Respiratory Symptoms In Children Research Articles

Socioeconomic and Health Determinants of the Prevalence of COVID-19 in a Population of Children with Respiratory Diseases and Symptoms.

Most epidemiological studies indicate that bronchial asthma is not a risk factor for COVID-19, but previous analyses have not additionally focused on the socioeconomic determinants of SARS-CoV-2 infection in children with asthma, bronchitis, and respiratory symptoms. This research aimed to investigate the correlation between the socioeconomic status of families and the prevalence of respiratory conditions such as asthma, bronchitis, and respiratory symptoms in children, in addition to exploring their association with the prevalence of COVID-19. The study involved a cross-sectional epidemiological investigation conducted in 2022, encompassing 2454 students from elementary schools in Poland. The parents of the students completed a questionnaire modeled after the International Study on Asthma and Allergies in Childhood (ISAAC). Socioeconomic status (SES) indicators were determined based on parental education, self-reported economic status, and housing conditions. To assess the impact of social factors and health on the occurrence of COVID-19, odds ratios (ORs) were calculated. The findings revealed several COVID-19 risk factors, including higher maternal (OR 2.2; 95%CI: 1.3-3.0) and paternal education (OR 1.9; 95%CI: 1.3-2.4), urban residence (OR 1.7; 95%CI: 1.3-2.1), the presence of mold in residences (OR 1.7; 95%CI: 1.0-2.3), bronchitis (OR 1.5; 95%CI: 1.2-2.0), and chronic cough (OR 1.8; 95%CI: 1.3-2.4). Further analysis, stratifying children based on their baseline health status (i.e., presence or absence of asthma, bronchitis, and chronic cough), indicated that higher parental education increased the risk of COVID-19 solely for children without pre-existing conditions. The occurrence of SARS-CoV-2 infections was found to be notably associated with mold exposure in children who did not have bronchial asthma. Rigorous multivariate analyses substantiated the collective impact of factors such as residential environment, the existence of mold and moisture, and a history of bronchitis. This study's conclusions highlight a higher frequency of SARS-CoV-2 infections in cases where bronchitis had been diagnosed previously and chronic cough was prevalent. Interestingly, the initially hypothesized higher prevalence of COVID-19 among children with bronchial asthma did not receive confirmation in our findings. This study highlights the importance of urban residence, exposure to mold or dampness, and higher parental education in the incidence of COVID-19. Higher parental education was a significant factor in increasing the risk of COVID-19 among children without bronchitis, chronic cough, and asthma.

Clinical efficacy and satisfaction of a digital wheeze detector in a multicentre randomised controlled trial: the WheezeScan study.

Wheezing is common in preschool children and its clinical assessment often challenging for caretakers. This study aims to evaluate the impact of a novel digital wheeze detector (WheezeScan™) on disease control in a home care setting. A multicentre randomised open-label controlled trial was conducted in Berlin, Istanbul and London. Participants aged 4-84 months with a doctor's diagnosis of recurrent wheezing in the past 12 months were included. While the control group followed usual care, the intervention group received the WheezeScan™ for at-home use for 120 days. Parents completed questionnaires regarding their child's respiratory symptoms, disease-related and parental quality of life, and caretaker self-efficacy at baseline (T0), 90 days (T1) and 4 months (T2). A total of 167 children, with a mean±sd age of 3.2±1.6 years, were enrolled in the study (intervention group n=87; control group n=80). There was no statistically significant difference in wheeze control assessed by TRACK (mean difference 3.8, 95% CI -2.3-9.9; p=0.2) at T1 between treatment groups (primary outcome). Children's and parental quality of life and parental self-efficacy were comparable between both groups at T1. The evaluation of device usability and perception showed that parents found it useful. In the current study population, the wheeze detector did not show significant impact on the home management of preschool wheezing. Hence, further research is needed to better understand how the perception and usage behaviour may influence the clinical impact of a digital support.

