Symptoms Of Wheeze Research Articles

The influence of air pollution on respiratory allergies, asthma and wheeze in childhood in Hungary.

Higher exposure to air pollution may contribute to the increased prevalence of allergic diseases in children. The study investigated the associations between the prevalence of childhood respiratory diseases and long-term exposure to NO2, SO<inf>2</inf>, PM<inf>10</inf>, especially some surrogates in schoolchildren in Hungary. We also analyzed the possible modification effects of some confounders by interaction analysis. A total of 6771 children aged 8-9-year-old residing at their current addresses since their births with air pollution monitoring stations were selected into this analysis. Health outcomes and their possible determinants, as well as surrogates of air pollution were surveyed by using a standardized questionnaire. Long-term exposure to PM<inf>10</inf>, NO2, and SO<inf>2</inf> was calculated at settlement level derived from daily average concentrations of pollutants. Descriptive and analytical statistical methods were applied. NO2 levels were positively associated with respiratory allergies and asthma. Decreased risk for ragweed, any other pollen, house dust mite and animal fur allergy was detected with PM<inf>10</inf> level. There were significant associations between respiratory allergies to ragweed, any other pollen, house dust mite, animal fur, wheeze symptoms and living or attending school nearby a factory, power station or bus station as well as living in a home with intensive noise or vibration. Gender, parental atopy, home mold and early respiratory infection were significant effect modifiers in some cases. The results of this study indicate that respiratory health in children is adversely affected by air pollutants.

Farm living and allergic rhinitis from childhood to young adulthood: Prospective results of the GABRIEL study

Growing up on a farm is associated with a reduced prevalence of respiratory allergies in childhood. Whether this protective effect remains into adulthood is unknown. We aimed to prospectively investigate the relationship between farm exposure and prevalence of allergic rhinitis and wheeze from childhood to early adulthood. Participants from phase 2 of the Multidisciplinary Study to Identify the Genetic and Environmental Causes of Asthma in the European Community (GABRIEL) who were living in southern Germany (aged 6-11 years at baseline and 20-25 years at follow-up) were invited to complete a questionnaire on sociodemographic data, farm contact, respiratory symptoms, and potential confounders. Odds ratios (ORs) with 95% CIs were modeled by using generalized estimating equations. Of the 2276 phase 2 participants, 1501 (66%) answered the follow-up questionnaire, of whom 1333 could be included in the analyses. Living on a farm was associated with reduced prevalence of allergic rhinitis (OR with persistent farm living=0.4 [95% CI= 0.2-0.6]; OR with farm living at baseline only= 0.4 [95% CI= 0.2-0.8]). The OR for development of symptoms from baseline to follow-up was almost 3 (OR= 2.7 [95% CI= 2.1-3.3]) irrespective of farm living. For symptoms of wheeze, no statistically significant association with farm living was observed. The protective effect of farm living on allergic rhinitis persists from childhood to early adulthood. Continuing exposure over puberty does not add to the effect. This confirms that the window of opportunity for a protective effect might be found in childhood.

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

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

Lower airway microbiome of children with recurrent wheezing: a clinical cohort study

BackgroundWheezing is one of the most common respiratory symptoms in childhood especially in infants. In recent years, the incidence of recurrent wheezing is on the rise worldwide. To investigate the lower airway microbiota in patients with recurrent wheezing and provide insights into clinical diagnosis and treatment.MethodsThis study initially enrolled 45 hospitalised children with recurrent wheezing symptoms awaiting complete fiberoptic bronchoscopy. Of these, 13 children with tracheobronchomalacia were excluded. The final population included 32 participants (group A). The control group comprised 23 children who inhaled a foreign body and were admitted to the hospital for fiberoptic bronchoscopy within 24 hours (group B). Deoxyribonucleic acid (DNA) was extracted from the bronchoalveolar lavage fluid (BALF) and amplified for the 16S ribosomal Ribonucleic Acid (rRNA) gene, and sequencing of the microbiome was performed using the Illumina Nova Seq 6000 system.ResultsThere were significant differences in the gestational duration (P=0.0458), mode of delivery (P=0.0261), and allergy status (P=0.0000) between groups A and B, but they had similar richness (P=0.8574). There was also a marked difference in the diversity of flora composition between the two groups (P=0.0095). The three most common phyla of microbiota in the two groups were Proteobacteria, Firmicutes, and Bacteroidetes. Species with notably different phyla included Proteobacteria, Bacteroidota, Fusobacteriota, and Acidobacteriota. There was a significant enrichment in the of Proteobacteria and lower levels of Bacteroidota, Fusobacteriota, and Acidobacteriota in group A compared to that in group B.ConclusionsSignificant changes occur in the lower airway microbiota during recurrent wheezing in children. The discovery of beneficial airway bacteria may facilitate the prevention and treatment of recurrent wheezing or asthma in children.

