1
|
Kraman SS, Pasterkamp H, Wodicka GR. Smart Devices Are Poised to Revolutionize the Usefulness of Respiratory Sounds. Chest 2023; 163:1519-1528. [PMID: 36706908 PMCID: PMC10925548 DOI: 10.1016/j.chest.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
The association between breathing sounds and respiratory health or disease has been exceptionally useful in the practice of medicine since the advent of the stethoscope. Remote patient monitoring technology and artificial intelligence offer the potential to develop practical means of assessing respiratory function or dysfunction through continuous assessment of breathing sounds when patients are at home, at work, or even asleep. Automated reports such as cough counts or the percentage of the breathing cycles containing wheezes can be delivered to a practitioner via secure electronic means or returned to the clinical office at the first opportunity. This has not previously been possible. The four respiratory sounds that most lend themselves to this technology are wheezes, to detect breakthrough asthma at night and even occupational asthma when a patient is at work; snoring as an indicator of OSA or adequacy of CPAP settings; cough in which long-term recording can objectively assess treatment adequacy; and crackles, which, although subtle and often overlooked, can contain important clinical information when appearing in a home recording. In recent years, a flurry of publications in the engineering literature described construction, usage, and testing outcomes of such devices. Little of this has appeared in the medical literature. The potential value of this technology for pulmonary medicine is compelling. We expect that these tiny, smart devices soon will allow us to address clinical questions that occur away from the clinic.
Collapse
Affiliation(s)
- Steve S Kraman
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY.
| | - Hans Pasterkamp
- University of Manitoba, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - George R Wodicka
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| |
Collapse
|
2
|
Ichinose M, Obara T, Shibata M, Kagawa T, Sakama T, Takakura H, Hirai K, Furuya H, Kato M, Mochizuki H. Clinical application of a lung sound analysis in infants with respiratory syncytial virus acute bronchiolitis. Pediatr Int 2023; 65:e15605. [PMID: 37615369 DOI: 10.1111/ped.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/11/2023] [Accepted: 06/09/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Objective investigation of the characteristics of acute bronchiolitis in infants is important for its diagnosis and treatment. METHODS Lung sound data of 50 patients diagnosed with respiratory syncytial virus (RSV) acute bronchiolitis (m:f = 29:21, median of age 7 months), 20 patients with RSV acute respiratory tract infections without acute bronchiolitis (m:f = 10:10, 5 months) and 38 age-matched control infants (m:f = 23:15, 8 months) were analyzed using a conventional method and compared. Furthermore, the relationships between lung sound parameters and clinical symptoms (clinical score, length of hospital stay and SpO2 level) in the bronchiolitis and the non-bronchiolitis patients were examined. RESULTS Results of lung sound analysis showed that the inspiratory sound power of patients with RSV respiratory tract infections was low and the expiratory sound power was high compared with those of the controls. When the patients with RSV respiratory tract infections were divided into the bronchiolitis and non-bronchiolitis groups, the expiratory/inspiratory ratio of the bronchiolitis patients was greater than that of the non-bronchiolitis patients. There was no difference in the clinical symptoms, clinical score and length of hospital stay between the bronchiolitis and non-bronchiolitis patients, except for the SpO2 level on admission. CONCLUSION Lung sound analysis confirmed that patients with RSV acute bronchiolitis present with marked airway narrowing. Considering these results as a characteristic of acute bronchiolitis, it would be meaningful to reflect it in the improvement of diagnosis, treatment and subsequent management.
Collapse
Affiliation(s)
- Mami Ichinose
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Takeru Obara
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Mayuko Shibata
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Takanori Kagawa
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Takashi Sakama
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Hiromitsu Takakura
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Kota Hirai
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Furuya
- Department of Basic Clinical Science and Public Health, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Kato
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| |
Collapse
|
3
|
Pinezich MR, Mir SM, Reimer JA, Kaslow SR, Chen J, Guenthart BA, Bacchetta M, O'Neill JD, Vunjak‐Novakovic G, Kim J. Sound-guided assessment and localization of pulmonary air leak. Bioeng Transl Med 2023; 8:e10322. [PMID: 36684064 PMCID: PMC9842055 DOI: 10.1002/btm2.10322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 01/25/2023] Open
Abstract
Pulmonary air leak is the most common complication of lung surgery, with air leaks that persist longer than 5 days representing a major source of post-surgery morbidity. Clinical management of air leaks is challenging due to limited methods to precisely locate and assess leaks. Here, we present a sound-guided methodology that enables rapid quantitative assessment and precise localization of air leaks by analyzing the distinct sounds generated as the air escapes through defective lung tissue. Air leaks often present after lung surgery due to loss of tissue integrity at or near a staple line. Accordingly, we investigated air leak sounds from a focal pleural defect in a rat model and from a staple line failure in a clinically relevant swine model to demonstrate the high sensitivity and translational potential of this approach. In rat and swine models of free-flowing air leak under positive pressure ventilation with intrapleural microphone 1 cm from the lung surface, we identified that: (a) pulmonary air leaks generate sounds that contain distinct harmonic series, (b) acoustic characteristics of air leak sounds can be used to classify leak severity, and (c) precise location of the air leak can be determined with high resolution (within 1 cm) by mapping the sound loudness level across the lung surface. Our findings suggest that sound-guided assessment and localization of pulmonary air leaks could serve as a diagnostic tool to inform air leak detection and treatment strategies during video-assisted thoracoscopic surgery (VATS) or thoracotomy procedures.
Collapse
Affiliation(s)
- Meghan R. Pinezich
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Seyed Mohammad Mir
- Department of Biomedical EngineeringStevens Institute of TechnologyHobokenNew JerseyUSA
| | - Jonathan A. Reimer
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
- Department of SurgeryColumbia University Medical CenterNew YorkNew YorkUSA
| | - Sarah R. Kaslow
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
- Department of SurgeryColumbia University Medical CenterNew YorkNew YorkUSA
| | - Jiawen Chen
- Department of Biomedical EngineeringStevens Institute of TechnologyHobokenNew JerseyUSA
| | | | - Matthew Bacchetta
- Department of Thoracic Surgery, Vanderbilt UniversityNashvilleTennesseeUSA
| | - John D. O'Neill
- Department of Cell BiologyState University of New York Downstate Medical CenterBrooklynNew YorkUSA
| | - Gordana Vunjak‐Novakovic
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
- Department of MedicineColumbia University Medical CenterNew YorkNew YorkUSA
| | - Jinho Kim
- Department of Biomedical EngineeringStevens Institute of TechnologyHobokenNew JerseyUSA
| |
Collapse
|
4
|
Kulkarni S, Kurane A, Sakate D. Impulse Oscillometry System for the Diagnosis of Wheezing Episode in Children in Office Practice. J Asthma Allergy 2022; 15:353-362. [PMID: 35320988 PMCID: PMC8935627 DOI: 10.2147/jaa.s344643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Objectively differentiating between wheezing episodes and other respiratory disorders will be helpful in treatment in office practice. The impulse oscillometry system has been useful in assessing airway resistance in children 3–6 years old. As the reference values are different in geographical regions the use of the impulse oscillometry is still limited. Comparison between the percent change in IOS parameters as compared to reference standards and changes in actual IOS parameters was done to diagnose wheezing episodes. Methodology Three to six years old children with a history of fever, cough, cold, and/or breathlessness with noisy breathing and who were not on any regular medications, whose parents gave consent were recruited in the study. The children underwent an impulse oscillometry system examination as per the guidelines. The test was repeated after they were given nebulization by salbutamol (2.5 mg) (before COVID 19 pandemic). Final diagnosis was done by following patients for 7 days. Results About 106 children were recruited in the study. Five children could not perform the IOS test. Eighteen children did not complete the follow-up. Hence, 83 children were analyzed. There were 47 males and 36 female patients. The change in actual values of AX, R5, and X20 showed statistically significant difference in wheezing episode group (p-value<0.001). The percentage change as compared to predicted values of R5 and X20 also showed a statistically significant difference in the wheezing episode group and the others group (p-value<0.001). Conclusion The change in actual values of AX, R5, X20, and resonant frequency may help to differentiate wheezing episode from other respiratory diseases.
