% sensitivity, and 95.86% specificity. We performed a gradient-weighted class activation mapping (Grad-CAM) visualization and the results were qualitatively evaluated by a pediatrician expert in LUS imaging: heatmaps highlight areas containing diagnostic-relevant LUS imaging-artifacts, e.g., A-, B-, pleural-lines, and consolidations. These complex patterns are automatically learnt from the data, thus avoiding hand-crafted features usage. By using LUS imaging, the proposed framework might aid in the development of an accessible and rapid decision support-method for diagnosing pulmonary diseases in children using LUS imaging.

Real-World Verification of Artificial Intelligence Algorithm-Assisted Auscultation of Breath Sounds in Children

Objective: Lung auscultation plays an important role in the diagnosis of pulmonary diseases in children. The objective of this study was to evaluate the use of an artificial intelligence (AI) algorithm for the detection of breath sounds in a real clinical environment among children with pulmonary diseases.Method: The auscultations of breath sounds were collected in the respiratory department of Shanghai Children's Medical Center (SCMC) by using an electronic stethoscope. The discrimination results for all chest locations with respect to a gold standard (GS) established by 2 experienced pediatric pulmonologists from SCMC and 6 general pediatricians were recorded. The accuracy, sensitivity, specificity, precision, and F1-score of the AI algorithm and general pediatricians with respect to the GS were evaluated. Meanwhile, the performance of the AI algorithm for different patient ages and recording locations was evaluated.Result: A total of 112 hospitalized children with pulmonary diseases were recruited for the study from May to December 2019. A total of 672 breath sounds were collected, and 627 (93.3%) breath sounds, including 159 crackles (23.1%), 264 wheeze (38.4%), and 264 normal breath sounds (38.4%), were fully analyzed by the AI algorithm. The accuracy of the detection of adventitious breath sounds by the AI algorithm and general pediatricians with respect to the GS were 77.7% and 59.9% (p < 0.001), respectively. The sensitivity, specificity, and F1-score in the detection of crackles and wheeze from the AI algorithm were higher than those from the general pediatricians (crackles 81.1 vs. 47.8%, 94.1 vs. 77.1%, and 80.9 vs. 42.74%, respectively; wheeze 86.4 vs. 82.2%, 83.0 vs. 72.1%, and 80.9 vs. 72.5%, respectively; p < 0.001). Performance varied according to the age of the patient, with patients younger than 12 months yielding the highest accuracy (81.3%, p < 0.001) among the age groups.Conclusion: In a real clinical environment, children's breath sounds were collected and transmitted remotely by an electronic stethoscope; these breath sounds could be recognized by both pediatricians and an AI algorithm. The ability of the AI algorithm to analyze adventitious breath sounds was better than that of the general pediatricians.

Diagnosis of common pulmonary diseases in children by X-ray images and deep learning

Acute lower respiratory infection is the leading cause of child death in developing countries. Current strategies to reduce this problem include early detection and appropriate treatment. Better diagnostic and therapeutic strategies are still needed in poor countries. Artificial-intelligence chest X-ray scheme has the potential to become a screening tool for lower respiratory infection in child. Artificial-intelligence chest X-ray schemes for children are rare and limited to a single lung disease. We need a powerful system as a diagnostic tool for most common lung diseases in children. To address this, we present a computer-aided diagnostic scheme for the chest X-ray images of several common pulmonary diseases of children, including bronchiolitis/bronchitis, bronchopneumonia/interstitial pneumonitis, lobar pneumonia, and pneumothorax. The study consists of two main approaches: first, we trained a model based on YOLOv3 architecture for cropping the appropriate location of the lung field automatically. Second, we compared three different methods for multi-classification, included the one-versus-one scheme, the one-versus-all scheme and training a classifier model based on convolutional neural network. Our model demonstrated a good distinguishing ability for these common lung problems in children. Among the three methods, the one-versus-one scheme has the best performance. We could detect whether a chest X-ray image is abnormal with 92.47% accuracy and bronchiolitis/bronchitis, bronchopneumonia, lobar pneumonia, pneumothorax, or normal with 71.94%, 72.19%, 85.42%, 85.71%, and 80.00% accuracy, respectively. In conclusion, we provide a computer-aided diagnostic scheme by deep learning for common pulmonary diseases in children. This scheme is mostly useful as a screening for normal versus most of lower respiratory problems in children. It can also help review the chest X-ray images interpreted by clinicians and may remind possible negligence. This system can be a good diagnostic assistance under limited medical resources.

