Basic clinical management of preschool wheeze

Decoding Pediatric Laryngopharyngeal Reflux: Unraveling Symptoms Through Multichannel Intraluminal Impedance and pH Insights

Background: The relationship between symptoms of laryngopharyngeal reflux (LPR) and objective reflux measurements obtained through multichannel intraluminal impedance-pH (MII-pH) monitoring remains unclear. Objectives: The aim of this study was to investigate the relationship between LPR symptoms and objective reflux episodes and possible associations between fibreoptic ENT findings, eosinophil counts, and serum IgE levels with reflux episodes detected by MII-pH. Methods: In this prospective study, MII-pH monitoring, fiberoptic laryngoscopy, nasal swabs for eosinophils, total serum IgE levels, and symptom assessment (Reflux Symptom Index, RSI) were performed in all children with suspected LPR. The Reflux Findings Score (RFS) was determined based on the laryngoscopy findings. Results: A total of 113 patients (mean age, 8 years) with LPR symptoms were included in the study. The number of reflux episodes was highest in children with chronic cough and recurrent broncho-obstruction. Secondary outcomes showed positive correlations between reflux episodes and ENT findings, particularly hypopharyngeal hyperemia, arytenoid hyperemia, and arytenoid erythema (p < 0.01, p < 0.001, and p < 0.001, respectively). The number of total, acidic, and weakly acidic reflux episodes was significantly positively correlated with RSI and RFS. Proximal total, acidic, and weakly acidic reflux episodes showed significant correlations with eosinophil counts in nasal swabs but negative correlations with serum IgE levels. Conclusions: This study highlights the significant role of weakly acidic reflux in pediatric LPR and its association with respiratory symptoms. Our findings emphasize the importance of objective monitoring techniques in the assessment of LPR and provide insights for refining diagnostic and management strategies.

Three-year outcome of a very young severe uncontrolled preschool wheezers cohort, a real-life study

Preschool wheeze is a public health issue. Disease control can be difficult to obtain in this population, in which no biologic therapy is indicated. We studied the evolution of severe preschool wheezers in real-life and identified the factors leading to no-control. We conducted a retrospective study at our tertiary asthma center. Each child under 3 years of age with severe, uncontrolled preschool wheeze was admitted to a pediatric day hospital for further investigations. We collected the results of clinical, biological and radiological exams, and follow-up data at 1 (Y+1), 2 (Y+2) and 3 years (Y+3). We included 135 patients; 63 (47 %) were still being followed at Y+3; 53 % were discontinued due to disease control. The median age at inclusion was 12 months. 29 % of patients followed up still had severe uncontrolled wheezing at Y+3. Eosinophils greater than 0.23G/L (p = 0.03) and a first case of bronchiolitis before the age of 2 months (p = 0.01) were factors in uncontrolled wheezing at Y1. Tobacco exposure was a factor associated with uncontrolled wheezing at Y+2 (p < 0.001). A first case of bronchiolitis before the age of 2 months (p = 0.007), male sex (p < 0.001) and a familial history of atopy (p = 0.05) were factors in uncontrolled disease at Y+3. We report a real-life study, with a very young population and very severe wheezing. Our therapeutic approach is original, enabling us to study the evolution of "therapeutic pressure" in the early years of this frequent disease, the pathophysiology of which is still poorly understood.

A novel syndrome of silent rhinovirus-associated bronchoalveolitis in children with recurrent wheeze

BACKGROUND

Rhinovirus (RV) infections trigger wheeze episodes in children. Thus, understanding of the lung inflammatory response to RV in children with wheeze is important.

OBJECTIVES

This study sought to examine the associations of RV on bronchoalveolar lavage (BAL) granulocyte patterns and biomarkers of inflammation with age in children with treatment-refractory, recurrent wheeze (n = 616).

METHODS

Children underwent BAL to examine viral nucleic acid sequences, bacterial cultures, granulocyte counts, and phlebotomy for both general and type-2 inflammatory markers.

RESULTS

Despite the absence of cold symptoms, RV was the most common pathogen detected (30%), and when present, was accompanied by BAL granulocytosis in 75% of children. Compared to children with no BAL pathogens (n = 341), those with RV alone (n = 127) had greater (P < .05) isolated neutrophilia (43% vs 16%), mixed eosinophils and neutrophils (26% vs 11%), and less pauci-granulocytic (27% vs 61%) BAL. Children with RV alone furthermore had biomarkers of active infection with higher total blood neutrophils and serum C-reactive protein, but no differences in blood eosinophils or total IgE. With advancing age, the log odds of BAL RV alone were lower, 0.82 (5th-95th percentile CI: 0.76-0.88; P < .001), but higher, 1.58 (5th-95th percentile CI: 1.01-2.51; P = .04), with high-dose daily corticosteroid treatment.

CONCLUSIONS

Children with severe recurrent wheeze often (22%) have a silent syndrome of lung RV infection with granulocytic bronchoalveolitis and elevated systemic markers of inflammation. The syndrome is less prevalent by school age and is not informed by markers of type-2 inflammation. The investigators speculate that dysregulated mucosal innate antiviral immunity is a responsible mechanism.

Prevalence of Wheezing and Its Association with Environmental Tobacco Smoke Exposure among Rural and Urban Preschool Children in Mpumalanga Province, South Africa

BACKGROUND

This study aimed to investigate the prevalence of wheezing and its association with environmental tobacco smoke exposure among rural and urban preschool children in Mpumalanga province, South Africa, an area associated with poor air quality.

METHODS

In this study, parents/caregivers of preschool children (n = 3145) completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Data were analysed using multiple logistic regression models.

RESULTS

The overall prevalence of Wheeze Ever was 15.14%, with a higher prevalence in urban preschoolers than rural preschoolers (20.71% vs. 13.30%, p < 0.000). Moreover, the total prevalence of Asthma Ever was 2.34%. The prevalence was greater in urban preschoolers than in rural preschoolers (3.92% vs. 1.81%, p < 0.001). In the final adjusted model, both urban- and rural-area children who lived with one or more people who smoked in the same household (WE: OR 1.44, 95% CI 1.11-1.86) (CW: OR 2.09, 95% CI 1.38-3.16) and (AE: OR 2.49, 95% CI 1.12-5.54) were found to have an increased likelihood of having Wheeze Ever, Current Wheeze, and Asthma Ever as compared to those who lived with non-smokers.

CONCLUSIONS

The implementation of smoking limits and prohibition is crucial in areas that are frequented or utilized by children. Hence, it is imperative for healthcare providers to actively champion the rights of those who do not smoke within the society, while also endorsing legislative measures aimed at curtailing the extent of tobacco smoke exposure.