Collapse
Affiliation(s)
- Suhas Kulkarni
- Department of Pediatrics, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
- Correspondence: Suhas Kulkarni, D.Y. Patil Medical College, Kolhapur, Maharashtra, India, Tel +91 231 2601235, Fax +91 231260138, Email
| | - Anil Kurane
- Department of Pediatrics, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
| | - Deepak Sakate
- Department of Statistics and Applied Mathematics, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| |
Collapse
|
5
|
Abstract
Many thousands of articles relating to asthma appear in medical and scientific journals each year, yet there is still no consensus as to how the condition should be defined. Some argue that the condition does not exist as an entity and that the term should be discarded. The key feature that distinguishes it from other respiratory diseases is that airway smooth muscles, which normally vary little in length, have lost their stable configuration and shorten excessively in response to a wide range of stimuli. The lungs' and airways' limited repertoire of responses results in patients with very different pathologies experiencing very similar symptoms and signs. In the absence of objective verification of airway smooth muscle (ASM) lability, over and underdiagnosis are all too common. Allergic inflammation can exacerbate symptoms but given that worldwide most asthmatics are not atopic, these are two discrete conditions. Comorbidities are common and are often responsible for symptoms attributed to asthma. Common amongst these are a chronic bacterial dysbiosis and dysfunctional breathing. For progress to be made in areas of therapy, diagnosis, monitoring and prevention, it is essential that a diagnosis of asthma is confirmed by objective tests and that all co-morbidities are accurately detailed.
Collapse
Affiliation(s)
- Mark L Everard
- Division of Child Health, Children's Hospital, Faculty of Medicine, University of Western Australia, Perth, WA 6009, Australia
| |
Collapse
|
6
|
Ntzounas A, Giannakopoulos I, Lampropoulos P, Vervenioti A, Koliofoti EG, Malliori S, Priftis KN, Dimitriou G, Anthracopoulos MB, Fouzas S. Changing trends in the prevalence of childhood asthma over 40 years in Greece. Pediatr Pulmonol 2021; 56:3242-3249. [PMID: 34288606 DOI: 10.1002/ppul.25575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND A series of repeated questionnaire surveys among 8- to 9-year-old school children in the city of Patras, Greece, demonstrated a continuous rise in the prevalence of wheeze/asthma from 1978 to 2003, with a plateau between 2003 and 2008. We further investigated wheeze/asthma trends within the same environment over the last decade. METHODS Two follow-up surveys were conducted in 2013 (N = 2554) and 2018 (N = 2648). Physician-diagnosed wheeze and asthma were analyzed in relation to their occurrence (recent-onset: within the last 2 years; noncurrent: before 2 years; persistent: both prior and within the last 2 years). In 2018, spirometry was also performed in participants reporting symptoms and in a sample of healthy controls. RESULTS The prevalence of current wheeze/asthma declined from 6.9% in 2008% to 5.2% in 2013% and 4.3% in 2018. The persistent and noncurrent wheeze/asthma groups followed this overall trend (P-for-trend <0.001), while the prevalence of recent-onset wheeze/asthma remained unchanged (P-for-trend >0.05). Persistent and noncurrent wheezers were also more frequently diagnosed with asthma, in contrast to those with recent-onset wheeze. The FEV1 z-score was less than -1 in 32.1% of children with recent-onset and in 22.4% of those with persistent wheeze/asthma; both rates were higher than those of the Noncurrent wheeze/asthma group (7.1%; p < .05) and of healthy controls (3.5%; p < .001). CONCLUSIONS The prevalence of childhood wheeze/asthma has declined significantly during the last decade in Greece. The reversing trend may in part be attributed to changing asthma perceptions among physicians and/or parents, especially in the case of younger children with troublesome respiratory symptoms.
Collapse
Affiliation(s)
- Alexandros Ntzounas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Ioannis Giannakopoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Panagiotis Lampropoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Aggeliki Vervenioti
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Eleana-Georgia Koliofoti
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Styliani Malliori
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Kostas N Priftis
- Third Department of Pediatrics, "Attikon" Hospital and Athens University Medical School, Athens, Greece
| | - Gabriel Dimitriou
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Michael B Anthracopoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Sotirios Fouzas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| |
Collapse
|
7
|
Habukawa C, Ohgami N, Arai T, Makata H, Tomikawa M, Fujino T, Manabe T, Ogihara Y, Ohtani K, Shirao K, Sugai K, Asai K, Sato T, Murakami K. Wheeze Recognition Algorithm for Remote Medical Care Device in Children: Validation Study. JMIR Pediatr Parent 2021; 4:e28865. [PMID: 33875413 PMCID: PMC8277407 DOI: 10.2196/28865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2020, peoples' lifestyles have been largely changed due to the COVID-19 pandemic worldwide. In the medical field, although many patients prefer remote medical care, this prevents the physician from examining the patient directly; thus, it is important for patients to accurately convey their condition to the physician. Accordingly, remote medical care should be implemented and adaptable home medical devices are required. However, only a few highly accurate home medical devices are available for automatic wheeze detection as an exacerbation sign. OBJECTIVE We developed a new handy home medical device with an automatic wheeze recognition algorithm, which is available for clinical use in noisy environments such as a pediatric consultation room or at home. Moreover, the examination time is only 30 seconds, since young children cannot endure a long examination time without crying or moving. The aim of this study was to validate the developed automatic wheeze recognition algorithm as a clinical medical device in children at different institutions. METHODS A total of 374 children aged 4-107 months in pediatric consultation rooms of 10 institutions were enrolled in this study. All participants aged ≥6 years were diagnosed with bronchial asthma and patients ≤5 years had reported at least three episodes of wheezes. Wheezes were detected by auscultation with a stethoscope and recorded for 30 seconds using the wheeze recognition algorithm device (HWZ-1000T) developed based on wheeze characteristics following the Computerized Respiratory Sound Analysis guideline, where the dominant frequency and duration of a wheeze were >100 Hz and >100 ms, respectively. Files containing recorded lung sounds were assessed by each specialist physician and divided into two groups: 177 designated as "wheeze" files and 197 as "no-wheeze" files. Wheeze recognitions were compared between specialist physicians who recorded lung sounds and those recorded using the wheeze recognition algorithm. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for all recorded sound files, and evaluated the influence of age and sex on the wheeze detection sensitivity. RESULTS Detection of wheezes was not influenced by age and sex. In all files, wheezes were differentiated from noise using the wheeze recognition algorithm. The sensitivity, specificity, positive predictive value, and negative predictive value of the wheeze recognition algorithm were 96.6%, 98.5%, 98.3%, and 97.0%, respectively. Wheezes were automatically detected, and heartbeat sounds, voices, and crying were automatically identified as no-wheeze sounds by the wheeze recognition algorithm. CONCLUSIONS The wheeze recognition algorithm was verified to identify wheezing with high accuracy; therefore, it might be useful in the practical implementation of asthma management at home. Only a few home medical devices are available for automatic wheeze detection. The wheeze recognition algorithm was verified to identify wheezing with high accuracy and will be useful for wheezing management at home and in remote medical care.
