Respiratory Symptoms In Children Research Articles

Cross-sectional associations between ambient air pollution and respiratory signs and symptoms among young children in Tehran

Exposure to ambient air pollutants may significantly affect the incidence of respiratory symptoms and lung function in children. The present study examined the associations between exposure to ambient air pollutants and respiratory symptoms in children. In this cross-sectional study, 1070 children under the age of seven years were recruited from 61 day-care centers of Tehran in 2015. Initially, day-care centers were selected at a radius of 2 km from the air pollution monitoring stations, and subsequently all the children attending these day-care centers were interviewed. The data on the respiratory complaints of children were obtained by using the ATS questionnaire (ATS-DLD-78-C). Moreover, the annual average concentration of pollutants was calculated based on the time children spent at home and at the day-care center using the air pollution monitoring stations. Crude and adjusted logistic regression analysis was conducted. The findings indicated that ambient air SO2 and NO2 concentrations near home were associated with current asthma for 1 part per billion (ppb) increase with an OR of 1.20 (1.00–1.45) and 1.08 (1.01–1.15), respectively. The odds of developing persistent phlegm for each unit (ppm) of raise in the average annual concentration of CO in ambient air near home (OR 1.40; 1.09 to 1.81) increased as well. The daily mean concentration of PM2.5, PM10, and SO2 was higher than the limits provided in the World Health Organization (WHO) air quality guidelines (AQGS). Moreover, the prevalence of severe wheezing, asthma history, and bronchitis was higher in boys. Therefore, long-term exposure to ambient air pollutants such as SO2, NO2, and CO may be associated with an increase in current asthma and persistent phlegm in children.

A 3.4-Å cryo-electron microscopy structure of the human coronavirus spike trimer computationally derived from vitrified NL63 virus particles.

Human coronavirus NL63 (HCoV-NL63) is an enveloped pathogen of the family Coronaviridae that spreads worldwide and causes up to 10% of all annual respiratory diseases. HCoV-NL63 is typically associated with mild upper respiratory symptoms in children, elderly and immunocompromised individuals. It has also been shown to cause severe lower respiratory illness. NL63 shares ACE2 as a receptor for viral entry with SARS-CoV-1 and SARS-CoV-2. Here, we present the in situ structure of HCoV-NL63 spike (S) trimer at 3.4-Å resolution by single-particle cryo-EM imaging of vitrified virions without chemical fixative. It is structurally homologous to that obtained previously from the biochemically purified ectodomain of HCoV-NL63 S trimer, which displays a three-fold symmetric trimer in a single conformation. In addition to previously proposed and observed glycosylation sites, our map shows density at other sites, as well as different glycan structures. The domain arrangement within a protomer is strikingly different from that of the SARS-CoV-2S and may explain their different requirements for activating binding to the receptor. This structure provides the basis for future studies of spike proteins with receptors, antibodies or drugs, in the native state of the coronavirus particles.

The Possible Therapeutic Effects of Some Medicinal Plants for Chronic Cough in Children.

The use of plants or their isolated bioactive components for the prevention and treatment of various disorders has been developed. Here, we aim to identify effective medicinal plants for relief of cough and respiratory symptoms in children. The data of this review article were obtained from published articles in scientific databases, including PubMed, Google Scholar, and Scopus, until December 2019. The keywords, including “Zataria multiflora Boiss.” OR “Portulaca oleracea L.” OR “Ferula assa-foetida L.” OR “Nigella sativa L.” AND “respiratory symptoms” OR “airway inflammation” OR “smooth muscle relaxant effects,” were searched individually or combined. The mentioned medicinal plants decreased total white blood cell (WBC), neutrophils, and eosinophils counts of blood and lung lavage in animal model-induced respiratory disorders. These plants also have protective effects on serum immunoglobulin, antibody titer, eosinophil count, and proinflammatory cytokines. Evidence from the studies indicated that the abovementioned medicinal plants have smooth muscle relaxant properties (bronchodilator effects) via stimulation of β-adrenoceptor or inhibition of muscarinic receptors (in vitro) and also improved the pulmonary function test in clinical settings. These medicinal plants are safe and easy to use. Based on the anti-inflammatory, anti-antispasmodic, and immunomodulatory effects, the clinical benefit may be assumed, therefore considering a place for these medicinal plants in relieve of chronic cough and symptoms of children's allergy, asthma, and common cold.