Enterovirus D68 vRNA induces type III IFN production via MDA5

Enterovirus D68 (EV-D68) primarily spreads through the respiratory tract and causes respiratory symptoms in children and acute flaccid myelitis (AFM). Type III interferons (IFNs) play a critical role in inhibiting viral growth in respiratory epithelial cells. However, the mechanism by which EV-D68 induces type III IFN production is not yet fully understood. In this study, we show that EV-D68 infection stimulates Calu-3 cells to secrete IFN-λ. The transfection of EV-D68 viral RNA (vRNA) stimulated IFN-λ via MDA5. Furthermore, our findings provide evidence that EV-D68 infection also induces MDA5-IRF3/IRF7-mediated IFN-λ. In addition, we discovered that EV-D68 infection downregulated MDA5 expression. Knockdown of MDA5 increased EV-D68 replication in Calu-3 cells. Finally, we demonstrated that the IFN-λ1 and IFN-λ2/3 proteins effectively inhibit EV-D68 infection in respiratory epithelial cells. In summary, our study shows that EV-D68 induces type III IFN production via the activated MDA5-IRF3/IRF7 pathway and that type III IFNs inhibit EV-D68 replication in Calu-3 cells.

Nutrition impacts of non-solid cooking fuel adoption on under-five children in developing countries

This paper examines the nutrition impacts of using non-solid cooking fuel on under-five children in developing countries. We draw on data from more than 1.12 million children in 62 developing countries from the Demographic and Health Surveys (DHS). Results from both fixed effects (FE) and instrumental variable (IV) estimates show that using non-solid cooking fuel significantly improves the nutrition outcomes of under-five children. Compared with their peers from households mainly using solid fuel, children from households mainly using non-solid fuel exhibit a lower probability of experiencing stunting (by 5.9 percentage points) and being underweight (by 1.2 percentage points). Our further investigation provides evidence for several underlying mechanisms, such as improved indoor air quality, induced reduction in children's respiratory symptoms, benefits on maternal health, and reduction in maternal time spent on fuel collection or cooking. Heterogenous analyses suggest that the nutrition benefits of using non-solid cooking fuel are more prominent among boys, children above three years old, and those from households of lower socioeconomic status, rural areas, and Southeast Asia.

2628. Prevalence of respiratory symptoms in children and staff in Pre-K—12th grade schools and subsequent results from respiratory virus testing

Abstract Background Little is known about the prevalence of respiratory symptoms and associated respiratory virus detection in students/ staff in primary and secondary schools. Methods School KIDS is a prospective respiratory viral surveillance program in a large Missouri school district. Participating students/ staff complete a monthly electronic symptom survey that asks about respiratory symptoms (sx) in the preceding 7 days; participants are categorized based on the presence of any respiratory sx: ongoing (current), resolved, and no sx. Within 36 hours of survey completion, participants undergo surveillance respiratory viral testing at school. Self-administered nasal swabs are tested via multipathogen PCR assay (Table). Prevalence of respiratory viruses in participants with and without sx were calculated. A mixed-effect multivariable logistic regression model was used to compare odds of a sample testing positive based on surveillance sx and enrollee age. Results A total of 544 students (30 pre-kindergarten (preK), 320 elementary, 117 middle, and 77 high) and 224 staff enrolled. A total of 2,537 sx surveys with corresponding respiratory samples were collected from November 2, 2022–April 15, 2023 (Table). Of the samples provided, 1,138 were preK-elementary (45%), 368 middle (14%), 276 high (11%), and 755 staff (30%). Participants reported ongoing (20%), resolved (14%), and no sx (66%). Prevalence of commonly reported sx were congestion (21%), runny nose (17%), cough (16%), and fever (3%). Overall respiratory virus test positivity was 26%; 50% of positive samples came from participants without sx. Flu A, PIV, and RSV were more frequently detected in those with ongoing sx. AdV, HMPV, RV/EV, and SARS-CoV-2 were more frequently detected in those with no sx. Increased odds of a positive test were observed among enrollees who reported runny nose (adjusted OR 1.4 [CI 1.0, 1.8]), congestion (adjusted OR 2.2 [CI1.6, 2.8]), cough (adjusted OR 1.5 [CI 1.1, 1.9]), or sore throat (adjusted OR 1.5 [CI 1.1, 2.0]) but not fever (adjusted OR 1.1 [CI 0.7,1.8]). Conclusion More research is needed to understand if students with respiratory sx are more likely than asymptomatic students to shed transmissible respiratory viruses. Disclosures Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support