Urban air pollution characteristics and associations with pre-school children respiratory health in four cities of Central China

The focus of this study was on the associations between air pollution, outdoor activities and symptoms of wheeze and rhinitis for pre-school children over Wuhan and surrounding cities. Air pollutants had downward trends over the study region from 2015 to 2020. Sulfur dioxide (SO2) content decreased significantly. Particulate matter was concentrated on the north side of the study area and nitrogen dioxide (NO2) was concentrated near Wuhan urban, while the distribution of ozone (O3) was relatively uniform. Odds Ratio (OR) showed that an increase in NO2 was associated with a high incidence of rhinitis, with an OR of 1.043 (1.025, 1.062 95% confidence interval). Reduction of O3 was associated with remissions of rhinitis symptoms in spring and autumn. The living environment is an important factor. Living near lakes was associated with the incidence of wheeze and living near roads was associated with the incidence of wheeze rhinitis, respectively. Additionally, appropriate outdoor activities showed association with a low incidence of wheeze and rhinitis symptoms in this region. This research improved our understanding of air pollution, outdoor activities and pre-school children's respiratory health. It was also a guide on the design of outdoor activities and outdoor courses for pre-school children during the process of urban construction.

Daily Associations of Air Pollution and Pediatric Asthma Risk Using the Biomedical REAI-Time Health Evaluation (BREATHE) Kit.

Background: Exposure to air pollution is associated with acute pediatric asthma exacerbations, including reduced lung function, rescue medication usage, and increased symptoms; however, most studies are limited in investigating longitudinal changes in these acute effects. This study aims to investigate the effects of daily air pollution exposure on acute pediatric asthma exacerbation risk using a repeated-measures design. Methods: We conducted a panel study of 40 children aged 8–16 years with moderate-to-severe asthma. We deployed the Biomedical REAI-Time Health Evaluation (BREATHE) Kit developed in the Los Angeles PRISMS Center to continuously monitor personal exposure to particulate matter of aerodynamic diameter < 2.5 µm (PM2.5), relative humidity and temperature, geolocation (GPS), and asthma outcomes including lung function, medication use, and symptoms for 14 days. Hourly ambient (PM2.5, nitrogen dioxide (NO2), ozone (O3)) and traffic-related (nitrogen oxides (NOx) and PM2.5) air pollution exposures were modeled based on location. We used mixed-effects models to examine the association of same day and lagged (up to 2 days) exposures with daily changes in % predicted forced expiratory volume in 1 s (FEV1) and % predicted peak expiratory flow (PEF), count of rescue inhaler puffs, and symptoms. Results: Participants were on average 12.0 years old (range: 8.4–16.8) with mean (SD) morning %predicted FEV1 of 67.9% (17.3%) and PEF of 69.1% (18.4%) and 1.4 (3.5) puffs per day of rescue inhaler use. Participants reported chest tightness, wheeze, trouble breathing, and cough symptoms on 36.4%, 17.5%, 32.3%, and 42.9%, respectively (n = 217 person-days). One SD increase in previous day O3 exposure was associated with reduced morning (beta [95% CI]: −4.11 [−6.86, −1.36]), evening (−2.65 [−5.19, −0.10]) and daily average %predicted FEV1 (−3.45 [−6.42, −0.47]). Daily (lag 0) exposure to traffic-related PM2.5 exposure was associated with reduced morning %predicted PEF (−3.97 [−7.69, −0.26]) and greater odds of “feeling scared of trouble breathing” symptom (odds ratio [95% CI]: 1.83 [1.03, 3.24]). Exposure to ambient O3, NOx, and NO was significantly associated with increased rescue inhaler use (rate ratio [95% CI]: O3 1.52 [1.02, 2.27], NOx 1.61 [1.23, 2.11], NO 1.80 [1.37, 2.35]). Conclusions: We found significant associations of air pollution exposure with lung function, rescue inhaler use, and “feeling scared of trouble breathing.” Our study demonstrates the potential of informatics and wearable sensor technologies at collecting highly resolved, contextual, and personal exposure data for understanding acute pediatric asthma triggers.