COVID-19 in children: An overview

COVID-19 or Coronavirus 2 had emerged in Wuhan, Hubei province in China in December 2019 only. From there it spread to almost whole of the world, spreading to many continents, WHO declared it as pandemic. So far, more than 3.5 million of the world population is infected and more than 245,000 people have died. Coronaviruses as such usually causes mild respiratory symptoms in children; however, SARS-CoV-2 or COVID-19 can cause severe acute respiratory syndrome (SARS) or death. Children presenting with respiratory distress have to be managed in intensive care units. COVID-19 spreads by the human to human transmission, forcing many countries going through administrationimposed lockdowns bringing economic activity to a halt. At present, there is no approved antiviral drug for specific therapy for COVID-19, therefore personal hygiene and social distancing play a major role in its prevention. In children the presentation can be mild, not raising any suspicion but has huge potential to cause community spread with a huge socio-economic cost.

Seasonal differences in the treatment of childhood asthma

Purpose: The purpose of the current study was to examine the frequency of respiratory symptoms in children with asthma who were off their medication during summer season.Materials and Methods: The records of 212 children with mild and moderate asthma were retrospectively analyzed between June and September 2017 at the pediatric pulmonary section, Mersin City Training & Research Hospital. Demographic characteristics, severity of asthma symptoms, current treatment, summer and fall season asthma attacks were compared among groups.Results: Data for a total 212 children at ages between 31/2 and 18 years were analyzed. Most patients did not report any asthma exacerbations (77.7% in preschool group and 87.0% in school-aged group) during summer. Approximately 42.6% of patients in preschool group and 32.6% of patients in school group showed variable asthma symptoms at the time of their fall clinic visit. Most patients did not report any asthma exacerbations (72.0% in preschool group and 70.9% in school-aged group) during summer. Approximately 44.0% of patients in preschool group and 56.2 % of patients in school group showed variable asthma symptoms at the time of their fall clinic visit.Conclusion: Most children with mild persistent asthma and moderate persistent asthma did not show any exacerbation in the absence of asthma controller treatment during summer. However, such a practice resulted an increase of asthma exacerbations during the subsequent fall season.

Has a singular focus of building regulations created unhealthy homes?

The energy efficiency performance requirements of the Australian National Construction Code have been regularly enhanced since 2003 to reduce greenhouse gas emissions. Since 2010 research has increasingly raised a concern about high air moisture content, moisture accumulation and mould growth. Coincidently, in Australia, asthma is the leading cause of disease in children aged 0–14 years, accounting for 17.9% of the total burden in boys and 18.6% in girls. Many researchers have supported a connection between damp housing and childhood respiratory symptoms. The contemporary code compliant houses in Australia may have inadvertently created ideal interior environments that promote mould growth. If the built environment is promoting mould growth, leading to sick building syndrome, it is a matter of serious concern, resulting from the design or technical flaws in the building fabric. This paper attempts to bridge the gap between architectural and medical science perspectives in this area of study.

Health effects of PM2.5 sources on children's allergic and respiratory symptoms in Fukuoka, Japan

Exposure to fine particulate matter (PM2.5) is a potential aggravating factor for respiratory and allergic diseases. However, which PM2.5 sources are associated with such diseases remains unclear. This study aimed to investigate the association of PM2.5 sources with allergic and respiratory symptoms in schoolchildren. PM2.5 samples were collected in Fukuoka during the spring in 2014 and 2015. Asian dust was observed in 2014. Ion components, elemental components, and organic components were analyzed. Positive matrix factorization (PMF) was conducted to calculate PM2.5 concentrations from each source. Mixed logistic regression analysis with a random intercept for each schoolchild was performed to evaluate the association of components and sources with symptoms. Among 2317 schoolchildren, the mean prevalence was 28.9%, 23.6%, 11.2%, and 11.4% for lower respiratory, nasal, ocular, and skin symptoms, respectively. PMF identified the following six PM2.5 sources “Secondary sulfate and coal combustion”, “Secondary nitrate”, “Heavy oil combustion”, “Sea salt”, “Soil” and “Traffic emission”. An interquartile range of PM2.5 mass was associated with nasal (Odds ratios 1.08, 95% confidence interval [1.03, 1.13]), ocular (1.10, [1.04, 1.16]), and skin symptoms (1.13, [1.06, 1.20]). Among the source factors, “Heavy oil combustion” was significantly associated with nasal symptom (1.11, [1.05, 1.18]) while “Sea salt” was associated with nasal (1.06, [1.02, 1.11]) and skin (1.073, [1.01, 1.14]) symptoms. We found “Soil”, which might be affected by Asian dust, was associated with ocular (1.07, [1.03, 1.10]) and skin (1.05, [1.01, 1.08]) symptoms. Further studies in other seasons or places are needed to clarify the influence of PM2.5 sources on children's health.