Maternal exposure to pyrethroid insecticides during pregnancy and respiratory allergy symptoms among children participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE)

BackgroundPyrethroid insecticides use for indoor residual spraying (IRS) in malaria-endemic areas results in high levels of exposure to local populations. Pyrethroids may cause asthma and respiratory allergies but no prior study has investigated this question in an IRS area. MethodsWe measured maternal urinary concentrations of pyrethroid metabolites (cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA) in samples collected at delivery from 751 mothers participating in the Venda Health Examination of Mothers, Babies, and their Environment (VHEMBE), a birth cohort study based in Limpopo, South Africa. At 3.5-year and 5-year follow-up visits, caregivers of 647 and 620 children, respectively, were queried about children's respiratory allergy symptoms based on validated instruments. We applied marginal structural models for repeated outcomes to estimate associations between biomarker concentrations and asthma diagnosis as well as respiratory allergy symptoms at ages 3.5 and 5 years. ResultsWe found that a10-fold increase in maternal urinary cis-DCCA, trans-DCCA and 3-PBA concentrations were associated with more than a doubling in the risk of doctor-diagnosed asthma (cis-DCCA: RR = 2.1, 95% CI = 1.3, 3.3; trans-DCCA: RR = 2.1, 95% CI = 1.1, 3.9; 3-PBA: RR = 2.4, 95% CI = 1.0, 5.8) and an about 80% increase in the risk of wheezing or whistling in the chest (cis-DCCA: RR = 1.8, 95% CI = 1.1, 3.0; trans-DCCA: RR = 1.7, 95% CI = 1.1, 2.6; 3-PBA: RR = 1.8, 95% CI = 1.0, 3.3) and suspected asthma (cis-DCCA: RR = 1.8, 95% CI = 1.1, 3.1; trans-DCCA: RR = 1.8, 95% CI = 1.1, 2.8). We also observed that higher concentrations of cis-DBCA and 3-PBA were related to increases in the risks of dry cough at night (RR = 3.5, 95% CI = 1.3, 9.5) and seasonal rhinoconjunctivitis (RR = 2.0, 95% CI = 1.1, 3.9), respectively. ConclusionMaternal exposure to pyrethroids may increase the risk of asthma and other respiratory allergy symptoms among preschool children from an IRS area.

Associations between prenatal exposure to outdoor PM2.5 and NO2 and childhood respiratory symptoms

Abstract Background Prenatal and early-life air pollution exposures have shown to play an important role in childhood respiratory and allergic diseases development. Our aim was to assess the effect of prenatal exposure to air pollution on several respiratory outcomes up to 12 years old. Methods We included 2054 children from the PELAGIE mother-child cohort in Brittany, France, followed-up at 2-, 6- or 12-years. Parents reported children's respiratory health history, family lifestyle and children immediate environment. PM2.5 and NO2 mean concentrations throughout the pregnancy were modelled at residential address using land use regression models. Ever asthma, rhinitis, allergic rhinitis and eczema at 12-years follow-up, considered as outcomes of interest, were defined using validated questionnaires. A multimorbidity phenotype was also constructed. We performed adjusted logistic regressions per increase of one interquartile range (IQR). Results Participating mothers’ mean age was 30 years (SD 4.1), 88% did not smoke during pregnancy, and 82% lived in rural areas. Fifty percent of children were boys; 55% of them had parents with history of asthma and/or allergies. Pregnancy concentrations of NO2 were 18.74±7.72μg/m3 (IQR=9.66) and PM2.5 15.11±2.21μg/m3 (IQR=3.38). Prevalence of asthma, rhinitis, allergic rhinitis and eczema was 28%, 11% and 38% respectively at 12-years follow-up. Overall, no significant associations were found with asthma, rhinitis or eczema, nor with the multimorbidity phenotype. Discussion/conclusions Prenatal exposures to ambient PM2.5 and NO2, at relatively low concentrations, did not show any significant associations with children's respiratory and allergic outcomes. Further analysis including logistic models stratified by sex and urban-rural area, and clustering approaches will be performed to assess if specific profiles of environmental exposures during pregnancy and early childhood are associated with childhood respiratory and allergic diseases. Key messages • The prenatal and postnatal periods are major vulnerability windows for children's respiratory health. • An exposome approach provides a better understanding of a larger set of urban/rural exposures and their associations with childhood respiratory and allergic diseases.