Collapse
Affiliation(s)
- Chizu Habukawa
- Department of Pediatrics, Minami Wakayama Medical Center, Tanabe, Japan
| | | | | | | | | | | | | | | | | | - Kenichiro Shirao
- Shirao Clinic of Pediatrics and Pediatric Allergy, Hiroshima, Japan
| | - Kazuko Sugai
- Sugai Children's Clinic Pediatrics/Allergy, Hiroshima, Japan
| | - Kei Asai
- Omron Healthcare Co, Ltd, Muko, Japan
| | | | - Katsumi Murakami
- Department of Psychosomatic Medicine, Sakai Sakibana Hospital, Sakai, Japan
| |
Collapse
|
8
|
Habukawa C, Ohgami N, Matsumoto N, Hashino K, Asai K, Sato T, Murakami K. A wheeze recognition algorithm for practical implementation in children. PLoS One 2020; 15:e0240048. [PMID: 33031408 PMCID: PMC7544038 DOI: 10.1371/journal.pone.0240048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The detection of wheezes as an exacerbation sign is important in certain respiratory diseases. However, few highly accurate clinical methods are available for automatic detection of wheezes in children. This study aimed to develop a wheeze detection algorithm for practical implementation in children. METHODS A wheeze recognition algorithm was developed based on wheezes features following the Computerized Respiratory Sound Analysis guidelines. Wheezes can be detected by auscultation with a stethoscope and using an automatic computerized lung sound analysis. Lung sounds were recorded for 30 s in 214 children aged 2 months to 12 years and 11 months in a pediatric consultation room. Files containing recorded lung sounds were assessed by two specialist physicians and divided into two groups: 65 were designated as "wheeze" files, and 149 were designated as "no-wheeze" files. All lung sound judgments were agreed between two specialist physicians. We compared wheeze recognition between the specialist physicians and using the wheeze recognition algorithm and calculated the sensitivity, specificity, positive predictive value, and negative predictive value for all recorded sound files to evaluate the influence of age on the wheeze detection sensitivity. RESULTS The detection of wheezes was not influenced by age. In all files, wheezes were differentiated from noise using the wheeze recognition algorithm. The sensitivity, specificity, positive predictive value, and negative predictive value of the wheeze recognition algorithm were 100%, 95.7%, 90.3%, and 100%, respectively. CONCLUSIONS The wheeze recognition algorithm could identify wheezes in sound files and therefore may be useful in the practical implementation of respiratory illness management at home using properly developed devices.
Collapse
Affiliation(s)
- Chizu Habukawa
- Department of Paediatrics, Minami Wakayama Medical Center, Wakayama, Japan
| | - Naoto Ohgami
- Clinical Development Department, Technology Development HQ, Development center, Omron Healthcare Co., Ltd, Kyoto, Japan
| | - Naoki Matsumoto
- Core Technology Department, Technology Development HQ, Development Center, Omron Healthcare Co., Ltd, Kyoto, Japan
| | - Kenji Hashino
- Core Technology Department, Technology Development HQ, Development Center, Omron Healthcare Co., Ltd, Kyoto, Japan
| | - Kei Asai
- Clinical Development Department, Technology Development HQ, Development center, Omron Healthcare Co., Ltd, Kyoto, Japan
| | - Tetsuya Sato
- Clinical Development Department, Technology Development HQ, Development center, Omron Healthcare Co., Ltd, Kyoto, Japan
| | - Katsumi Murakami
- Department of Psychosomatic Medicine, Sakai Sakibana Hospital, Osaka, Japan
| |
Collapse
|
9
|
Douros K, Everard ML. Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That. Front Pediatr 2020; 8:218. [PMID: 32432064 PMCID: PMC7214804 DOI: 10.3389/fped.2020.00218] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as "bronchiolitis," "reactive airways disease," "viral wheeze," and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies. This lack of clarity is due, in large part, to a failure to understand the basic underlying inflammatory and associated processes and, in part, due to the lack of a simple test to identify a condition such as asthma. Moreover, there is a lack of insight into the fact that the same pathology can produce different clinical signs at different ages. The consequence is that terminology and fashions in treatment have tended to go around in circles. As was noted almost 60 years ago, amongst pre-school children with a viral LRTI and airways obstruction there are those with a "viral bronchitis" and those with asthma. In the former group, a neutrophil dominated inflammation response is responsible for the airways' obstruction whilst amongst asthmatics much of the obstruction is attributable to bronchoconstriction. The airways obstruction in the former group is predominantly caused by airways secretions and to some extent mucosal oedema (a "snotty lung"). These patients benefit from good supportive care including supplemental oxygen if required (though those with a pre-existing bacterial bronchitis will also benefit from antibiotics). For those with a viral exacerbation of asthma, characterized by bronchoconstriction combined with impaired b-agonist responsiveness, standard management of an exacerbation of asthma (including the use of steroids to re-establish bronchodilator responsiveness) represents optimal treatment. The difficulty is identifying which group a particular patient falls into. A proposed simplified approach to the nomenclature used to categorize virus associated LRTIs is presented based on an understanding of the underlying pathological processes and how these contribute to the physical signs.
Collapse
Affiliation(s)
- Konstantinos Douros
- Third Department of Paediatrics, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | - Mark L. Everard
- Division of Paediatrics and Child Health, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| |
Collapse
|
10
|
Abstract
Introduction Chronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways inflammation and this may be due to a variety of aetiologies. A key part of assessment is obtaining an accurate cough history. It has previously been shown that parental reporting of 'wheeze' is frequently inaccurate. This study aimed to determine whether parental reporting of the quality of a child's cough is likely to be accurate. Methods Parents of 48 'new' patients presenting to a respiratory clinic with chronic cough were asked to describe the nature of their child's cough. They were then shown video clips of different types of cough using age-appropriate examples, and their initial report was compared with the types of cough chosen from the video. Results In a quarter of cases, the parents chose a video clip of a 'dry' or 'wet' cough having given the opposite description. In a further 20% parents chose examples of both 'dry' and 'wet' coughs despite having used only one descriptor. Discussion While the characteristics of a child's cough carry important information that may be helpful in reaching a diagnosis, clinicians should interpret parental reporting of the nature of a child's cough with some caution in that one person's 'dry' cough may very well be another person's 'wet' cough.
Collapse
Affiliation(s)
- Deirdre Donnelly
- Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
11
|
Weiss D, Erie C, Butera J, Copt R, Yeaw G, Harpster M, Hughes J, Salem DN. An in vitro acoustic analysis and comparison of popular stethoscopes. Med Devices (Auckl) 2019; 12:41-52. [PMID: 30697087 PMCID: PMC6339642 DOI: 10.2147/mder.s186076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the performance of various commercially available stethoscopes using standard acoustic engineering criteria, under recording studio conditions. Materials and methods Eighteen stethoscopes (11 acoustic, 7 electronic) were analyzed using standard acoustic analysis techniques under professional recording studio conditions. An organic phantom that accurately simulated chest cavity acoustics was developed. Test sounds were played via a microphone embedded within it and auscultated at its surface by the stethoscopes. Recordings were made through each stethoscope’s binaurals and/or downloaded (electronic models). Recordings were analyzed using standard studio techniques and software, including assessing ambient noise (AMB) rejection. Frequency ranges were divided into those corresponding to various standard biological sounds (cardiac, respiratory, and gastrointestinal). Results Loudness and AMB rejection: Overall, electronic stethoscopes, when set to a maximum volume, exhibited greater values of perceived loudness compared to acoustic stethoscopes. Significant variation was seen in AMB rejection capability. Frequency detection: Marked variation was also seen, with some stethoscopes performing better for different ranges (eg, cardiac) vs others (eg, gastrointestinal). Conclusion The acoustic properties of stethoscopes varied considerably in loudness, AMB rejection, and frequency response. Stethoscope choice should take into account clinical conditions to be auscultated and the noise level of the environment.
Collapse
Affiliation(s)
- Daniel Weiss
- Department of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA, .,Bongiovi Medical & Health Technologies, Inc., Port St Lucie, FL, USA,
| | - Christine Erie
- Department of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA, .,Bongiovi Medical & Health Technologies, Inc., Port St Lucie, FL, USA,
| | - Joseph Butera
- Bongiovi Medical & Health Technologies, Inc., Port St Lucie, FL, USA,
| | - Ryan Copt
- Bongiovi Medical & Health Technologies, Inc., Port St Lucie, FL, USA,
| | - Glenn Yeaw
- Bongiovi Medical & Health Technologies, Inc., Port St Lucie, FL, USA,
| | - Mark Harpster
- Bongiovi Medical & Health Technologies, Inc., Port St Lucie, FL, USA,
| | - James Hughes
- Bongiovi Medical & Health Technologies, Inc., Port St Lucie, FL, USA, .,Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Deeb N Salem
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
12
|
Quigley MA, Carson C, Kelly Y. Breastfeeding and Childhood Wheeze: Age-Specific Analyses and Longitudinal Wheezing Phenotypes as Complementary Approaches to the Analysis of Cohort Data. Am J Epidemiol 2018; 187:1651-1661. [PMID: 29617923 PMCID: PMC6070068 DOI: 10.1093/aje/kwy057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/09/2018] [Indexed: 11/12/2022] Open
Abstract
Systematic reviews suggest that breastfeeding is associated with a lower risk of asthma, although marked heterogeneity exists. Using UK Millennium Cohort Study data (n = 10,126 children, born 2000-2002), we examined the association between breastfeeding duration and wheezing in the previous year, first for each age group separately (ages 9 months, 3 years, 5 years, 7 years, and 11 years) and then in terms of a longitudinal wheezing phenotype: "early transient" (wheezing any time up to age 5 years but not thereafter), "late onset" (any time from age 7 years but not beforehand), and "persistent" (any time up to age 5 years and any time from age 7 years). The association between breastfeeding and wheeze varied by age (2-sided P for interaction = 0.0003). For example, breastfeeding for 6-9 months was associated with lower odds of wheezing at ages 9 months, 3 years, and 5 years but less so at ages 7 years and 11 years (adjusted odds ratios = 0.73, 0.78, 0.79, 0.84, 1.06, respectively). There was a strong dose-response relationship for breastfeeding per month and early transient wheeze (adjusted odds ratio for linear trend = 0.961, 95% confidence interval: 0.942, 0.980) but no clear trend for late-onset or persistent wheeze. Our results identified heterogeneity in the association between breastfeeding and wheezing according to age at wheezing and wheezing phenotype.