Association of Allergic Symptoms in the First 2 Years of Life With Sleep Outcomes Among Chinese Toddlers.

Background: Previous studies have linked allergic symptoms to sleep in children, but the associations might be different when considering different types of allergic symptoms or sleep outcomes. Moreover, the combined effects of multiple allergic symptoms remain unclear in early life. This study aimed to investigate the associations between multiple allergic symptoms and sleep outcomes in early life.Methods: We included 673 toddlers aged 2 years from a birth cohort in Guangzhou, China. We identified allergic symptoms (skin, eyes and nose, gastrointestinal tract, mouth and lips, and wheeze) within 2 years via standard questionnaires. Sleep outcomes including sleep duration and quality over the past month were assessed based on the Chinese version of the Brief Infant Sleep Questionnaire. Associations between allergic symptoms and sleep outcomes were examined using multivariable linear regression and logistic regression.Results: Compared to children without allergic symptoms, children with allergic nasal and ocular symptoms had higher odds of frequent nighttime awakenings (OR = 1.41; 95% CI: 1.03, 1.93) and irregular sleep (OR = 1.45, 95% CI: 1.05, 2.00); children with allergic gastrointestinal symptoms slept 0.28 h less during nighttime (95% CI: −0.48, −0.07) and 0.25 h less per day (95% CI: −0.43, −0.08), and had 59% higher odds of irregular sleep (95% CI: 1.24, 2.04). We also found significant association of multiple allergic symptoms with shortened nighttime sleep duration and increased irregular sleep. Whereas, allergic skin, mouth and lips, and wheeze symptoms were not significantly associated with sleep outcomes.Conclusion: Allergic symptoms within 2 years of age were adversely associated with sleep outcomes, which highlight the importance of early screening of allergic symptoms in toddlers in order to improve their sleep outcomes.

Sex Differences in Baseline Risk Factors for Asthma Between Early Adolescence and Young Adulthood.

Several studies have shown sex differences in the prevalence of asthma and an association with age. The aim of the present study was to prospectively investigate the development of asthma, wheeze, rhinitis, and allergic symptoms in adolescence and adulthood. We also aimed to determine whether sex modifies the association between baseline risk factors and incidence of asthma in early adulthood. In the Screening Project Asthma in Schools (SPAIS) study, adolescents aged 12-15 years completed a standardized respiratory questionnaire (International Study of Asthma and Allergies in Childhood) and underwent measurements of fractional exhaled nitric oxide (FeNO) and lung function (FEV1) at baseline. Two follow-up assessments with similar questionnaires were performed after 4 and 16 years, with a total of 491 participants in all 3 examinations. The prevalence of asthma and wheeze were unchanged after 4 years but had increased after 16 years. However, the increase was significant only for females. The prevalence of rhinitis and allergy symptoms increased steadily, albeit with no differences between the sexes. The sex interaction analysis showed that higher FeNO (P=.01) and a family history of asthma (P=.02) increased the risk of incident asthma for males but not for females. An increased prevalence of respiratory symptoms was seen primarily between late adolescence and young adulthood; the difference was significant for females but not for males. Allergic risk factors in early adolescence for incident asthma in early adulthood were confirmed in males but not in females. Awareness of these sex differences in the development of symptoms and of the associated risk factors is important in clinical practice.