Association of biomass fuel smoke with respiratory symptoms among children under 5 years of age in urban areas: results from Bangladesh Urban Health Survey, 2013

BackgroundLittle is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age.MethodsData were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics.ResultsAround 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. The prevalence of respiratory symptoms of under-five children among in-house and outdoor biomass fuel users was 23.0% and 21.9%, respectively. Results of fitted multiple logistic regression models showed that the odds of having respiratory symptoms among children under 5 years of age were increased due to in-house biomass fuel use [OR = 1.18; 95% CI, 1.04–1.36] compared with the non-biomass user. An increased risk of respiratory symptoms was also significantly associated with mother’s birth complication [OR = 1.51; 95% CI, 1.36–1.67], non-government organization (NGO) membership of mothers [OR = 1.32; 95% CI, 1.16–1.51], age of the child (6–23m) [OR = 1.29; 95% CI, 1.10–1.52], and nutritional status (stunting) [OR = 1.18; 95% CI, 1.06–1.31].ConclusionThis study found the use of in-house biomass fuel as a significant risk factor associated with respiratory symptoms of children under 5 years of age. More longitudinal studies should be designed to establish a causal relationship between HAP (household air pollution) and respiratory symptoms among children with more direct measures of HAP and clinical procedure.

Coal burning-derived SO2 and traffic-derived NO2 are associated with persistent cough and current wheezing symptoms among schoolchildren in Ulaanbaatar, Mongolia

BackgroundChildren in Ulaanbaatar are exposed to air pollution, but few epidemiological studies have been conducted on the effects of environmental risk factors on children’s health. Also, no studies have yet examined the prevalence of respiratory symptoms in children in suburban areas, where air quality-monitoring stations have not yet been installed. This cross-sectional study evaluated the associations between outdoor air pollution and respiratory symptoms among schoolchildren in urban and suburban districts of Ulaanbaatar.MethodsThe ATS-DLD-78 C questionnaire was used to investigate the respiratory symptoms of schoolchildren aged 6–12 years (n = 1190) who lived in one of three urban districts or a suburban district of Ulaanbaatar. In each district, the outdoor concentrations of nitrogen dioxide (NO2) and sulfur dioxide (SO2) were measured at two sites (at ≤100 m and > 100 m from the nearest major road) in the 2-year period from 2015 to 2016. The associations between health outcomes and exposure to air pollutants were estimated using the multinomial logistic regression method.ResultsThe outdoor concentration of SO2 was significantly associated with persistent cough symptom (OR = 1.12, 95% CI 1.04–1.22). Furthermore, the outdoor concentration of NO2 was significantly associated with the current wheezing symptom (OR = 1.33, 95% CI 1.01–1.75) among children in urban and suburban.ConclusionsThe prevalence of persistent cough symptom was markedly high among the schoolchildren in urban/suburban districts of Ulaanbaatar. Overall, the increases in the prevalence of respiratory symptoms among children might be associated with ambient air pollution in Ulaanbaatar.

Influence of residential land cover on childhood allergic and respiratory symptoms and diseases: Evidence from 9 European cohorts