Williams-Beuren syndrome presenting as pulmonary edema with pleural effusion: a new pulmonary manifestation of elastin vasculopathy

Introduction: Williams-Beuren syndrome (WBS) is a gene deletion disorder characterized by distinct facial features, cardiovascular anomalies, and intellectual disability. Many genes are involved in WBS, of which the elastin (ELN) gene deletion is almost present in all cases. Limited data exist about pulmonary diseases in children with WBS. Furthermore, pleural effusion (PE) has not been reported in these patients. Case Presentation: A term, small-for-gestational-age (SGA) male Caucasian newborn presented with respiratory distress shortly after vaginal birth. A chest radiograph showed significant pulmonary edema with bilateral pleural effusion. A 2D Echocardiogram demonstrated supravalvular aortic stenosis and branch pulmonary stenosis suspecting WBS. A genetic evaluation revealed an interstitial 1.5Mb deletion in the long arm of chromosome 7 involving band q11.23 confirming the diagnosis of WBS. The child underwent surgical repair at 4 months for age due to cardiac disease progression. Conclusions: An unexplained finding of pulmonary edema and PE in a newborn can be associated with genetic disorders and warrants investigation for WBS, especially in SGA newborns.

Lung ultrasound-a new diagnostic modality in persistent tachypnea of infancy.

Lung ultrasound (LUS) has been increasingly used in diagnosing and monitoring of various pulmonary diseases in children. The aim of the current study was to evaluate its usefulness in children with persistent tachypnea of infancy (PTI). This was a controlled, prospective, cross-sectional study that included children with PTI and healthy subjects. In patients with PTI, LUS was performed at baseline and then after 6 and 12 months of follow-up. Baseline results of LUS were compared to (a) baseline high-resolution computed tomography (HRCT) images, (b) LUS examinations in control group, and (c) follow-up LUS examinations. Twenty children with PTI were enrolled. B-lines were found in all children with PTI and in 11 (55%) control subjects (P < .001). The total number of B-lines, the maximal number of B lines in any intercostal space, the distance between B-lines, and pleural thickness were significantly increased in children with PTI compared to controls. An irregularity of the pleural line was found in all patients with PTI and in none of the healthy children. There were no significant changes in LUS findings in patients with PTI during the study period. The comparison of HRCT indices and LUS findings revealed significant correlations between the mean lung attenuation, skewness, kurtosis and fraction of interstitial pulmonary involvement, and the number of B-lines as well as the pleural line thickness. LUS seems to be a promising diagnostic tool in children with PTI. Its inclusion in the diagnostic work-up may enable to reduce the number of costly, hazardous, and ionizing radiation-based imaging procedures.

Ultra‐low‐dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

ObjectiveTo evaluate the feasibility of using ultra‐low‐dose computed tomography of the chest with iterative reconstruction without anesthesia for assessment of pulmonary diseases in children. MethodsThis prospective study enrolled 86 consecutive pediatric patients (ranging from 1 month to 18 years) that underwent ultra‐low‐dose computed tomography due to suspicion of pulmonary diseases, without anesthesia and contrast. Parameters used were: 80kVp; 15–30mA; acquisition time, 0.5s; and pitch, 1.375. The adaptive statistical iterative reconstruction technique was used. Subjective visual evaluation and quantitative assessment of image quality were done using a 5‐point scale in 12 different structures of the chest. ResultsMean age was 66 months (interquartile range, 16–147). Final diagnosis was performed in all exams, and 44 (51.2%) were diagnosed with cystic fibrosis, 27 (31.4%) with bronchiolitis obliterans, and 15 (17.4%) with congenital pulmonary airways malformations. Diagnostic quality was achieved in 98.9%, of which 82.6% were considered excellent and 16.3% were slightly blurred but did not interfere with image evaluation. Only one case (1.2%) presented moderate blurring that slightly compromised the image, and previous examinations demonstrated findings compatible with bronchiolitis obliterans. Mean effective radiation dose was 0.39±0.15mSv. Percentages of images with motion artifacts were 0.3% for cystic fibrosis, 1.3% for bronchiolitis obliterans, and 1.1% for congenital pulmonary airways malformations. ConclusionChest ultra‐low‐dose computed tomography without sedation or anesthesia delivering a sub‐millisievert dose can provide image quality to allow identification of common pulmonary anatomy and diseases.

Feasibility of Training Clinical Officers in Point-of-Care Ultrasound for Pediatric Respiratory Diseases in Aweil, South Sudan

.Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such as Aweil, South Sudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat children with antibiotics who only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings. Our goal was to examine the feasibility of training the mid-level provider cadre clinical officers (COs) in a Médecins Sans Frontières project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) between COs and experts for lung consolidation with air bronchograms was 0.73 (0.63–0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74–0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.