Comparison of Respiratory Symptoms among Under Five Children Living in Households Using Biomass Fuel and Fossil Fuel in An Urban Area of Bangladesh

A cross-sectional study was conducted at Uttarkhan Thana under Dhaka City Corporation, Bangladesh, between January and December of 2018, to compare respiratory symptoms in under five children living in households using biomass fuels and fossil fuels. The study community comprised of three areas named Vatulia, Munda and Pulartek of Ward No. 4 of Uttarkhan Thana. Total number of households were 1329. Population size in total was 5114, where 2548 were male and 2566 were female. Among them 200 households were chosen by simple random sampling technique – selected households had under five children and met the inclusion criteria (i.e., mother or caregiver of children under five years of age wanted to participate voluntarily. However, we excluded children having congenital anomalies and households using electricity for cooking purpose. A semi-structured questionnaire was used as data collection instrument. Questionnaire included socio-demographic characteristics such as age, sex, educational status, marital status, occupation, number of family members. Cooking related information, e.g., frequency of cooking, duration of cooking, type of fuel used, presence of children during cooking, sleeping in the kitchen and respiratory symptoms in children, e.g., nasal discharge, cough, breathing problems, chest tightness, wheezing, and sore throat were included in the data sheet. Besides, it contained information regarding location of the kitchen, area of the kitchen and presence of any ventilation facility and chimney. Nasal discharge (79.7% vs. 71.6%), cough (69.9% vs. 64.2%), and sore throat (9% vs. 6%) were more common in biomass fuel users’ children. In contrast, shortness of breath (22.4% vs. 18.8%) and wheezing (31.3% vs. 24.1%) were more common among fossil fuel users’ children. However, none of those differences were statistically significant (P>0.05). CBMJ 2023 July: vol. 12 no. 02 P: 164-170

Preterm birth, birth weight, infant weight gain and their associations with childhood asthma and spirometry: a cross-sectional observational study in Nairobi, Kenya

BackgroundIn sub-Saharan Africa, the origins of asthma and high prevalence of abnormal lung function remain unclear. In high-income countries (HICs), associations between birth measurements and childhood asthma and lung function...

The Association Between Urinary Concentrations of Organophosphate Metabolites and Asthma-Related Outcomes Among Schoolchildren From Informal Settlements.

Objectives: There is inconsistent evidence on the relationship between pesticide exposure and childhood respiratory outcomes in non-agricultural settings. This study investigated the association between organophosphate (OP) pesticide exposure and asthma-related outcomes in children residing in four informal settlements. Methods: The study was a longitudinal study of 590 schoolchildren, with a 12months follow-up period. A standardised questionnaire adopted from the International Study of Asthma and Allergies in Childhood was administered to caregivers for child's respiratory symptoms and household characteristics. Spirometry and fractional-exhaled nitric oxide, including a phadiatop test (atopy status) and urinary dialkyl phosphate (DAP) metabolites were measured at baseline and follow-up. DAP metabolites included diethylphosphate (DEP) and dimethyl phosphate (DMP) measured at baseline and follow-up and dimethylthiophosphate (DMTP) measured only at baseline. Results: The mean ages of schoolchildren were 9.9 ± 0.91years and the overal incidence proportions of new doctor diagnosed asthma was 2.2%. No consistent patterns of increased risk of asthma outcomes with increasing DAP concentrations was found in multivariate analysis. Conclusion: Future studies with longer follow-up periods and repeated OP biomonitoring are recommended.