IntroductionRecent research focused on the interaction between land cover and the development of allergic and respiratory disease has provided conflicting results and the underlying mechanisms are not fully understood. In particular, green space, which confers an overall positive impact on general health, may be significantly contributing to adverse respiratory health outcomes. This study evaluates associations between surrounding residential land cover (green, grey, agricultural and blue space), including type of forest cover (deciduous, coniferous and mixed), and childhood allergic and respiratory diseases. MethodsData from 8063 children, aged 3–14 years, were obtained from nine European population-based studies participating in the HEALS project. Land-cover exposures within a 500 m buffer centred on each child's residential address were computed using data from the Coordination of Information on the Environment (CORINE) program. The associations of allergic and respiratory symptoms (wheeze, asthma, allergic rhinitis and eczema) with land coverage were estimated for each study using logistic regression models, adjusted for sex, age, body mass index, maternal education, parental smoking, and parental history of allergy. Finally, the pooled effects across studies were estimated using meta-analyses. ResultsIn the pooled analyses, a 10% increase in green space coverage was significantly associated with a 5.9%–13.0% increase in the odds of wheezing, asthma, and allergic rhinitis, but not eczema. A trend of an inverse relationship between agricultural space and respiratory symptoms was observed, but did not reach statistical significance. In secondary analyses, children living in areas with surrounding coniferous forests had significantly greater odds of reporting wheezing, asthma and allergic rhinitis. ConclusionOur results provide further evidence that exposure to green space is associated with increased respiratory disease in children. Additionally, our findings suggest that coniferous forests might be associated with wheezing, asthma and allergic rhinitis. Additional studies evaluating both the type of green space and its use in relation to respiratory conditions should be conducted in order to clarify the underlying mechanisms behind associated adverse impacts.

Children's acute respiratory symptoms associated with PM2.5 estimates in two sequential representative surveys from the Mexico City Metropolitan Area

BackgroundRespiratory diseases are a major component of morbidity in children and their symptoms may be spatially and temporally exacerbated by exposure gradients of fine particulate matter (PM2.5) in large polluted urban areas, like the Mexico City Metropolitan Area (MCMA). ObjectivesTo analyze the association between satellite-derived and interpolated PM2.5 estimates with children's (≤9 years old) acute respiratory symptoms (ARS) in two probabilistic samples representing the MCMA. MethodsWe obtained ARS data from the 2006 and 2012 National Surveys for Health and Nutrition (ENSaNut). Two week average exposure to PM2.5 was assessed for each household with spatial estimates from a hybrid model with satellite measurements of aerosol optical depth (AOD-PM2.5) and also with interpolated PM2.5 measurements from ground stations, from the Mexico City monitoring network (MNW-PM2.5). We used survey-adjusted logistic regressions to analyze the association between PM2.5 estimates and ARS reported on children. ResultsA total of 1,005 and 1,233 children were surveyed in 2006 and 2012 representing 3.1 and 3.5 million children, respectively. For the same years and over the periods of study, the estimated prevalence of ARS decreased from 49.4% (95% CI: 44.9,53.9%) to 37.8% (95% CI: 34,41.7%). AOD-PM2.5 and MNW-PM2.5 estimates were associated with significantly higher reports of ARS in children 0–4 years old [OR2006 = 1.29 (95% (CI): 0.99,1.68) and OR2006 = 1.24 (95% CI: 1.08,1.42), respectively]. We observed positive non-significant associations in 2012 in both age groups and in 2006 for children 5–9 years old. No statistically significant differences in health effect estimates of PM2.5 were found comparing AOD-PM2.5 or MNW-PM2.5 for exposure assessment. ConclusionsOur findings suggest that PM2.5 is a risk factor for the prevalence of ARS in children and expand the growing evidence of the utility of new satellite AOD-based methods for estimating health effects from acute exposure to PM2.5.

Exposure level and influential factors of HCHO, BTX and TVOC from the interior redecoration of residences

Although indoor air pollution caused by decoration and its consequent influential factors have been spotlighted, information regarding the effect of redecoration are still limited. Therefore, 143 bedrooms were redecorated identically by a specific company, and the concentration of formaldehyde (HCHO), benzene, toluene, xylene (BTX), and total volatile organic compounds (TVOC) were measured in order to determine the pollution level inside the redecorated sample dwellings, also to obtain the relationship between the mentioned compounds and their influential factors. The median concentration level of HCHO, BTX, and TVOC were 70, 10, and 160 μg/m3, respectively. 89.51% and 74.83% of the dwellings had adverse exposure level of HCHO and TVOC, respectively, which had the score of 40 based on IAQ indices (where 80 is “good” and 20 is “bad”). 81.82% of the dwellings were at the risk of respiratory symptoms in children, considering the fact that safe exposure limit of 8-h HCHO is 50 μg/m3 in Canada. Over 86% of the dwellings exceeded the threshold of HCHO set by U.S.Agency Toxic Substances Disease Registry based on health hazard assessments in the relevant toxicological literature. Only 0.7% of all dwellings exceeded health thresholds of TVOC at 600 μg/m3 from Portuguese and china. There was either a very low level of correlation or no correlation between pollutants, environmental factors, and architectural characteristics, such as temperature, Relative Humidity, building ages, and room volume. HCHO and TVOC concentration in low-rise residences were higher than that of high-rise residences (p < 0.01). Compared to wood flooring, TVOC concentration was higher when tile was used as the flooring material (p < 0.05), due to the use of adhesives.

