[Respiratory allergy and environmental pollution in pediatrics]

Pediatric recurrent respiratory tract infections: when and how to explore the immune system? (About 53 cases)

Recurrent respiratory tract infections are one of the most frequent reasons for pediatric visits and hospitalization. Causes of this pathology are multiple ranging from congenital to acquired and local to general. Immune deficiencies are considered as underlying conditions predisposing to this pathology. Our work is about to determine when and how to explore the immune system when facing recurrent respiratory infections. This was based on the records of 53 children hospitalized at the pediatrics unit of Hassan II University Hospital, Fez Morocco. Thirty boys and 23 girls with age ranging from 5 months to 12 years with an average age of 2 years were involved in this study. Bronchial foreign body was the main etiology in children of 3 to 6 year old. Gastro-esophageal reflux, which in some cases is a consequence of chronic cough, as well as asthma were most frequent in infants (17 and 15% respectively). Immune deficiency was described in 7.5% of patients and the only death we deplored in our series belongs to this group. Recurrent respiratory tract infections have multiple causes. In our series they are dominated by foreign body inhalation and gastroesophageal reflux, which in some cases is a consequence of a chronic cough. Immune deficiency is not frequent but could influence the prognosis. Therefore immune explorations should be well codified.

Moderate increases in ambient PM2.5 and ozone are associated with lung function decreases in beach lifeguards

OBJECTIVE

Exposure to pollutants would adversely affect lung function of healthy athletes.

METHODS

Pulmonary function was recorded on beach lifeguards at three different times during the day. Daily and average peak pollutant levels were calculated. Linear regression analyses were made comparing lung function changes in response to pollutant levels. A multivariate model was constructed to explain the combined effects of pollutants.

RESULTS

Afternoon forced vital capacity (FVC) and forced expired volume in 1 second (FEV1) decreased significantly compared with morning values and decreased with increasing fine particulates (PM2.5). FEV1/FVC decreased with increasing ozone (O3) levels.

CONCLUSION

The deleterious effect of PM2.5 and O3 were transient and occurred at pollutant levels far below national standards. At low levels of exposure, PM2.5 was associated with reduced lung volumes, while increasing O3 levels were associated with airway obstruction.

Rhinopharyngites de l’enfant

La rhinopharyngite désigne une inflammation modérée des voies aériennes supérieures d’origine infectieuse. Les signes habituels en sont l’obstruction nasale, la rhinorrhée, l’éternuement, la douleur pharyngée et la toux. Le terme de rhinopharyngite est spécifiquement français. Les auteurs anglo-saxons parlent de rhume (common cold) ou de upper respiratory tract infection (URI) pour décrire une inflammation aiguë des voies aériennes supérieures, et d’adénoïdite chronique (chronic adenoiditis) pour désigner une infection chronique des végétations adénoïdes responsable de rhinorrhées fébriles itératives ou d’obstruction des voies aériennes supérieures. Les rhinopharyngites aiguës non compliquées sont d’origine virale. Leur évolution spontanée est habituellement rapide et non compliquée. Elles ne nécessitent donc ni prélèvement bactériologique ni antibiothérapie systématique. En première intention, elles relèvent exclusivement d’un traitement antalgique et antipyrétique associé à des lavages des fosses nasales au sérum salé iso- ou hypertonique. Les complications des rhinopharyngites sont infectieuses, essentiellement représentées par les otites et les sinusites, et respiratoires obstructives. Le caractère fréquemment itératif des rhinopharyngites à partir de l’âge de 6 mois reflète un processus physiologique de maturation du système immunitaire. En présence de rhinopharyngites fréquentes et invalidantes, les principaux facteurs de risque devant être recherchés et si possible éradiqués sont le tabagisme passif et la fréquentation d’une collectivité d’enfants. L’adénoïdectomie n’est pas indiquée en l’absence de complications. Le développement d’antiviraux efficaces dans la prévention et dans le traitement des rhinopharyngites fait l’objet d’intenses recherches cliniques et expérimentales.

Rinofaringitis infantiles

La rinofaringitis designa una inflamación moderada de las vías respiratorias superiores de origen infeccioso. Sus signos habituales son obstrucción nasal, rinorrea, estornudos, dolor faríngeo y tos. Los autores anglosajones hablan de catarro (common cold) o de infección de vías respiratorias altas para describir una inflamación de las vías respiratorias superiores, y de adenoiditis crónica (chronic adenoiditis) para designar una infección crónica de las vegetaciones adenoides que produce rinorrea febril recidivante u obstrucción de las vías respiratorias altas. Las rinofaringitis agudas no complicadas son de origen vírico. Habitualmente su evolución espontánea es rápida y sin complicaciones. Por tanto, no hay que obtener muestras bacteriológicas ni hacer un tratamiento antibiótico sistemático. Como tratamiento de primera línea, sólo precisan analgésicos y antipiréticos asociados a lavados de las fosas nasales con suero salino isotónico o hipertónico. Las complicaciones de las rinofaringitis son infecciosas –representadas esencialmente por las otitis y las sinusitis– y respiratorias obstructivas. El carácter a menudo repetitivo de las rinofaringitis a partir de los 6 meses de edad refleja un proceso fisiológico de maduración del sistema inmunitario. Cuando existen rinofaringitis frecuentes e invalidantes, los principales factores de riesgo que se deben buscar, y de ser posible erradicar, son el tabaquismo pasivo y los contactos con una población infantil. La adenoidectomía ya no está indicada si no existen complicaciones. Se están realizando investigaciones clínicas y experimentales sobre el desarrollo de fármacos antivíricos eficaces para la prevención y el tratamiento de las rinofaringitis.

[Respiratory distress in pediatric admission and emergency services. Epidemiology and evaluation criteria]

The medical part of the activity in the emergency units increased and has been ascribed to the raised number of infants or children admitted for acute dyspnea. This review is based on the published reports and the experience from the paediatric emergency unit from the Rouen area with 450,000 inhabitants, in France. We put forward the known epidemiological data and discussed the available means for the practitioner, which could help him in the decision to hospitalize. This review suggests that algorithms of treatment and severity evaluations must be set up in paediatric emergency units in order to validate them and specify the children who requires hospitalisation.