Agricultural burning in Imperial Valley, California and respiratory symptoms in children: A cross-sectional, repeated measures analysis

Burning of agricultural fields is an understudied source of air pollution in rural communities in the United States. Smoke from agricultural burning contains air toxics that adversely impact respiratory health. Imperial County in southeastern California is a highly productive agricultural valley that heavily employs agricultural burning to clear post-harvest crop remnants. We related individual-level exposure to agricultural burns to parent-reported respiratory symptoms in children.We leveraged the Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) cohort of 735 predominantly Hispanic low-income elementary school students in Imperial County. Parents reported children's respiratory health symptoms and family demographic characteristics in questionnaires collected at enrollment and in annual follow-up assessments from 2017 to 2019. Permitted agricultural burns in Imperial County from 2016 to 2019 were spatially linked to children's geocoded residential addresses. We used generalized estimating equations to evaluate prevalence differences (PDs) in respiratory symptoms with increasing exposure to agricultural burning within 3 km in the 12 months prior to each assessment.Nearly half of children (346, 49 %) lived within 3 km of at least one agricultural burn in the year prior to study enrollment. In adjusted models, each additional day of agricultural burning in the prior year was associated with a one percentage point higher prevalence of wheezing (PD 1.1 %; 95 % CI 0.2 %, 2.0 %) and higher bronchitic symptoms (PD 1.0 %; 95 % CI -0.2 %, 2.1 %). Children exposed to four or more days of burning had an absolute increased prevalence of wheezing and bronchitic symptoms of 5.9 % (95 % CI -0.3 %, 12 %) and 5.6 % (95 % CI -1.8 %, 13 %), respectively, compared to no burn exposure. Associations with wheezing were stronger among children with asthma (PD 14 %; 95 % CI -1.4 %, 29 %).To our knowledge, this is the first U.S. study of agricultural burning and children's respiratory health. This work suggests that reducing agricultural burning could improve children's respiratory health.

COVID-19-induced liver injury in infants, children, and adolescents.

Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms in children. Most children develop an asymptomatic and mild illness, with a minority requiring specialist medical care. Gastrointestinal manifestations and liver injury can also occur in children following infection. The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion, immune response, or medication effects. Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease. However, the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes. On the other hand, the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor. Respiratory, hemodynamic, and nutritional supportive therapies are the mainstay of management. Vaccination of children at increased risk of developing severe COVID-19 disease is indicated. This review describes the liver manifestations in children with COVID-19, detailing its epidemiology, basic mechanisms, clinical expression, management, and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.

Dietary fibre in relation to lung function and respiratory symptoms from childhood to adulthood.

Epidemiological studies suggest beneficial associations between dietary fibre intake, lung function and chronic respiratory symptoms in adults. Our aim was to investigate the association between dietary fibre intake in childhood and respiratory health up to adulthood. The individual fibre intake of 1956 participants from the Swedish population-based birth cohort BAMSE was estimated from 98- and 107-item food frequency questionnaires at ages 8 and 16 years, respectively. At 8, 16 and 24 years, lung function was measured by spirometry. Respiratory symptoms (cough, mucus production, breathing difficulties/wheeze) were assessed by questionnaires, and airway inflammation by exhaled nitric oxide fraction (FENO) (≥25 ppb) at 24 years. Longitudinal associations with lung function were analysed by mixed-effects linear regression; associations with respiratory symptoms and airway inflammation were analysed by logistic regression, adjusting for potential confounders. There were no associations between fibre intake at 8 years, as total and from different sources, spirometry measurements and respiratory symptoms at 24 years. Higher fruit fibre intake tended to be inversely associated with airway inflammation at 24 years (OR 0.70, 95% CI 0.48-1.00), which became non-significant after exclusion of participants with food-related allergic symptoms (OR 0.74, 95% CI 0.49-1.10). No associations between fibre intake at 8 and 16 years as an updated lagged exposure and spirometry measurements up to 24 years were observed. In this longitudinal study, we observed no consistent association between dietary fibre intake in childhood and lung function or respiratory symptoms up to adulthood. Further research on dietary fibre in relation to respiratory health across the life course is needed.