Peach Tree Pollen and Prunus persica 9 Sensitisation and Allergy in Children and Adolescents

Background: Although plant and fruit pollens are entomophilous and relevant in exposed workers, we have shown a high frequency of sensitisation and symptoms induction of peach tree pollen (PTP) and Prunus persica 9 (Pru p 9) in adults from areas of peach cultivars. Methods: We studied the sensitisation and clinical relevance of PTP and Pru p 9 in a large group of children and adolescents aged 3–19 years. A detailed questionnaire plus skin prick testing to prevalent allergens, PTP, and Pru p 9 were carried out. The clinical relevance was established by nasal provocation test (NPT) and symptom score index. Results: We evaluated 685 children (mean age 8.75 ± 3.3 years, median 9 years), 52% of them female. Sensitisation to PTP occurred in 20% of the cases following olive tree (33%) and Phleum pratense (26%). In a randomly selected subgroup of subjects sensitised to PTP, 30% were skin prick test-positive to Pru p 9. Most cases had rhinitis or rhinoconjunctivitis. NPT showed the relevance of PTP and Pru p 9 in the induction of symptoms. Conclusion: PTP and Pru p 9 are relevant in the induction of sensitisation and respiratory symptoms in children and adolescents. This allergen should be evaluated in children living in regions of peach tree cultivars.

Asthma medication increases dental caries among children in Taiwan: An analysis using the National Health Insurance Research Database

Background/purposeAsthma is a common, chronic disease that causes respiratory symptoms in children. Dental caries is also a common chronic disease in the pediatric population. Therefore, the aim of the present study was to investigate the correlation between asthma medications and dental caries among children in Taiwan. Materials and methodsThe Taiwan National Health Insurance Research Database was used in this retrospective cohort study to analyze the correlation between asthma and dental caries in children. The prevalence and severity of caries were compared between children with and without asthma. The effects of different asthma medications on dental caries were also compared. ResultsA total of 4601 children with asthma and 4589 children without asthma were included in this study. The caries prevalence of children without asthma was 85.2%, and that of children with asthma was 90.0%. The prevalence of caries in children with asthma was significantly higher than that in children without asthma (P < 0.001). The caries status was categorized into mild, moderate and severe dental caries. The rate of mild dental caries was higher in the children without asthma (35.1%) than in the children with asthma (29.8%). The rate of severe caries was significantly higher in children with asthma (34.3%) than in those without asthma (30.7%). Also, children with asthma using bronchodilators had a higher rate of severe dental caries (39%) than in children without asthma (30.7%). ConclusionChildren receiving asthma medications had higher dental caries prevalence and higher rate of severe caries than children without asthma.

Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka

BackgroundHousehold air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years.MethodsA prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households.ResultsTwo hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098–2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01–1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking.ConclusionThe CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.