Inhaled therapy for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterised by progressive symptoms of productive cough, breathlessness, wheeze and exacerbations. Airway obstruction is detected by quality assured spirometry, and is defined as a Forced Expired Volume in one second / Forced Vital Capacity ratio &lt;0.7. Inhaled therapy is the most effective treatment solution, with bronchodilators and inhaled steroids helping to improve symptoms, quality of life and lung function, while reducing risk of exacerbations. Bronchodilators are available as both monotherapy and as dual combination therapy. Inhaled steroids can be added to inhaled long-acting bronchodilators, but are not without significant complications, including pneumonia. Therefore, careful assessment of the phenotype of a patient with chronic obstructive pulmonary disease must be given before commencing any therapy that contains inhaled steroid and other treatments, such as flu vaccination, smoking cessation and pulmonary rehabilitation should be given due consideration.

S2165 A Breath-Taking Case of Esophageal Dilation

Introduction: Esophageal dilation is rarely associated with shortness of breath. In this abstract, we present a case of severe esophageal dilation likely due to achalasia which resulted in airway obstruction. Case Description/Methods: An 80 year old man with past medical history congestive heart failure and hypothyroidism presented with a worsening neck mass and difficulty breathing. He endorsed weight gain, abdominal distension and bloating. He denied stridor, nausea, vomiting, or regurgitation. He noted dysphagia to solids for the last two years; however, he was able to swallow liquids. An esophagram obtained two years prior showed distal narrowing of the esophagus with proximal dilation. The neck was bulging to the right with significant neck fullness. There was no abdominal distension. CT neck revealed a distended esophagus compressing and mild to moderate narrowing of the subglottic airway. The gaseous distended esophagus protruded into the right anterior neck. EGD revealed severe dilation in the upper and middle third of the esophagus. There was also severe esophagitis dissecans in the entire middle and lower esophagus with an area of black mucosal discoloration in the middle of the esophagus. ANA, Anti-Scl-70 Ab, T. Cruzi IgG Ab were negative. Discussion: In the case described, the patient's shortness of breath was caused by heart failure exacerbation but also likely due to esophageal dilation causing compression on the airway. His history of distal esophageal narrowing two years prior and EGD without signs of mechanical obstruction of the distal esophagus suggest his esophageal dilation was likely due to achalasia. Unfortunately, the patient deteriorated clinically and transitioned to hospice cares shortly thereafter. He died several weeks later. Achlasia is associated with respiratory complaints typically in the form of aspiration. Retained esophageal products can cause symptoms of cough, sore throat, hoarseness, and wheezing. Esophageal dilation can result from achalasia or pseudoachalasia. EGD is useful to differentiate between these two entities. Barium esophagram and esophageal manometry are also useful in establishing the diagnosis of achalasia. Due to the severity of the patient's condition in the above case, barium esophagram and esophageal manometry were not performed. The black esophagus noted on EGD was likely due to ischemia as a result of severe dilation.Figure 1.: CT neck shows a distended esophagus compressing the trachea and adjacent structures.