Outpatient respiratory outcomes in children with BPD on supplemental oxygen.

Preterm children with bronchopulmonary dysplasia (BPD) frequently require supplemental oxygen in the outpatient setting. In this study, we sought to determine patient characteristics and demographics associated with need for supplemental oxygen at initial hospital discharge, timing to supplemental oxygen liberation, and associations between level of supplemental oxygen and likelihood of respiratory symptoms and acute care usage in the outpatient setting. A retrospective analysis of subjects with BPD on supplemental oxygen (O2 ) was performed. Subjects were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021. Data were obtained by chart review and caregiver questionnaires. Children with BPD receiving ≥1 Lof O2 were more likely to have severe BPD, pulmonary hypertension, and be older at initial hospital discharge. Children discharged on higher levels of supplemental O2 were slower to wean to room air compared to lower O2 groups (p < 0.001). Additionally, weaning off supplemental O2 in the outpatient setting was delayed in children with gastrostomy tubes and those prescribed inhaled corticosteroids, on public insurance or with lower household incomes. Level of supplemental O2 at discharge did not influence outpatient acute care usage or respiratory symptoms. BPD severity and level of supplemental oxygen use at discharge did not correlate with subsequent acute care usage or respiratory symptoms in children with BPD. Weaning of O2 however was significantly associated with socioeconomic status and respiratory medication use, contributing to the variability in O2 weaning in the outpatient setting.

Respiratory morbidity in preschool and school-age children born very preterm and its association with parents’ health-related quality of life and family functioning

The purpose of this study is to describe the prevalence and severity of respiratory symptoms in children born very preterm and to assess their association with parents’ health-related quality of life (HRQoL) and family functioning. We conducted a cross-sectional study and recruited children born less than 32 weeks’ gestation between January 2006 and December 2019, in the greater Zurich area, Switzerland. Between May and December 2021, parents were invited to complete an online survey for their preterm child and for a control term born (≥ 37 weeks’ gestation) sibling aged 1 to 18 years. We used a validated questionnaire to assess respiratory symptoms and thePediatrics Quality of Life Family Impact Module (PedsQL FIM) to assess parents’ HRQoL and family functioning. The survey was completed for 616 very preterm children (99 with bronchopulmonary dysplasia (BPD)) and 180 controls. Girls made up 45% (46% in controls) of the sample, and 63% (60% in controls) of participants were aged 6 to 18 years (school-age). Very preterm children reported a higher risk of respiratory symptoms than controls, especially preschoolers and those with moderate-to-severe BPD. Parents of children with “mild” and “moderate-severe” respiratory symptoms had on average −3.9 (95%CI: −6.6 to −1.1) and −8.2 (−11.2 to −5.2) lower PedsQL FIM total score, respectively, than parents of children with no symptoms. The same pattern was observed after stratifying by age categories. Conclusions: Our study suggests that respiratory morbidity in very preterm children has a negative impact on parents’ HRQoL and family functioning, even beyond the first years of life.What is Known:• The burden of respiratory morbidity associated with very premature birth is high and last far beyond the neonatal period.• Respiratory morbidity contributes to lower health-related quality of life (HRQoL) in parents of very preterm children in early infancy.What is New:• Respiratory morbidity in very preterm children has a negative impact on parents’ HRQoL and family functioning beyond the first years of life.• Parents of very preterm children with moderate and severe respiratory symptoms are the ones who report lower scores, both for preschool and school-age children.