Collapse
Affiliation(s)
- Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| |
Collapse
|
13
|
Abstract
Wheezing is the most widely reported adventitious lung sound in the English language. It is recognized by health professionals as well as by lay people, although often with a different meaning. Wheezing is an indicator of airway obstruction and therefore of interest particularly for the assessment of young children and in other situations where objective documentation of lung function is not generally available. This review summarizes our current understanding of mechanisms producing wheeze, its subjective perception and description, its objective measurement, and visualization, and its relevance in clinical practice.
Collapse
|
14
|
Imai E, Enseki M, Nukaga M, Tabata H, Hirai K, Kato M, Mochizuki H. A lung sound analysis in a child thought to have cough variant asthma: A case report. Allergol Int 2018; 67:150-152. [PMID: 28673440 DOI: 10.1016/j.alit.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Eri Imai
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Mayumi Enseki
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Mariko Nukaga
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Hideyuki Tabata
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Kota Hirai
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Masahiko Kato
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan.
| |
Collapse
|
15
|
Puder LC, Wilitzki S, Bührer C, Fischer HS, Schmalisch G. Computerized wheeze detection in young infants: comparison of signals from tracheal and chest wall sensors. Physiol Meas 2016; 37:2170-2180. [PMID: 27869106 DOI: 10.1088/0967-3334/37/12/2170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Computerized wheeze detection is an established method for objective assessment of respiratory sounds. In infants, this method has been used to detect subclinical airway obstruction and to monitor treatment effects. The optimal location for the acoustic sensors, however, is unknown. The aim of this study was to evaluate the quality of respiratory sound recordings in young infants, and to determine whether the position of the sensor affected computerized wheeze detection. Respiratory sounds were recorded over the left lateral chest wall and the trachea in 112 sleeping infants (median postmenstrual age: 49 weeks) on 129 test occasions using an automatic wheeze detection device (PulmoTrack®). Each recording lasted 10 min and the recordings were stored. A trained clinician retrospectively evaluated the recordings to determine sound quality and disturbances. The wheeze rates of all undisturbed tracheal and chest wall signals were compared using Bland-Altman plots. Comparison of wheeze rates measured over the trachea and the chest wall indicated strong correlation (r ⩾ 0.93, p < 0.001), with a bias of 1% or less and limits of agreement of within 3% for the inspiratory wheeze rate and within 6% for the expiratory wheeze rate. However, sounds from the chest wall were more often affected by disturbances than sounds from the trachea (23% versus 6%, p < 0.001). The study suggests that in young infants, a better quality of lung sound recordings can be obtained with the tracheal sensor.
Collapse
Affiliation(s)
- Lia C Puder
- Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117 Berlin, Germany
| | | | | | | | | |
Collapse
|
16
|
Melbye H, Garcia-Marcos L, Brand P, Everard M, Priftis K, Pasterkamp H. Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians' classification of lung sounds from video recordings. BMJ Open Respir Res 2016; 3:e000136. [PMID: 27158515 PMCID: PMC4854017 DOI: 10.1136/bmjresp-2016-000136] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 12/04/2022] Open
Abstract
Background The European Respiratory Society (ERS) lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at determining the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes. Methods Recordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients. Multirater kappa (Fleiss' κ) was calculated for each of the 10 adventitious sounds and for combined categories of sounds. Results The majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Poor to fair agreement (κ<0.40) was usually found for the detailed descriptions of the adventitious sounds, whereas moderate to good agreement was reached for the combined categories of crackles (κ=0.62) and wheezes (κ=0.59). The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine. Conclusions Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions.
Collapse
Affiliation(s)
- Hasse Melbye
- Faculty of Health Sciences, General Practice Research Unit , UIT the Arctic University of Norway , Tromsø , Norway
| | - Luis Garcia-Marcos
- Pediatric Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain; IMIB-Arrixaca Biohealth Research Institute, Murcia, Spain
| | - Paul Brand
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands; Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Mark Everard
- School of Paediatrics, University of Western Australia, Princess Margaret Hospital , Subiaco, Western Australia , Australia
| | - Kostas Priftis
- Children's Respiratory and Allergy Unit, Third Dept of Paediatrics , "Attikon" Hospital, University of Athens Medical School , Athens , Greece
| | - Hans Pasterkamp
- Section of Respirology, Dept of Pediatrics and Child Health , University of Manitoba , Winnipeg, Manitoba , Canada
| |
Collapse
|
17
|
Fischer HS, Puder LC, Wilitzki S, Usemann J, Bührer C, Godfrey S, Schmalisch G. Relationship between computerized wheeze detection and lung function parameters in young infants. Pediatr Pulmonol 2016; 51:402-10. [PMID: 26360639 DOI: 10.1002/ppul.23310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 07/08/2015] [Accepted: 07/29/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Computerized respiratory sound analysis (CORSA) has been validated in the assessment of wheeze in infants, but it is unknown whether automatically detected wheeze is associated with impaired lung function. This study investigated the relationship between wheeze detection and conventional lung function testing (LFT) parameters. METHODS CORSA was performed using the PulmoTrack® monitor in 110 infants, of median (interquartile range) postmenstrual age 50 (46-56) weeks and median body weight 4,810 (3,980-5,900) g, recovering from neonatal intensive care. In the same session, LFT was performed, including tidal breathing measurements, occlusion tests, body plethysmography, forced expiratory flow by rapid thoracoabdominal compression, sulfur hexafluoride (SF6 ) multiple breath washout (MBW), and capillary blood gas analysis. Infants were classified as wheezers or non-wheezers using predefined cut-off values for the duration of inspiratory and expiratory wheeze. RESULTS Wheezing was detected in 72 (65%) infants, with 43 (39%) having inspiratory and 53 (48%) having expiratory wheezing. Endotracheal mechanical ventilation in the neonatal period for > 24 hr was associated with inspiratory wheeze (P = 0.009). Airway resistance was increased in both inspiratory (P = 0.02) and expiratory (P = 0.004) wheezers and correlated with the duration of expiratory wheeze (r = 0.394, P < 0.001). Expiratory wheezers showed a significant increase in respiratory resistance (P = 0.001), time constant (0.012), and functional residual capacity using SF6 MBW (P = 0.019). There was no association between wheezing and forced expiratory flow or blood gases. CONCLUSION CORSA can help identify neonates and young infants with subclinical airway obstruction and may prove useful in the follow-up of high-risk infants.