Актуальные вопросы хронических неспецифических заболеваний легких у детей

Актуальные вопросы хронических неспецифических заболеваний легких у детей

Ultra-low-dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

ObjectiveTo evaluate the feasibility of using ultra-low-dose computed tomography of the chest with iterative reconstruction without anesthesia for assessment of pulmonary diseases in children. MethodsThis prospective study enrolled 86 consecutive pediatric patients (ranging from 1 month to 18 years) that underwent ultra-low-dose computed tomography due to suspicion of pulmonary diseases, without anesthesia and contrast. Parameters used were: 80kVp; 15–30mA; acquisition time, 0.5s; and pitch, 1.375. The adaptive statistical iterative reconstruction technique was used. Subjective visual evaluation and quantitative assessment of image quality were done using a 5-point scale in 12 different structures of the chest. ResultsMean age was 66 months (interquartile range, 16–147). Final diagnosis was performed in all exams, and 44 (51.2%) were diagnosed with cystic fibrosis, 27 (31.4%) with bronchiolitis obliterans, and 15 (17.4%) with congenital pulmonary airways malformations. Diagnostic quality was achieved in 98.9%, of which 82.6% were considered excellent and 16.3% were slightly blurred but did not interfere with image evaluation. Only one case (1.2%) presented moderate blurring that slightly compromised the image, and previous examinations demonstrated findings compatible with bronchiolitis obliterans. Mean effective radiation dose was 0.39±0.15mSv. Percentages of images with motion artifacts were 0.3% for cystic fibrosis, 1.3% for bronchiolitis obliterans, and 1.1% for congenital pulmonary airways malformations. ConclusionChest ultra-low-dose computed tomography without sedation or anesthesia delivering a sub-millisievert dose can provide image quality to allow identification of common pulmonary anatomy and diseases.

Flexible bronchoscopy in pulmonary diseases in children with congenital cardiovascular abnormalities.

There is a lack of data describing the role of flexible bronchoscopy (FB) in evaluating pulmonary diseases in children with congenital cardiovascular abnormalities in China. Determining whether those children suffer from respiratory complications may be useful for future preoperative planning and family counseling. The present study aimed to investigate the features and FB-associated findings with respect to pulmonary diseases in children with congenital cardiovascular abnormalities. The role of FB in guiding the treatment and safety of procedures was also evaluated. A cohort of 57 children with congenital cardiovascular abnormalities underwent FB for pulmonary diseases between November 2013 and June 2015. The demographics, bronchoscopy diagnoses, cellular analysis and microbiology of bronchoalveolar lavage fluid (BALF), and the clinically valuable contributions and side-effects of FB were analyzed retrospectively. The bronchoscopies were performed in patients with a median age of 4 months (range, 9 days-9 years) and 9 patients were intubated and mechanically ventilated. The most common types of congenital cardiovascular abnormalities were atrial septal defect, ventricular septal defect and patent ductus arteriosus. External compression of airways, tracheobronchomalacia, laryngomalacia, and airway narrowing were the most common airway abnormalities revealed by FB. BALF cellular analysis revealed an elevated total cell count and neutrophil percentage; 19.2% specimens harbored an etiological agent. FB findings contributed towards the clinical management of 26.3% patients. The complications of FB were mild and transient. In the present study, the majority of patients with cardiovascular abnormalities exhibited other airway disorders. The present findings suggest that FB was a useful and safe tool in the evaluation of this specific group of children.

Pay attention to congenital pulmonary diseases in children

Pay attention to congenital pulmonary diseases in children

Chronic obstructive pulmonary diseases in children

ObjectivesTo verify and describe the main events related to the diagnosis and management of chronic obstructive pulmonary diseases in children (COPDC) and adolescents, considering the interrelated physiopathology, genetic, and environmental characteristics. SourcesRelevant literature from PubMed was selected and reviewed. Summary of the findingsCOPDC have an environmental and/or genetic origin and its manifestation has manifold genotypes, phenotypes, and endotypes. Although COPDC has no cure, it can be clinically controlled. Chronic cough is the main symptom and bronchiectasis can be present in several COPDC patients. The management of COPDC is more effective if based on guidelines and when treatment regimen adherence is promoted. Oral and inhaled corticosteroids, bronchodilators, inhaled antibiotics, and treatment of pulmonary exacerbation (PE) are the bases of COPDC management, and should be individualized for each patient. ConclusionsCorrect diagnosis and knowledge of risk factors and comorbidities are essential in COPDC management. Procedures and drugs used should be based on specific guidelines for each COPDC case. Treatment adherence is critical to obtain the benefits of management. COPDC clinical control must be evaluated by the decrease in PEs, improved quality of life, reduction of pulmonary function loss, and lung structural damage. For most cases of COPDC, monitoring by interdisciplinary teams in specialized reference centers with surveillance strategies and continuous care leads to better outcomes, which must be evaluated by decreasing pulmonary function damage and deterioration, better prognosis, better quality life, and increased life expectancy.