Combined multi-channel intraluminal impedance measurement and pHmetry in the detection of gastroesophageal reflux disease in children with cystic fibrosis

ObjectiveTo assess the prevalence of GERD exclusively by means of multichannel intraluminal impedanciometry associated with pH monitoring (MIIpH) and compare it with respiratory symptoms in children with CF. To compare MIIpH with pHmetry alone to perform GERD diagnosis. MethodsAn analytical cross-sectional study was conducted with children diagnosed with CF who underwent MIIpH. Clinical and laboratory markers, including respiratory and digestive symptoms, were used for comparative analyses. High-resolution chest computed tomography was performed on patients with symptoms of chronic lung disease. Severity was classified according to the Bhalla score. ResultsA total of 29 children < 10 yo (18 girls) were evaluated; 19 of whom with physiological GER and 10 with GERD. Of the children with GERD, seven had predominantly acid GER, two acid+non-acid GER, and one non-acid GER. Three patients had GERD diagnosed only by MIIpH. Bhalla scores ranged from seven to 17.75 with no significant relationship with GERD. The number of pulmonary exacerbations was associated with a decrease in esophageal clearance regardless of the position in pHmetry and MIIpH. ConclusionsThe prevalence of GERD was 34% in children with CF. There was no association between respiratory disease severity and GER types. MIIpH detected 30% more patients with GERD than pHmetry.

Social Inequalities: Do They Matter in Asthma, Bronchitis, and Respiratory Symptoms in Children?

Background: Social inequalities (e.g., poverty and low level of education) generate inequalities in health. Aim: The aim of the study was to determine the relationships between indicators of social inequalities and the frequency of respiratory symptoms, asthma, and bronchitis in children. Material and Methods: In 2019, an epidemiological cross-sectional study on 3237 students from elementary schools in Silesia Voivodships (South Poland) was conducted. The students' parents completed a questionnaire based on the International Study on Asthma and Allergies in Childhood (ISAAC). Social inequalities in the children's families were determined according to parents' education and professional status (working vs. unemployed), self-assessment of economic status, and housing conditions. To determine the influence of social factors on the occurrence of asthma, bronchitis, and respiratory symptoms, the odds ratio (OR) was calculated. Results: Children living in apartments with traces of mold had a higher risk of developing asthma (OR = 1.5, 95%CI: 1.17-1.96; p = 0.002) or bronchitis (OR = 1.4, 95%CI: 1.13-1.72; p = 0.002), wheezing attacks at nights (OR = 1.4; 95%CI: 1.01-1.93), wheezy in the last 12 months (OR = 1.6; 95%CI:1.24-2.08; p &lt; 0.001), and chronic cough (OR = 1.9; 95%CI: 1.49-2.46; p &lt; 0.001). Exposure to environmental tobacco smoke (ETS) was associated with higher risk of cough (OR = 1.5 95%CI: 1.22-1.96; p &lt; 0.001) and dyspnea in the last 12 months (OR = 1.4; 95%CI: 1.04-2.00; p = 0.02). Low socioeconomic status (SES) was associated with increased risk of chronic cough (OR = 1.5; 95%CI: 1.09-2.03; p = 0.009) and increased risk of wheezy in the last 12 months (OR = 1.4; 95%CI: 1.06-1.97; p = 0.008). Asthma and bronchitis were not dependent on parents' education or professional status. Conclusions: Social inequalities have significant impacts on the occurrence of respiratory symptoms, bronchitis, and asthma in children. Interventions aimed at preventing bronchitis and childhood asthma should also focus on social health determinants.

Effective Treatment of Chronic Cough with Tinidazole as the Newest Antiprotozoa against Lophomonas blattarum.