Collapse
Affiliation(s)
| | - Lia Carlotta Puder
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Silke Wilitzki
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Jakob Usemann
- Department of Pediatric Pneumology and Immunology, Charité University Medical Center, Berlin, Germany.,Department of Pediatric Pneumology, University Children's Hospital, Basel, Switzerland
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Simon Godfrey
- Emeritus Professor of Pediatrics, Hadassah-Hebrew University, Jerusalem, Israel
| | - Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| |
Collapse
|
18
|
Maguire C, Cantrill H, Hind D, Bradburn M, Everard ML. Hypertonic saline (HS) for acute bronchiolitis: Systematic review and meta-analysis. BMC Pulm Med 2015; 15:148. [PMID: 26597174 PMCID: PMC4657365 DOI: 10.1186/s12890-015-0140-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/10/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute bronchiolitis is the commonest cause of hospitalisation in infancy. Currently management consists of supportive care and oxygen. A Cochrane review concluded that, "nebulised 3 % saline may significantly reduce the length of hospital stay". We conducted a systematic review of controlled trials of nebulised hypertonic saline (HS) for infants hospitalised with primary acute bronchiolitis. METHODS Searches to January 2015 involved: Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Embase; Google Scholar; Web of Science; and, a variety of trials registers. We hand searched Chest, Paediatrics and Journal of Paediatrics on 14 January 2015. Reference lists of eligible trial publications were checked. Randomised or quasi-randomised trials which compared HS versus either normal saline (+/- adjunct treatment) or no treatment were included. Eligible studies involved children less than 2 years old hospitalised due to the first episode of acute bronchiolitis. Two reviewers extracted data to calculate mean differences (MD) and 95 % Confidence Intervals (CIs) for length of hospital stay (LoS-primary outcome), Clinical Severity Score (CSS) and Serious Adverse Events (SAEs). Meta-analysis was undertaken using a fixed effect model, supplemented with additional sensitivity analyses. We investigated statistical heterogeneity using I(2). Risk of bias, within and between studies, was assessed using the Cochrane tool, an outcome reporting bias checklist and a funnel plot. RESULTS Fifteen trials were included in the systematic review (n = 1922), HS reduced mean LoS by 0.36, (95 % CI 0.50 to 0.22) days, but with considerable heterogeneity (I(2) = 78 %) and sensitivity to alternative analysis methods. A reduction in CSS was observed where assessed [n = 516; MD -1.36, CI -1.52, -1.20]. One trial reported one possible intervention related SAE, no other studies described intervention related SAEs. CONCLUSIONS There is disparity between the overall combined effect on LoS as compared with the negative results from the largest and most precise trials. Together with high levels of heterogeneity, this means that neither individual trials nor pooled estimates provide a firm evidence-base for routine use of HS in inpatient acute bronchiolitis.
Collapse
Affiliation(s)
- Chin Maguire
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.
| | - Hannah Cantrill
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.
| | - Mike Bradburn
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.
| | - Mark L Everard
- School of Paediatrics and Child Health (SPACH), The University of Western Australia, Perth, Australia.
| |
Collapse
|
19
|
Goldstein H, Tagg A, Lawton B, Davis T. Easing the wheeze. Emerg Med Australas 2015; 27:384-6. [PMID: 26289296 DOI: 10.1111/1742-6723.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Henry Goldstein
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Tagg
- Emergency Department, Footscray Hospital, Melbourne, Victoria, Australia
| | - Ben Lawton
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Emergency Department, Logan Hospital, Logan City, Queensland, Australia
| | - Tessa Davis
- Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Everard ML, Hind D, Ugonna K, Freeman J, Bradburn M, Dixon S, Maguire C, Cantrill H, Alexander J, Lenney W, McNamara P, Elphick H, Chetcuti PA, Moya EF, Powell C, Garside JP, Chadha LK, Kurian M, Lehal RS, MacFarlane PI, Cooper CL, Cross E. Saline in acute bronchiolitis RCT and economic evaluation: hypertonic saline in acute bronchiolitis - randomised controlled trial and systematic review. Health Technol Assess 2015; 19:1-130. [PMID: 26295732 PMCID: PMC4781529 DOI: 10.3310/hta19660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Acute bronchiolitis is the most common cause of hospitalisation in infancy. Supportive care and oxygen are the cornerstones of management. A Cochrane review concluded that the use of nebulised 3% hypertonic saline (HS) may significantly reduce the duration of hospitalisation. OBJECTIVE To test the hypothesis that HS reduces the time to when infants were assessed as being fit for discharge, defined as in air with saturations of > 92% for 6 hours, by 25%. DESIGN Parallel-group, pragmatic randomised controlled trial, cost-utility analysis and systematic review. SETTING Ten UK hospitals. PARTICIPANTS Infants with acute bronchiolitis requiring oxygen therapy were allocated within 4 hours of admission. INTERVENTIONS Supportive care with oxygen as required, minimal handling and fluid administration as appropriate to the severity of the disease, 3% nebulised HS every ± 6 hours. MAIN OUTCOME MEASURES The trial primary outcome was time until the infant met objective discharge criteria. Secondary end points included time to discharge and adverse events. The costs analysed related to length of stay (LoS), readmissions, nebulised saline and other NHS resource use. Quality-adjusted life-years (QALYs) were estimated using an existing utility decrement derived for hospitalisation in children, together with the time spent in hospital in the trial. DATA SOURCES We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases from inception or from 2010 onwards, searched ClinicalTrials.gov and other registries and hand-searched Chest, Paediatrics and Journal of Paediatrics to January 2015. REVIEW METHODS We included randomised/quasi-randomised trials which compared HS versus saline (± adjunct treatment) or no treatment. We used a fixed-effects model to combine mean differences for LoS and assessed statistical heterogeneity using the I (2) statistic. RESULTS The trial randomised 158 infants to HS (n = 141 analysed) and 159 to standard care (n = 149 analysed). There was no difference between the two arms in the time to being declared fit for discharge [median 76.6 vs. 75.9 hours, hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.75 to 1.20] or to actual discharge (median 88.5 vs. 88.7 hours, HR 0.97, 95% CI 0.76 to 1.23). There was no difference in adverse events. One infant developed bradycardia with desaturation associated with HS. Mean hospital costs were £2595 and £2727 for the control and intervention groups, respectively (p = 0.657). Incremental QALYs were 0.0000175 (p = 0.757). An incremental cost-effectiveness ratio of £7.6M per QALY gained was not appreciably altered by sensitivity analyses. The systematic review comprised 15 trials (n = 1922) including our own. HS reduced the mean LoS by -0.36 days (95% CI -0.50 to -0.22 days). High levels of heterogeneity (I (2) = 78%) indicate that the result should be treated cautiously. CONCLUSIONS In this trial, HS had no clinical benefit on LoS or readiness for discharge and was not a cost-effective treatment for acute bronchiolitis. Claims that HS achieves small reductions in LoS must be treated with scepticism. FUTURE WORK Well-powered randomised controlled trials of high-flow oxygen are needed. STUDY REGISTRATION This study is registered as NCT01469845 and CRD42014007569. FUNDING DETAILS This project was funded by the NIHR Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment; Vol. 19, No. 66. See the HTA programme website for further project information.
Collapse
Affiliation(s)
- Mark L Everard
- School of Paediatrics and Child Health (SPACH), University of Western Australia, Perth, WA, Australia
| | - Daniel Hind
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kelechi Ugonna
- Department of Respiratory Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Jennifer Freeman
- Division of Epidemiology & Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Chin Maguire
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Alexander
- Children's Centre, Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Warren Lenney
- Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, UK
| | - Paul McNamara
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Heather Elphick
- Department of Respiratory Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Philip Aj Chetcuti
- Children's Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eduardo F Moya
- Department of Paediatrics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Colin Powell
- Department of Child Health, University Hospital of Wales, Cardiff, UK
| | - Jonathan P Garside
- Children's Outpatients, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Lavleen Kumar Chadha
- Paediatrics, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK
| | - Matthew Kurian
- Paediatrics, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK
| | | | | | - Cindy L Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Cross
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
21
|
Panico L, Stuart B, Bartley M, Kelly Y. Asthma trajectories in early childhood: identifying modifiable factors. PLoS One 2014; 9:e111922. [PMID: 25379671 PMCID: PMC4224405 DOI: 10.1371/journal.pone.0111922] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/02/2014] [Indexed: 11/19/2022] Open
Abstract
Background There are conflicting views as to whether childhood wheezing represents several discreet entities or a single but variable disease. Classification has centered on phenotypes often derived using subjective criteria, small samples, and/or with little data for young children. This is particularly problematic as asthmatic features appear to be entrenched by age 6/7. In this paper we aim to: identify longitudinal trajectories of wheeze and other atopic symptoms in early childhood; characterize the resulting trajectories by the socio-economic background of children; and identify potentially modifiable processes in infancy correlated with these trajectories. Data and Methods The Millennium Cohort Study is a large, representative birth cohort of British children born in 2000–2002. Our analytical sample includes 11,632 children with data on key variables (wheeze in the last year; ever hay-fever and/or eczema) reported by the main carers at age 3, 5 and 7 using a validated tool, the International Study of Asthma and Allergies in Childhood module. We employ longitudinal Latent Class Analysis, a clustering methodology which identifies classes underlying the observed population heterogeneity. Results Our model distinguished four latent trajectories: a trajectory with both low levels of wheeze and other atopic symptoms (54% of the sample); a trajectory with low levels of wheeze but high prevalence of other atopic symptoms (29%); a trajectory with high prevalence of both wheeze and other atopic symptoms (9%); and a trajectory with high levels of wheeze but low levels of other atopic symptoms (8%). These groups differed in terms of socio-economic markers and potential intervenable factors, including household damp and breastfeeding initiation. Conclusion Using data-driven techniques, we derived four trajectories of asthmatic symptoms in early childhood in a large, population based sample. These groups differ in terms of their socio-economic profiles. We identified correlated intervenable pathways in infancy, including household damp and breastfeeding initiation.
