All that Wheezes is not Asthma or Bronchiolitis

The severity of the first occurrence of bronchiolitis increased the risk of developing asthma symptoms

AIM

The relationship between bronchiolitis and asthma is complex. We assessed whether patients admitted to a paediatric intensive care unit (PICU) with bronchiolitis had a greater risk of developing asthma than patients admitted to a paediatric ward.

METHODS

We retrospectively included children under 1 year of age, who were hospitalised for bronchiolitis for the first time at the University Hospital of Caen, France, between 2010 and 2014. The children were divided into two groups: 89 were admitted to the paediatric ward and 89 were admitted to the PICU. We wanted to assess which group developed more asthma before 6 years of age. The Global Initiative for Asthma definition was used.

RESULTS

The median age of the 178 children (55% boys) was 32 (interquartile range 19-56) days. We found that 35% of the PICU group and 19% of the ward group had asthma at 6 years of age. The mean onset of symptoms was 3 years earlier in the PICU group than the ward group (p < 0.01). Both these findings were significant.

CONCLUSION

The severity of the first episode of bronchiolitis increased the risk of developing asthma symptoms. Regular follow-ups are suggested for infants admitted to PICUs for bronchiolitis.

The assessment and management of acute dyspnoea: a case study

Dyspnoea - a broad term that describes an unpleasant awareness of one's breathing, often synonymous with breathlessness - is a presenting complaint of significant burden to emergency care. In this case study the authors reflect on the assessment and treatment of a patient presenting to the emergency department (ED) with breathlessness. The importance of effective history taking and physical examination is highlighted, and an overview of the techniques used to elicit information is provided. Appropriate investigations are discussed alongside their limitations. Differential diagnoses are considered; however, particular focus is given to chronic obstructive pulmonary disease. Existing treatment options, both pharmacological and non-pharmacological, are critiqued, and recommendations are made for further research and future practice. Review of this article will equip advanced clinical practitioners to effectively assess, diagnose and treat patients presenting to the ED with dyspnoea.

Probiotics in Children with Asthma

A type-2 immune response usually sustains wheezing and asthma in children. In addition, dysbiosis of digestive and respiratory tracts is detectable in patients with wheezing and asthma. Probiotics may rebalance immune response, repair dysbiosis, and mitigate airway inflammation. As a result, probiotics may prevent asthma and wheezing relapse. There is evidence that some probiotic strains may improve asthma outcomes in children. In this context, the PROPAM study provided evidence that two specific strains significantly prevented asthma exacerbations and wheezing episodes. Therefore, oral probiotics could be used as add-on asthma therapy in managing children with asthma, but the choice should be based on documented evidence.