IRON PILL ASPIRATION MIMICKING ASTHMA

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Foreign body aspiration can be a life-threatening event. Aspiration of iron pill can cause significant bronchial destruction via necrosis. Iron pill quickly disintegrates in the airway, inducing deep mucosal necrosis responsible for severe complications if not diagnosed promptly. We report a case of iron pill aspiration with asthma like presentation leading to severe bronchial stenosis. CASE PRESENTATION: A 50-year-old nonsmoking female, with past medical history of hypertension and arthropathy was referred to pulmonology for wheezing and shortness of breath that started after she had accidentally aspirated an iron pill. Examination was significant for expiratory wheezing. X-ray of the chest was normal. Bronchoscopy performed for the removal of the iron pill revealed complete obstruction of the right lower lobe (RLL) bronchus with thick mucoid secretions coated in iron and granulation tissue. Follow up bronchoscopy showed similar findings which included severe persistent airway inflammation. Cultures obtained grew cryptococcus neoformans. For which patient was she was treated with oral Diflucan for 1 year. Pulmonary function test showed no evidence of restriction or obstruction Once the infection was fully treated patient underwent endobronchial ultrasound (EBUS) which was performed as a therapeutic intervention for the RLL lesion as patient still had persistent symptoms of wheezing. EBUS showed severe stenosis of the RLL which was relieved following CRE balloon-tipped catheter insertion into the stenotic segment of the lower trachea followed by local intralesional steroid injection. On follow up three months later patient reported significant improvement in her symptoms. DISCUSSION: Iron pill aspiration syndrome is a relatively rare cause of severe bronchial inflammation leading to endobronchial stenosis [1,2]. The diagnosis is made by the presence of history of aspiration, airway inflammation and iron deposition as noted on histopathology. Oxidation of iron pill can cause bronchial mucosal inflammation, ulceration and necrosis which progresses to bronchial narrowing and possibly irreversible stenosis [3]. Early diagnosis with bronchoscopy and treatment plays a crucial role in overall prognosis. Our case represents a remarkable recovery with balloon dilation and intralesional steroid injection resulting in relief of stenosis. CONCLUSIONS: •Physicians should be very prudent with prescribing iron pills in individuals who are at high risk of aspiration in order to avoid serious bronchial complications. •Prompt bronchoscopic intervention and management is required to prevent progression to serious complications. •Physicians should consider balloon dilation with intralesional steroid injection for patients with refractory symptoms after removal of the foreign object. REFERENCE #1: Caterino U., Battistoni P., Batzella S., Iacono R. Dello, Lucantoni G., Galluccio G. Syndrome of iron pill inhalation in four patients with accidental tablet aspiration: severe airway complications are described. Respir. Med. Case Rep. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501451/ REFERENCE #2: Management of Iron Pill Aspiration Syndrome: Advanced Bronchoscopic InterventionMonali Patil MD* Arjun Mohan MD; and Kassem Harris MD University at Buffalo, Buffalo, NY, https://journal.chestnet.org/article/S0012-3692(16)57346-2/pdf REFERENCE #3: The Iron Lung: When Iron Pill Aspiration Results in an Immediate Bronchoscopy. A Successful Medical Therapy to a Serious ConditionSarah Abuseif, Mohamed Elsawaf, Gustavo De La Luz, https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A5565 DISCLOSURES: No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by Adel El Abbassi, source=Web Response No relevant relationships by Saman Saeed, source=Web Response No relevant relationships by Haniya Saeed, source=Web Response No relevant relationships by Dima Youssef, source=Web Response

Agreement of parent‐ and child‐reported wheeze and its association with measurable asthma traits

ObjectivesIn epidemiological studies, childhood asthma is usually assessed with questionnaires directed at parents or children, and these may give different answers. We studied how well parents and children agreed when asked to report symptoms of wheeze and investigated whose answers were closer to measurable traits of asthma.MethodsLuftiBus in the school is a cross‐sectional survey of respiratory health among Swiss schoolchildren aged 6–17 years. We applied questionnaires to parents and children asking about wheeze and exertional wheeze in the past year. We assessed agreement between parent–child answers with Cohen's kappa (k), and associations of answers from children and parents with fractional exhaled nitric oxide (FeNO) and forced expiratory volume in 1 s over forced vital capacity (FEV1/FVC), using quantile regression.ResultsWe received questionnaires from 3079 children and their parents. Agreement was poor for reported wheeze (k = 0.37) and exertional wheeze (k = 0.36). Median FeNO varied when wheeze was reported by children (19 ppb, interquartile range [IQR]: 9–44), parents (22 ppb, IQR: 12–46), both (31 ppb, IQR: 16–55), or neither (11 ppb, IQR: 7–19). Median absolute FEV1/FVC was the same when wheeze was reported by children (84%, IQR: 78–89) and by parents (84%, IQR: 78–89), lower when reported by both (82%, IQR: 78–87), and higher when reported by neither (87%, IQR: 82–91). For exertional wheeze findings were similar. Results did not differ by age or sex.ConclusionOur findings suggest that surveying both parents and children and combining their responses can help us to better identify children with measurable asthma traits.