Collapse
Affiliation(s)
- Lidia Panico
- Institut National d'Etudes Démographiques, Paris, France
- * E-mail:
| | - Beth Stuart
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Mel Bartley
- International Centre for Lifecourse Studies, Department for Epidemiology and Population Health, University College London, London, United Kingdom
| | - Yvonne Kelly
- International Centre for Lifecourse Studies, Department for Epidemiology and Population Health, University College London, London, United Kingdom
| |
Collapse
|
22
|
Puder LC, Fischer HS, Wilitzki S, Usemann J, Godfrey S, Schmalisch G. Validation of computerized wheeze detection in young infants during the first months of life. BMC Pediatr 2014; 14:257. [PMID: 25296955 PMCID: PMC4287542 DOI: 10.1186/1471-2431-14-257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several respiratory diseases are associated with specific respiratory sounds. In contrast to auscultation, computerized lung sound analysis is objective and can be performed continuously over an extended period. Moreover, audio recordings can be stored. Computerized lung sounds have rarely been assessed in neonates during the first year of life. This study was designed to determine and validate optimal cut-off values for computerized wheeze detection, based on the assessment by trained clinicians of stored records of lung sounds, in infants aged <1 year. METHODS Lung sounds in 120 sleeping infants, of median (interquartile range) postmenstrual age of 51 (44.5-67.5) weeks, were recorded on 144 test occasions by an automatic wheeze detection device (PulmoTrack®). The records were retrospectively evaluated by three trained clinicians blinded to the results. Optimal cut-off values for the automatically determined relative durations of inspiratory and expiratory wheezing were determined by receiver operating curve analysis, and sensitivity and specificity were calculated. RESULTS The optimal cut-off values for the automatically detected durations of inspiratory and expiratory wheezing were 2% and 3%, respectively. These cutoffs had a sensitivity and specificity of 85.7% and 80.7%, respectively, for inspiratory wheezing and 84.6% and 82.5%, respectively, for expiratory wheezing. Inter-observer reliability among the experts was moderate, with a Fleiss' Kappa (95% confidence interval) of 0.59 (0.57-0.62) for inspiratory and 0.54 (0.52 - 0.57) for expiratory wheezing. CONCLUSION Computerized wheeze detection is feasible during the first year of life. This method is more objective and can be more readily standardized than subjective auscultation, providing quantitative and noninvasive information about the extent of wheezing.
Collapse
Affiliation(s)
| | | | | | | | | | - Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Berlin, Germany.
| |
Collapse
|
23
|
Hu Y, Kim EG, Cao G, Liu S, Xu Y. Physiological acoustic sensing based on accelerometers: a survey for mobile healthcare. Ann Biomed Eng 2014; 42:2264-77. [PMID: 25234130 DOI: 10.1007/s10439-014-1111-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/05/2014] [Indexed: 02/07/2023]
Abstract
This paper reviews the applications of accelerometers on the detection of physiological acoustic signals such as heart sounds, respiratory sounds, and gastrointestinal sounds. These acoustic signals contain a rich reservoir of vital physiological and pathological information. Accelerometer-based systems enable continuous, mobile, low-cost, and unobtrusive monitoring of physiological acoustic signals and thus can play significant roles in the emerging mobile healthcare. In this review, we first briefly explain the operation principle of accelerometers and specifications that are important for mobile healthcare. Applications of accelerometer-based monitoring systems are then presented. Next, we review a variety of accelerometers which have been reported in literatures for physiological acoustic sensing, including both commercial products and research prototypes. Finally, we discuss some challenges and our vision for future development.
Collapse
Affiliation(s)
- Yating Hu
- Engineering Technology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | | | | | | | | |
Collapse
|
24
|
Abstract
A clinical diagnosis of asthma is often considered when a child presents with recurrent cough, wheeze and breathlessness. However, there are many other causes of wheeze in a young child. These range from recurrent viral infections to chronic suppurative lung disease, gastro-oesophageal reflux disease and rare structural abnormalities. Arriving at a diagnosis includes taking into consideration the symptomatology, triggers, atopic features, family history, absence of red flags and therapeutic trial, where indicated.
Collapse
Affiliation(s)
- Mark Chung Wai Ng
- SingHealth Family Medicine Residency Programme, 3 Second Hospital Avenue, Singapore 168937.
| | | |
Collapse
|
25
|
Abstract
OBJECTIVE To investigate the performance of parent-reported data in identifying physician-confirmed asthma. DESIGN AND SETTING Validation study using linkage between the Avon Longitudinal Study of Parents and Children (ALSPAC) and electronic patient records held within the General Practice Research Database (GPRD). PARTICIPANTS Participants were those eligible to participate in ALSPAC who also had a record in the GPRD; this included 765 individuals, just under 4% of ALSPAC-eligible participants. The analysis was based on 141 participants with complete parent-reported asthma data. PRIMARY AND SECONDARY OUTCOME MEASURES The main GPRD outcome measure was whether a child had a diagnosis of asthma before they were nine. Parent-reported measures were doctor diagnosis of asthma (before mean age 7.5 years), various outcomes based on wheezing and breathlessness recorded longitudinally between 6 months and 8.5 years. Secondary outcomes were bronchial hyper-responsiveness (BHR), forced expiratory volume in 1 s/forced vital capacity ratio and skin prick test responses. RESULTS Among the 141 participants with complete parent-reported data, 26 (18%) had an asthma diagnosis before age nine. Using general practitioner (GP)-recorded asthma as the gold standard, the question 'Has a doctor ever diagnosed your child with asthma?' was both sensitive (88.5%) and specific (95.7%). 'Ever wheezed' had the highest sensitivity (100%) but low specificity (60%). More specific definitions were obtained by restricting to those who had wheezed on more than one occasion, experienced frequent wheeze and/or wheezed after the age of 3, but these measures had low sensitivities. BHR only identified 50% of those with a GP-recorded diagnosis. CONCLUSIONS Parental reports of a doctor's diagnosis agree well with a GP-recorded diagnosis. High specificity for asthma can be achieved by using detailed wheezing questions, although these definitions are likely to exclude mild cases of asthma. Our study shows that linkage between observational studies and electronic patient records has the potential to enhance epidemiological research.