Chronic cough is a common problem in the setting of family physicians. Recently, Lophomonas blattarum was considered a cause of respiratory symptoms in children and adults. This study is aimed at determining the effect of antiprotozoal treatment of Lophomonas in patients with a chronic cough in Mashhad during 2020-2021. This study was a randomized clinical trial. In this study, 60 patients with chronic cough and unremarkable imaging findings, who were unresponsive to three steps of standard treatment, were randomly assigned to the treatment, with 2 weeks of tinidazole and placebo. The tinidazole and placebo were prepared in a completely identical shape, and a random assignment was performed by a third party. The primary outcome was a complete resolution of cough. A follow-up of treatment was performed. Data were analyzed using the SPSS software version 25. The basic demographic results showed no significant differences of sex and age between two groups. The results of this study showed a complete resolution of all respiratory symptoms in 40% (12), a complete improvement of cough in 40% (12), and a complete resolution of dyspnea in 50% (10) of the tinidazole group. The remaining showed significant improvement in the severity of cough and dyspnea. Postnasal drip, sputum, body temperature, and airway hyperresponsiveness were improved significantly. After tinidazole treatment, laboratory assessment of bronchial lavage and sputum revealed that 86 percent of smears were converted to negative. Tinidazole effectively resolved the chronic cough and most of the respiratory symptoms. Lophomonas blattarum is a potential mechanism for chronic cough.

Increased rate of respiratory symptoms in children with Down syndrome: a 2-year web-based parent-reported prospective study

To compare the incidence of respiratory symptoms and short-term consequences between children with Down syndrome and children from the general population, we conducted a prospective parent-reported observational study. Children with Down syndrome (≤ 18 years) were included between March 2012 and June 2014. Caregivers received a baseline questionnaire with follow-up 1–2 years after inclusion. Caregivers received a weekly questionnaire about respiratory symptoms, fever, antibiotic prescriptions, doctor’s visits, and consequences for school and work attendance. Children with Down syndrome were compared to a cohort of the general population (“Kind en Ziek” study) with similar weekly questionnaires. A total of 9,011 childweeks were reported for 116 participants with Down syndrome (75% response rate). The frequency of respiratory symptoms was higher in children with Down syndrome than in children from the general population (30% vs 15.2%). In addition, symptoms subsided later (around 8 vs 5 years of age). The seasonal influence was limited, both in children with Down syndrome and children from the general population. Consequences of respiratory disease were significant in children with Down syndrome compared to children from the general population, with a higher rate of doctor’s visits (21.3% vs 11.8%), antibiotic prescriptions (47.8% vs 26.3%), and absenteeism from school (55.5% vs 25.4%) and work (parents, 9.4% vs 8.1%). Conclusion: Children with Down syndrome have a higher frequency of respiratory symptoms and symptoms last until a later age, confirming the impression of professionals and caregivers. Individualized treatment plans might prevent unfavorable consequences of chronic recurrent respiratory disease in children with Down syndrome.What is Known:• Children with Down syndrome have an altered immune system and are prone to a more severe course of respiratory tract infections.• The overall conception is that patients with Down syndrome suffer from respiratory tract infections more often.What is New:• Children with Down syndrome suffer from respiratory symptoms more frequently than children from the general population.• The respiratory symptoms in children with Down syndrome subside at a later age compared to children from the general population.

Housing quality and its impact on Acute Respiratory Infection (ARI) symptoms among children in Punjab, Pakistan.

Exposure to poor housing quality and household air pollution (HAP) are significant factors for morbidity and mortality in Pakistan. Children under five are particularly at risk of acute respiratory infections (ARIs). Globally, it has been estimated that 6.6 million children less than five years of age die every year from this disease. Little is known regarding the effect of HAP and poor housing quality on children's respiratory symptoms in Pakistan. Statistics concerning Pakistan's largest province, Punjab, are also not promising. Hence, an association between housing quality and respiratory symptoms among children under the age of five in Punjab has been studied in this paper. Using data from MICS 2017-18, logistic regression models were applied to the sample of 35000 children under the age of five living in poor housing quality. We estimated that acute respiratory infection (ARI) symptoms are higher among children when the floor of a house is made of natural material. However, the lower ARI symptoms were found among children living in a house with a wall made of natural material. On the other hand, we found that children residing in the western region of Punjab are at a higher risk of ARI symptoms. The findings remain consistent with the previous researchers. In addition to promoting increased access to quality housing material during construction activities, we suggest that critical community-based interventions are required to combat local issues and problems at the micro-level.