Chronic obstructive pulmonary diseases in children

ObjectivesTo verify and describe the main events related to the diagnosis and management of chronic obstructive pulmonary diseases in children (COPDC) and adolescents, considering the interrelated physiopathology, genetic, and environmental characteristics. SourcesRelevant literature from PubMed was selected and reviewed. Summary of the findingsCOPDC have an environmental and/or genetic origin and its manifestation has manifold genotypes, phenotypes, and endotypes. Although COPDC has no cure, it can be clinically controlled. Chronic cough is the main symptom and bronchiectasis can be present in several COPDC patients. The management of COPDC is more effective if based on guidelines and when treatment regimen adherence is promoted. Oral and inhaled corticosteroids, bronchodilators, inhaled antibiotics, and treatment of pulmonary exacerbation (PE) are the bases of COPDC management, and should be individualized for each patient. ConclusionsCorrect diagnosis and knowledge of risk factors and comorbidities are essential in COPDC management. Procedures and drugs used should be based on specific guidelines for each COPDC case. Treatment adherence is critical to obtain the benefits of management. COPDC clinical control must be evaluated by the decrease in PEs, improved quality of life, reduction of pulmonary function loss, and lung structural damage. For most cases of COPDC, monitoring by interdisciplinary teams in specialized reference centers with surveillance strategies and continuous care leads to better outcomes, which must be evaluated by decreasing pulmonary function damage and deterioration, better prognosis, better quality life, and increased life expectancy.

Lung diseases in children

Lung diseases belong to the most common acute and chronic childhood diseases. With specific diagnostics and therapy the outcome of many congenital and acquired pulmonary diseases in children and adults can be substantially improved. The aim of this review is the presentation and evaluation of important lung diseases in children taking recent developments into consideration. This article presents a review of the literature on selected acute and chronic lung diseases in children and adolescents. Acute pneumonia remains one of the most frequent causes of mortality in children worldwide. Antibiotic treatment has reduced the morbidity and mortality in Western industrialized countries; however, the treatment of complications, such as pleural empyema and lung abscesses remains challenging. With a prevalence of 10 %, asthma has evolved into the most common chronic disease in children and adolescents in Germany. Using anti-inflammatory inhalation therapy, effective control of asthma symptoms can be achieved in most patients. Cystic fibrosis (CF) remains the most common fatal inherited disease among Caucasians. More than 90 % of the mortality and morbidity of CF are caused by an early onset and progressive chronic obstructive lung disease. Approval of the first causal mutation-specific pharmacotherapy for a subgroup of patients with CF represents a milestone in individualized therapy of lung diseases. The pathogenesis of other rare chronic lung diseases including interstitial lung diseases (ILD) is still mostly unknown. Continuous improvement in the diagnostics and therapy is crucial to further improve the management and outcome of acute and chronic lung diseases in children. Pediatric pulmonology, as an interdisciplinary subspecialty at the interface of pediatrics, pulmonology and infectious diseases, plays a key role in the translation of scientific progress into clinical practice.

Ambient Environmental risk factors for childhood wheezing illness.

It is a great consensus in the scientific community that environmental factors, such as weather conditions and ambient air pollution, have vital impacts on respiratory diseases. Further, these factors imply the potential to have many significant impacts on aeroallergens, and therefore related diseases such as asthma and allergic rhinitis. The impacts are more pronounced in sensitive groups of population, such as children and elderly, living in urbanized areas. Over the last three decades, studies have shown changes in production, dispersion and allergen content of pollen and spores, which may be region- and species-specific. In addition, these changes may have been influenced by air pollutants interacting directly with pollen. It is not easy to evaluate the impact of climate change and air pollution on the prevalence of asthma in general and on the timing of asthma exacerbations. However, the global rise in asthma prevalence and severity suggests that air pollution and climate changes could be contributing. The objective of this review is to summarize the environmental impacts on pulmonary diseases in children based on recent literature over the world.