Collapse
Affiliation(s)
- Rosaleen P Cornish
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Andrew W Boyd
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Raquel Granell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tjeerd Van Staa
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London, UK
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
26
|
|
27
|
Affiliation(s)
- Will D Carroll
- Nottingham University, Derbyshire Children's Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
| | | |
Collapse
|
28
|
Andrès E, Brandt C, Hajjam A. Progrès et innovations dans le domaine de l’auscultation. Ing Rech Biomed 2012; 33:191-201. [DOI: 10.1016/j.irbm.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
29
|
Andrès E, Hajjam A, Brandt C. Advances and innovations in the field of auscultation, with a special focus on the development of new intelligent communicating stethoscope systems. Health Technol 2012. [DOI: 10.1007/s12553-012-0017-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
30
|
Abstract
Wheeze, a common symptom in pre-school children, is a continuous high-pitched sound, with a musical quality, emitting from the chest during expiration. A pragmatic clinical classification is episodic (viral) wheeze and multiple-trigger wheeze. Diagnostic difficulties include other conditions that give rise to noisy breathing which could be misinterpreted as wheeze. Most preschool children with wheeze do not need rigorous investigations. Primary prevention is not possible but avoidance of environmental tobacco smoke exposure should be strongly encouraged. Bronchodilators provide symptomatic relief in acute wheezy episodes but the evidence for using oral steroids is conflicting for children presenting to the Emergency Department [ED]. Parent initiated oral steroid courses cannot be recommended. High dose inhaled corticosteroids [ICS] used intermittently are effective in children with frequent episodes of moderately severe episodic (viral) wheeze or multiple-trigger wheeze, but this associated with short term effects on growth and cannot be recommended as a routine. Maintenance treatment with low to moderate continuous ICS in pure episodic (viral) wheeze is ineffective. Whilst low to moderate dose regular ICS work in multi-trigger wheeze, the medication does not modify the natural history of the condition. Even if there is a successful trial of treatment with ICS, a break in treatment should be given to see if the symptoms have resolved or continuous therapy is still required. Maintenance as well as intermittent Montelukast has a role in both episodic and multi trigger wheeze. Good multidisciplinary support and education is essential in managing this common condition.
Collapse
Affiliation(s)
- Jayesh M Bhatt
- Consultant in Respiratory Paediatrics, Nottingham University Hospitals NHS Trust (QMC campus), Nottingham, NG7 2UH.
| | | |
Collapse
|
31
|
Andrès E, Brandt C, Gass R, Reichert S. [New developments in the field of human auscultation]. Rev Pneumol Clin 2010; 66:209-213. [PMID: 20561489 DOI: 10.1016/j.pneumo.2009.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 09/14/2009] [Accepted: 10/21/2009] [Indexed: 05/29/2023]
Affiliation(s)
- E Andrès
- Service de médecine interne, diabète et maladies métaboliques, clinique médicale B, CHRU de Strasbourg, hôpital civil, hôpitaux universitaires de Strasbourg, 1, porte de l'Hôpital, 67091 Strasbourg cedex, France.
| | | | | | | |
Collapse
|
32
|
Hunger T, Rzehak P, Wichmann HE, Heinrich J. Prognostic values of specific respiratory sounds for asthma in adolescents. Eur J Pediatr 2010; 169:39-46. [PMID: 19319569 DOI: 10.1007/s00431-009-0976-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/13/2009] [Indexed: 10/21/2022]
Abstract
Childhood wheezing is a common condition associated with asthma, but the term is often misapplied. The present study aimed to investigate the prognostic values of specific respiratory sounds for asthma onset in adolescence. In a prospective study, six specific respiratory sounds were evaluated for their prediction of asthma. Parents were asked for respiratory sounds of their initially asthma-free children and to describe them in specified terms. Self-reported doctor-diagnosed asthma of 1,569 children aged 5 to 14 years from Germany was assessed at baseline and at follow-up for up to 12 years later. Except for 'ronchus' (17%), reported 'gasp' and 'whimper' had the highest positive predictive values of 15% and 11%, respectively. These sounds also showed the greatest increase in asthma incidence (odds ratio = 3.18; 95%CI, 1.46-6.94 and odds ratio = 2.09; 95%CI, 1.00-4.37). It could be shown that from six respiratory sounds, 'gasp' and 'whimper' were the expressions with the best prediction for asthma onset. This study suggests that parents can sensibly distinguish between respiratory sounds and that it is important to specify breathing sounds, as not all are good predictors for asthma.
Collapse
|
33
|
Don M, Korppi M, Valent F, Vainionpaa R, Canciani M. Human metapneumovirus pneumonia in children: Results of an Italian study and mini-review. ACTA ACUST UNITED AC 2009; 40:821-6. [DOI: 10.1080/00365540802227110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Massimiliano Don
- From the Paediatric Department, School of Medicine, DPMSC, University of Udine, Italy
| | - Matti Korppi
- Paediatric Research Centre, Tampere University and University Hospital, Tampere, Finland
| | - Francesca Valent
- Hygiene Department, School of Medicine, DPMSC, University of Udine, Italy
| | | | - Mario Canciani
- From the Paediatric Department, School of Medicine, DPMSC, University of Udine, Italy
| |
Collapse
|
34
|
Abstract
The respiratory syncytial virus should be considered as the most likely pathogen in an infant or young child with a significant acute lower respiratory tract infection during the characteristic epidemic season. While the diagnosis of an RSV infection is relatively straight forward, the clinical diagnosis applied to the associate illness is far less clear cut. Criteria for assessment is based on clinical assessment of severity at examination and associated risk factors. Social factors may further influence the likelihood of admission. Guidelines are consistent in noting that there are no scoring systems or other tests that can reliably predict the need for supportive care or HDU admission. Criteria for the administration of oxygen vary. There are marked differences in the duration of hospitalisation for RSV admission between the USA, UK and Scandinavia. Longer length of admission is associated with significantly higher rates of nosicomial infection.
Collapse
|
35
|
Abstract
The child who has recurrent infections poses one of the most difficult diagnostic challenges in pediatrics. The clinician faces a two-fold challenge in determining first whether the child is normal or has a serious disease, and then, in the latter case, how to confirm or exclude the diagnosis with the minimum number of the least invasive tests. It is hoped that, in the absence of good-quality evidence for most clinical scenarios, the experience-based approach described in this article may prove a useful guide to the clinician.
Collapse
Affiliation(s)
- Andrew Bush
- Imperial School of Medicine at National Heart and Lung Institute, London, UK.
| |
Collapse
|
36
|
Abstract
Although clinicians place considerable weight on the identification of the various forms of noisy breathing, there are serious questions regarding both the accuracy (validity) and the reliability (repeatability) of these noises. To avoid diagnostic errors, clinicians need to consider the whole constellation of symptoms and signs, and not focus on the specific "type" of noise. Given the high error rate with "parent-reported wheeze" there is a need to reexamine the extensive literature on the epidemiology of wheeze in infants and young children, because parent-reported wheeze is unconfirmed by a clinician. It is obvious we need more high-quality research evidence to derive better evidence on the clinical utility of these noises, and their natural history.
Collapse
Affiliation(s)
- Craig Mellis
- Central Clinical School, University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia.
| |
Collapse
|
37
|
Abstract
Croup and acute bronchiolitis are common forms of virally induced respiratory disease in infancy and early childhood. There is good evidence that corticosteroids can ameliorate disease severity and alter the natural history of symptoms in patients who have croup and that temporary symptomatic benefit can be obtained from the use of nebulized adrenaline. The principle weakness when reviewing therapeutic interventions for acute bronchiolitis is the lack of a clear diagnostic test or definition. Current evidence suggests that oxygen is the only useful pharmacologic agent for correcting hypoxia.
Collapse
Affiliation(s)
- Mark L Everard
- Department of Respiratory Medicine, Sheffield Children's Hospital, Western Bank, Sheffield, UK.
| |
Collapse
|
38
|
Abstract
Bronchiolitis and preschool recurrent wheeze (PSRW) are common paediatric problems causing significant morbidity and mortality in the first years of life. Respiratory syncytial virus (RSV) and rhinoviruses are the commonest pathogens associated with these illnesses. Why some infants are severely affected, requiring admission to hospital, whilst others experience a simple cold is not fully understood: research has suggested that the innate immune response to these viruses is important. The innate immune system has many components and activation or deficiency in one or many areas may explain the different clinical presentations and disease severities that can occur in these infants. This review will summarize the recent evidence highlighting how RSV and rhinoviruses may modulate the innate immune response in both bronchiolitis and PSRW, and discuss how these illnesses affect the long-term development of the infant lung and the possible susceptibility to persistent airway disease.
Collapse
|
39
|
Andrès E, Gass R, Brandt C, Reichert S, Collet C, Nguyen G, Baldassari K. De nouveaux outils au service de l’auscultation. Ing Rech Biomed 2008. [DOI: 10.1016/j.irbm.2008.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
40
|
Abstract
BACKGROUND Distinction between normal and abnormal respiratory sounds is important for accurate diagnosis. CURRENT DATA This paper describes the state of the art, scientific publications and ongoing research related to the respiratory sounds. The study includes a description of the various techniques that are being used to record auscultatory sounds and a physical description of known pathological sounds (wheezes and crackles) for which automatic detection tools have been developed. VIEWPOINTS The next stage will include exploiting all the qualities of the sounds. This augmentation of the spectrum studied, linked to signal analysis techniques, will allow the definition of new characteristic markers.