A Study of Electrocardiographic Changes in Asthmatic Patients Attending Kirkuk General Hospital

Background: Asthma is a common chronic respiratory disease affecting (7-10%) of the population in different countries. It is characterized by variable symptoms of wheeze, shortness of breath, chest tightness and cough. Asthma is usually associated with airway hyper-responsiveness to direct or indirect stimuli. Patient with acute asthma will manifest electrocardiograghic changes ranging from sinus tachycardia, P, ST and T wave changes etc, these abnormalities persisted for up to 10 days, may reflect positional changes of the heart, were reverted to normal after therapy. Aims: To study the various ECG abnormalities in acute asthma and to demonstrate the reversibility of these abnormalities after treatment. Material and Methods: This study was conducted on (110) patients all were adults, their age ranged from 20 years to more than 50 years who attended to the emergency department in Kirkuk General Hospital over a period of one year from April 2017 to April 2018 with aconfirmed diagnosis of acute severe asthma were studied. Ten patients were excluded from study because their ECG changes were related to cardiac and thyroid disorder. Patients were included in the study only if an ECG had been performed on admission and within 24 hour of their stay in hospital. A standard 12 Lead ECG was performed on admission for each patient and it repeated until it had returned to normal. In each patient, on admission, plasma urea, full blood count, thyroid functions test (in selected cases) cardiac enzymes (in those with chest pain) were performed. The diagnosis of acute asthma is made by taking a thorough history and physical exam, and patients without a previous diagnosis of asthma, a spirometry performed to confirm airway obstruction and reversibility. Result: The commonest ECG changes were sinus tachycardia which was found in (50%) of patients with a heart rate ranging between 120-130 beats/ min, while the lowest rate of ECG changes was right bundle branch block were observed in (2%) of patients. The male patients were affected more than female and the highest incidence observed was among age group 41-50 years. The ST segment depression, T wave inversion & sinus tachycardia are the main ECG changes in (30%) of life threatening type of acute asthma. While P pulmonale & ST segment depression were observed in only (4%) of patients with near fatal asthma. Conclusion: Patients with acute asthma can manifest various ECG changes and these changes returned to normal after medical therapy, usually within 10 days.

Trajectories of asthma and allergy symptoms from childhood to adulthood.

Phenotypes of asthma and allergic diseases are mainly studied separately for children and adults. To explore the role of adolescence and young adulthood, we investigated symptom trajectories at the transition from childhood into adulthood. Latent class analysis (LCA) was conducted in a population initially recruited for the German arm of Phase II of the International Study of Asthma and Allergies in Childhood and followed-up three times until their early 30s (N=2267). Indicators included in LCA were 12-month prevalences of symptoms of wheeze, rhinoconjunctivitis, and eczema. Latent classes were further characterised regarding important traits such as skin prick tests. Logistic regression models were used to investigate associations with environmental determinants such as smoking and occupational exposures. Six latent classes were identified: an asymptomatic one as well as three with single and two with co-occurring symptoms. All trajectories essentially established between baseline assessment at around 10years and the first follow-up at around 17years. Probabilities for symptoms increased from childhood to adolescence, especially for wheeze-related latent classes, while they remained constant in adulthood. Wheeze-related latent classes were also positively associated with exposures during adolescence (e.g. active smoking). Distinct trajectories of asthma and allergy symptoms establish from childhood through adolescence and stabilize during early adulthood. This pattern was most notable in wheeze-related latent classes which also showed the strongest positive associations with environmental exposures in adolescence/young adulthood. Therefore, not only childhood but also adolescence is relevant for disease development and offers considerable potential for prevention and health promotion.

Asthma, rhinitis and eczema symptoms in Quito, Ecuador: a comparative cross-sectional study 16 years after ISAAC

BackgroundIn 2003, the International Study of Asthma and Allergies in Childhood (ISAAC) estimated the prevalence of asthma, rhinitis and eczema symptoms in Quito, Ecuador. Since then, no update of this...