Prenatal exposure to organochlorine compounds and lung function during childhood

IntroductionPrenatal exposure to organochlorine compounds (OCs) can increase the risk of reported respiratory symptoms in children. It remains unclear whether these compounds can also impact on lung function. We assessed the association between prenatal exposure to OCs and lung function during childhood. MethodsWe included 1308 mother-child pairs enrolled in a prospective cohort study. Prenatal concentrations of p,p′-dichlorodiphenyltrichloroethane [p,p′-DDT], p,p′-dichlorodiphenyldichloroethylene [p,p′-DDE], hexachlorobenzene [HCB], and seven polychlorinated biphenyls [PCBs] were measured in cord blood. Spirometry was performed in the offspring at ages 4 (n = 636) and 7 years (n = 1192). ResultsMore than 80% of samples presented quantifiable levels of p,p′-DDE, HCB, PCB-138, PCB-153, and PCB-180; p,p′-DDE was the compound with the highest median concentrations. At 4 years, prenatal p,p′-DDE exposure was associated with a decrease in forced expiratory volume in 1 s (FEV1) in all quartiles of exposure (e.g., third quartile [0.23–0.34 ng/mL]: β for FEV1 −53.61 mL, 95% CI −89.87, −17.35, vs. the lowest). Prenatal p,p′-DDE levels also decreased forced vital capacity (FVC) and FEV1/FVC, but associations did not reach statistical significance in most exposure quartiles. At 7 years, p,p′-DDE was associated with a decrease in FVC and FEV1 in only the second quartile of exposure (e.g. β for FEV1 −36.96 mL, 95% CI −66.22, −7.70, vs. the lowest). Prenatal exposure to HCB was associated with decreased FVC and FEV1, but in only the second quartile and at 7 years (e.g. [0.07–0.14 ng/mL]: β for FEV1 −25.79 mL, 95% CI −55.98, 4.39, vs. the lowest). PCBs were not consistently associated with lung function. ConclusionPrenatal exposure to p,p′-DDE may decrease lung function during childhood, especially FEV1 and at medium levels of exposure. Further and deeper knowledge on the impact of environmental chemicals during pregnancy on lung development is needed.

Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis

Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent’s quality of life was assessed as secondary outcome. In 36 children (2–8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children’s Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed.What is Known:• Cough and wheezing are the predominant symptoms of acute bronchitis.• There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies.What is New:• Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies.

DOZ047.49: Tracheoscopic findings and their impact on respiratory symptoms in children with esophageal atresia

Introduction Esophageal atresia is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis and occasionally to life threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms. Methods In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations and corresponding clinical symptoms were retrospectively analyzed. Results The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B, C, D) compared to patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. Presence of respiratory symptoms like cough, stridor or bronchitis was not associated with a higher grade of tracheal collapse compared to patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in non-symptomatic patients). Conclusion Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of &gt; 80%, a ventral pulsation and obstructive apnea or cyanosis in combination, are at risk for life threatening situations.

Tracheoscopic Findings and Their Impact on Respiratory Symptoms in Children with Esophageal Atresia.

Esophageal atresia (EA) is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis, and occasionally to life-threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with EA and tracheoesophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms. In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations, and corresponding clinical symptoms were retrospectively analyzed. The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B-D) compared with patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. The presence of respiratory symptoms such as cough, stridor, or bronchitis was not associated with a higher grade of tracheal collapse compared with patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in nonsymptomatic patients). Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of >80%, a ventral pulsation, and obstructive apnea or cyanosis in combination, are at risk for life-threatening situations and further surgical treatment should be considered.

Heavy metal quantification of classroom dust in school environment and its impacts on children health from Rawang (Malaysia).

This study aimed to determine bioavailable heavy metal concentrations (As, Cd, Co, Cu, Cr, Ni, Pb, Zn) and their potential sources in classroom dust collected from children's hand palms in Rawang (Malaysia). This study also aimed to determine the association between bioavailable heavy metal concentration in classroom dust and children's respiratory symptoms. Health risk assessment (HRA) was applied to evaluate health risks (non-carcinogenic and carcinogenic) due to heavy metals in classroom dust. The mean of bioavailable heavy metal concentrations in classroom dust found on children's hand palms was shown in the following order: Zn (1.25E + 01μg/g) > Cu (9.59E-01μg/g) > Ni (5.34E-01μg/g) > Cr (4.72E-02μg/g) > Co (2.34E-02μg/g) > As (1.77E-02μg/g) > Cd (9.60E-03μg/g) > Pb (5.00E-03μg/g). Hierarchical cluster analysis has clustered 17 sampling locations into three clusters, whereby cluster 1 (S3, S4, S6, S15) located in residential areas and near to roads exposed to vehicle emissions, cluster 2 (S10, S12, S9, S7) located near Rawang town and cluster 3 (S13, S16, S1, S2, S8, S14, S11, S17, S5) located near industrial, residential and plantation areas. Emissions from vehicles, plantations and industrial activities were found as the main sources of heavy metals in classroom dust in Rawang. There is no association found between bioavailable heavy metal concentrations and respiratory symptoms, except for Cu (OR = 0.03). Health risks (non-carcinogenic and carcinogenic risks) indicated that there are no potential non-carcinogenic and carcinogenic risks of heavy metals in classroom dust toward children health.