Collapse
Affiliation(s)
- S Reichert
- Ecole de l'Auscultation, Faculté de Médecine de Strasbourg, Strasbourg, France
| | | | | | | |
Collapse
|
41
|
Henderson J, Granell R, Heron J, Sherriff A, Simpson A, Woodcock A, Strachan DP, Shaheen SO, Sterne JAC. Associations of wheezing phenotypes in the first 6 years of life with atopy, lung function and airway responsiveness in mid-childhood. Thorax 2008; 63:974-80. [PMID: 18678704 PMCID: PMC2582336 DOI: 10.1136/thx.2007.093187] [Citation(s) in RCA: 352] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Patterns of wheezing during early childhood may indicate differences in aetiology and prognosis of respiratory illnesses. Improved characterisation of wheezing phenotypes could lead to the identification of environmental influences on the development of asthma and airway diseases in predisposed individuals. Methods: Data collected on wheezing at seven time points from birth to 7 years from 6265 children in a longitudinal birth cohort (the ALSPAC study) were analysed. Latent class analysis was used to assign phenotypes based on patterns of wheezing. Measures of atopy, airway function (forced expiratory volume in 1 s (FEV1), mid forced expiratory flow (FEF25-75)) and bronchial responsiveness were made at 7–9 years of age. Results: Six phenotypes were identified. The strongest associations with atopy and airway responsiveness were found for intermediate onset (18 months) wheezing (OR for atopy 8.36, 95% CI 5.2 to 13.4; mean difference in dose response to methacholine 1.76, 95% CI 1.41 to 2.12 %FEV1 per μmol, compared with infrequent/never wheeze phenotype). Late onset wheezing (after 42 months) was also associated with atopy (OR 6.6, 95% CI 4.7 to 9.4) and airway responsiveness (mean difference 1.61, 95% CI 1.37 to 1.85 %FEV1 per μmol). Transient and prolonged early wheeze were not associated with atopy but were weakly associated with increased airway responsiveness and persistent wheeze had intermediate associations with these outcomes. Conclusions: The wheezing phenotypes most strongly associated with atopy and airway responsiveness were characterised by onset after age 18 months. This has potential implications for the timing of environmental influences on the initiation of atopic wheezing in early childhood.
Collapse
Affiliation(s)
- J Henderson
- Department of Community Based Medicine, University of Bristol, Bristol, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Exercise induced wheeze and atopic disorders predict persistent asthma
Collapse
|
43
|
Andrès E, Brandt C, Gass R. De l’intérêt de caractériser les sons de l’auscultation pulmonaire à la création d’une école de l’auscultation. Presse Med 2008; 37:925-7. [DOI: 10.1016/j.lpm.2008.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 03/17/2008] [Accepted: 03/17/2008] [Indexed: 10/22/2022] Open
|
44
|
Abstract
OBJECTIVE This paper describes state of the art, scientific publications and ongoing research related to the methods of analysis of respiratory sounds. METHODS AND MATERIAL Review of the current medical and technological literature using Pubmed and personal experience. RESULTS The study includes a description of the various techniques that are being used to collect auscultation sounds, a physical description of known pathologic sounds for which automatic detection tools were developed. Modern tools are based on artificial intelligence and on technics such as artificial neural networks, fuzzy systems, and genetic algorithms… CONCLUSION The next step will consist in finding new markers so as to increase the efficiency of decision aid algorithms and tools.
Collapse
Affiliation(s)
- Sandra Reichert
- Ph.D., e-health UTBM student, Alcatel-Lucent, Chief Technical Office, Strasbourg, France
| | - Raymond Gass
- Technical Academy Fellow, Alcatel-Lucent, Chief Technical Office, Strasbourg, France
| | - Christian Brandt
- M.D., Head of the Cardiology Department, Clinique Médicale B, CHRU Strasbourg, Strasbourg, France
| | - Emmanuel Andrès
- M.D., Ph.D., Head of the Internal Medicine Department, Clinique Médicale B, CHRU Strasbourg, Strasbourg, France
| |
Collapse
|
45
|
|
46
|
|
47
|
Abstract
BACKGROUND Persistent bacterial bronchitis (PBB) seems to be under-recognised and often misdiagnosed as asthma. In the absence of published data relating to the management and outcomes in this patient group, a review of the outcomes of patients with PBB attending a paediatric respiratory clinic was undertaken. METHODS A retrospective chart review was undertaken of 81 patients in whom a diagnosis of PBB had been made. Diagnosis was based on the standard criterion of a persistent, wet cough for >1 month that resolves with appropriate antibiotic treatment. RESULTS The most common reason for referral was a persistent cough or difficult asthma. In most of the patients, symptoms started before the age of 2 years, and had been present for >1 year in 59% of patients. At referral, 59% of patients were receiving asthma treatment and 11% antibiotics. Haemophilus influenzae and Streptococcus pneumoniae were the most commonly isolated organisms. Over half of the patients were completely symptom free after two courses of antibiotics. Only 13% of patients required > or =6 courses of antibiotics. CONCLUSION PBB is often misdiagnosed as asthma, although the two conditions may coexist. In addition to eliminating a persistent cough, treatment may also prevent progression to bronchiectasis. Further research relating to both diagnosis and treatment is urgently required.
Collapse
Affiliation(s)
- Deirdre Donnelly
- Paediatric Respiratory Unit, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK
| | | | | |
Collapse
|
48
|
|
49
|
Everard ML. The relationship between respiratory syncytial virus infections and the development of wheezing and asthma in children. Curr Opin Allergy Clin Immunol 2006; 6:56-61. [PMID: 16505613 DOI: 10.1097/01.all.0000200506.62048.06] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The relationship between respiratory syncytial virus lower-respiratory-tract infections in early childhood and asthma has been the subject of much debate. Most, but not all, previous cohort studies have failed to identify a link between early respiratory syncytial virus infection and atopic asthma. Recent studies have helped clarify some apparently contradictory findings. RECENT FINDINGS Cohort studies focusing on wheezing in early childhood have indicated that this is associated with an increased incidence of atopic asthma but that this risk is not increased by respiratory syncytial virus infection. Indeed, wheeze associated with rhinovirus infection may be a better marker for possible asthma. In contrast, there is no increased risk of atopic disease in infants with respiratory syncytial virus 'acute bronchiolitis', a phenotype characterized by widespread crepitation. Post-bronchiolitic symptoms are associated with intercurrent viral infections in particular and the incidence of symptoms falls rapidly during infancy. SUMMARY These studies confirm earlier suggestions that the phenotype of respiratory illness and hence the host response rather than the infecting organism is the best predictor of the future pattern of respiratory illness. Such considerations must be central to the design of any future intervention or cohort studies.
Collapse
Affiliation(s)
- Mark L Everard
- Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK.
| |
Collapse
|
50
|
Abstract
To examine differences between virus-associated wheeze and wheeze associated with other triggers (multi-trigger wheeze) in elementary school children, we performed a cross-sectional school-based questionnaire study of 5,998 children mainly 7 to 12 years of age, with outliers 6 and 13 years of age. Using parent-completed questionnaires, we identified 522 children who wheezed only during upper respiratory tract infections (virus-associated wheeze), 1,186 children who wheezed on other occasions (multi-trigger wheeze), and 4,290 children with no wheeze. In comparison with children who had multi-trigger wheeze, children with virus-associated wheeze were more likely to be male, to be younger, and to have less frequent wheezy episodes. They were less likely to have night cough, shortness of breath or chest tightness, to have a personal or parental history of atopic disorders, to have a diagnosis of asthma, or to be receiving asthma treatment. Both types of wheeze were associated with social deprivation, a relationship that persisted after controlling for family smoking. Virus-associated wheeze is a common but diminishing problem in this age group, and the differences between virus-associated wheeze and multi-trigger wheeze already noted in pre-school children persist in this older age group.
Collapse
Affiliation(s)
- Heather J Wassall
- Department of Child Health, University of Aberdeen, Foresterhill, Aberdeen, UK
| | | | | | | | | |
Collapse
|