Do allergic clinical manifestations increase the risk of behavioral problems in children? A cross-sectional study.

Children with allergic clinical manifestations tend to have behavioral or emotional problems such as hyperactivity or worse mental health. However, previous studies on this association did not adequately adjust for confounders like parenting stress, demographic characteristics, or allergy presentation. This study aimed to investigate the relationship between childhood allergic clinical manifestations and behavioral problems, adjusting for confounders such as demographic characteristics, parenting stress, and allergy-related variables. We conducted an online cross-sectional survey among caregivers of children aged 2-6years (n=633). The Strengths and Difficulties Questionnaire (SDQ) was used to determine children's behavioral characteristics as the primary outcome. Allergic clinical manifestations, wheeze, rash, and nose symptoms were the exposure variables. Associations were estimated using logistic regression analyses with propensity scores to adjust for confounders. We analyzed 633 caregivers of children aged 2-6years (valid rate, 61.5%). Univariate analyses showed that wheezing was associated with conduct problems (odds ratio [OR]=1.48, 95% confidence interval [CI]:1.01-2.16), a behavioral component of the SDQ. Rash was also associated with hyperactivity (OR=1.62, 95% CI: 1.02-2.57). Furthermore, nose symptoms were associated with conduct problems (OR=1.65, 95% CI:1.16-2.33) and emotional symptoms (OR=1.62, 95% CI:1.06-2.45). After adjusting for potential confounders, wheezing (adjusted OR=1.69, 95% CI:1.04-2.75) and nose symptoms (adjusted OR=1.56, 95% CI: 1.05-2.34) remained associated with conduct problems. This study revealed that a history of wheezing and nose symptoms in children is associated with an increased risk of behavioral problems, in particular, conduct problems.

Correlation between Platelet Count, TSH and Thyroxine in a Patient Presenting with Myxedema

Myxedema is a very rare and life threatening endocrine emergency which results from severe hypothyroidism and effects almost every organ system. We-hereby-present a 64-year-old-woman with PMH of hypothyroidism, liver cirrhosis, DM, HLD who presented to our ED because of altered mental status and dizziness. Patient reported feeling ill for the last two days, appeared lethargic, and responded slowly to questions. She denied headache, fever, changes in vision/smell, neck pain, chest pain, cough/ wheezing, abdominal pain, bowel or urinary symptoms. On arrival to the ED, patient was hypothermic with temperature of 93.2 F, hypotensive with blood pressure of 99/49 mm Hg, heart rate of 53 beats per minute and respiratory rate of 15 breaths per minute. On examination, the patient was lethargic, confused at times, heart sounds regular, no murmurs, soft, non-tender ab-domen, no significant findings on neck exam. Laboratory work-up was significant for white cell count of 2.6 L x 103 /uL, Hb 11.6 g/dL, HCT 33.8%, platelet count 53 x 103 /uL, TSH at presentation 73.30 mIU/L, free T4 was 0.12 ng/dL. Patient was treated with 200 mcg of IV levothyroxine, 10 mcg of leothyronine, 100 mg of hydrocortisone. In the ED, patient was given broad spectrum anti-biotics for the possibility of an infection triggering her myxedema. Over the course of days, it was observed that as the TSH trended down, the thyroid hormone level increased and the platelets trended up.

Role of montelukast in multitrigger wheezers attending chest clinic in Punjab, India.

Wheeze is seen in 40% of preschool children, one-third of these may develop recurrent wheeze. Montelukast is an oral, once a day, easy to give therapy but there is no definite evidence to support its use in a recent meta-analysis. Present study was done to evaluate role of daily montelukast and various factors affecting the outcome after therapy in multitrigger wheeze (MTW). A prospective study conducted in Pediatric chest clinic over 18 months at DMCH, Ludhiana. Children from 6 months to 5 years, diagnosed cases of MTW were started on montelukast. Diagnosis based on symptoms of recurrent wheeze triggered by various allergens/precipitants was made by pediatrician in charge of chest clinic. Children were followed up at 1 and 3 months. They were labeled as controlled, partially controlled, or uncontrolled as per global initiative for asthma guidelines. Data were used to compare the outcome related to various factors. Total 139 out of 150 children came for regular follow-up. At the end of 3 months, 94 (67.7%) were controlled, 8 (5.7%) partially controlled, and 37 (26.6%) children remained uncontrolled on montelukast. Factors associated with poor control were onset of symptoms at younger age (<6 months of age), family history of allergies, prior multiple visits or hospitalizations due to MTW, use of MDI in the past. No significant side effects were reported by parents. Symptomatically two-third of children became better after starting montelukast. There were few factors which resulted in poorer control in subset of patients.

Gestational diabetes and childhood asthma in a racially diverse US pregnancy cohort.

Childhood asthma is a common chronic disease that likely has prenatal origins. Gestational diabetes alters maternal physiology and may influence fetal risk for childhood-onset disease. However, the association between gestational diabetes and child asthma is not well characterized. To investigate the association between gestational diabetes and wheeze/asthma at approximately 4years of age in a racially diverse US cohort. We studied mother-child dyads enrolled prenatally in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study. Gestational diabetes was determined by medical chart review. At approximately 4years of age, we assessed child respiratory outcomes including parent report of physician-diagnosed asthma (ever), current wheeze (symptoms within the past 12months), and current asthma (physician diagnosis and/or medication or symptoms within the past 12months). We used the modified Poisson regression to assess associations between gestational diabetes and child respiratory outcomes, adjusting for maternal age, race, prenatal smoking, pre-pregnancy body mass index, parity, asthma history, socioeconomic status, and infant sex. Among 1107 women, 66% were African American/Black. Six percent (n=62) had gestational diabetes documented during pregnancy. Gestational diabetes was associated with increased risk of physician-diagnosed asthma (adjusted risk ratio (RR) [95% Confidence Interval]: 2.13 [1.35, 3.38]; prevalence: 14%), current wheeze (RR: 1.85 [1.23, 2.78]; prevalence: 19%), and current asthma (RR: 2.01 [1.30, 3.10]; prevalence: 16%). Gestational diabetes was associated with increased risk of asthma and wheeze outcomes. Additional studies are needed to elucidate modifiable pathways underlying this association.

Alendronate overdose/intoxication: Suicidal attempt in a case report

IntroductionAlendronate is a nitrogen-containing biphosphonate that inhibits osteoclastic bone resorption. Lethal dose (LD50) was aproximately 626mg/kg in male rats, and 552mg/kg in female. Signs and Symptoms of overdose clammy skin, CNS depression, dysphagia, hiccups, miosis, respiratory depression, seizures and wheezing. Supportive therapy and monitor of urine flow, calcium and phsophorous level is essential for the management of voluntary overdose.ObjectivesTo present the case of a 76-year-old woman who made a suicide attempt by ingestion of 8 tablets of 70 mg of alendronate.To describe the treatment of alendronate poisoning and the follow-up parameters for the control of complications.MethodsClinical case presentation through retrospective review of clinical notes and non-systematic literature review.ResultsA 76-year-old woman was taken to the emergency department after voluntarily ingesting 8 alendronate tablets (70 mg per tablet) 1 hour ago reporting “suicidal thoughts”. After clinical evaluation, gastric lavage, administration of activated charcoal, and IV ranitidine were used. After 24-hour observation and after psychiatric evaluation, the patient was discharged.ConclusionsHypocalcaemia, hypophosphataemia and upper gastrointestinal adverse reactions, such as upset stomach, heartburn, oesophagitis, gastritis, or ulcer, may result from oral overdose. In case of overdose with alendronate, milk or antacids should be given to bind alendronate. Giving milk or antacids, to bind the bisphosphonate and minimize absorption, has been suggested for oral overdose. Due to the risk of esophageal irritation, vomiting should not be induced and the patient should remain fully upright. For decontamination is recomended activated charcoal and gastric lavage.DisclosureNo significant relationships.