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Bossley CJ, Kavaliunaite E, Harman K, Cook J, Ruiz G, Gupta A. Post-acute COVID-19 outcomes in children requiring hospitalisation. Sci Rep 2022; 12:8208. [PMID: 35581348 PMCID: PMC9113067 DOI: 10.1038/s41598-022-12415-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/13/2022] [Indexed: 12/27/2022] Open
Abstract
Post-acute COVID-19 causes long term sequalae in adults. This is less well described in children. We performed clinical assessments on a large cohort of children and young people admitted with a positive SARS-CoV-2 RNA swab. We assessed for symptoms of post-acute COVID-19 syndrome after 4 weeks or more. We found that most (85%) of children made a full recovery following SARS-CoV-2 infection. A small number had symptoms which lasted for more than 4 weeks, most of which had resolved at 3 months. Symptoms included dry cough, fatigue and headache. One patient suffered from anosmia. We conclude that most children and young people do not suffer from past-acute COVID-19 syndrome, and make a full recovery from infection.
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Affiliation(s)
- Cara J Bossley
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Ema Kavaliunaite
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Katharine Harman
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - James Cook
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Gary Ruiz
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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2
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Osinibi M, Gupta A, Harman K, Bossley CJ. Passive tobacco smoke in children and young people during the COVID-19 pandemic. The Lancet Respiratory Medicine 2021; 9:693-694. [DOI: 10.1016/s2213-2600(21)00231-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Fereos G, Buchanan C, Allen P, Inusa B, Bossley CJ. A mysterious cause of chronic cough. Breathe (Sheff) 2021; 16:200163. [PMID: 33447277 PMCID: PMC7792853 DOI: 10.1183/20734735.0163-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/13/2022] Open
Abstract
A 15-year-old-girl of African descent with sickle cell anaemia (HbSS) presented with an 18-month history of gradually worsening productive cough. She had a history of a previous pneumonia, acute chest crises and two episodes of acute pancreatitis. She was on regular blood transfusions. She underwent a splenectomy in December 2013. There was no documented history of hypercalcaemia. She had no history of fevers or tuberculosis (TB) contacts. This case alerts professionals to take a broad approach when considering childhood chronic cough in sickle cell disease. Certain respiratory conditions are difficult to recognise in childhood, with many children suffering from delayed diagnosis.https://bit.ly/2GZAgmE
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Affiliation(s)
- George Fereos
- King's College London, School of Medical Education, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | | | - Pamela Allen
- King's College Hospital NHS Foundation Trust, London, UK
| | - Baba Inusa
- Evelina London Children's Hospital, London, UK
| | - Cara J Bossley
- King's College Hospital NHS Foundation Trust, London, UK
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4
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Davies G, Stanojevic S, Raywood E, Duncan JA, Stocks J, Lum S, Bush A, Viviani L, Wade A, Calder A, Owens CM, Goubau C, Carr SB, Bossley CJ, Pao C, Aurora P. An observational study of the lung clearance index throughout childhood in cystic fibrosis: early years matter. Eur Respir J 2020; 56:13993003.00006-2020. [PMID: 32444409 PMCID: PMC7527650 DOI: 10.1183/13993003.00006-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/02/2019] [Accepted: 04/23/2020] [Indexed: 01/15/2023]
Abstract
The London Cystic Fibrosis Collaboration (LCFC) has prospectively followed a clinically diagnosed cohort of infants with cystic fibrosis (CF) born in South East England since 1999 [1–4]. Over the past 20 years, the LCFC has obtained comprehensive measures of lung function and structure, including measures of ventilation inhomogeneity (lung clearance index (LCI)) and high-resolution computed tomography (HRCT) scans. By pre-school age, 73% of this cohort had LCI above the limits of normal, compared with 7% with abnormal forced expiratory volume in 0.5 seconds (FEV0.5) [1]. Children with elevated LCI during pre-school years also had worse lung function at early school age [2]. The aim of this study was to investigate how LCI changes across childhood to better understand to what extent LCI results at pre-school age are an indicator of lung disease severity in adolescence. Lung clearance index (LCI) in the early years was associated with LCI during adolescence in children with cystic fibrosis. Pre-school LCI may help to identify children in whom treatment could be intensified.https://bit.ly/2yKyMbM
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Affiliation(s)
- Gwyneth Davies
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK .,Dept of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Joint first authors
| | - Sanja Stanojevic
- Translational Medicine, SickKids Research Institute, Toronto, ON, Canada.,Joint first authors
| | - Emma Raywood
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Julie A Duncan
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Janet Stocks
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Sooky Lum
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Imperial College and Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Laura Viviani
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Angie Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section, UCL GOS ICH, London, UK
| | - Alistair Calder
- Dept of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Catherine M Owens
- Dept of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christophe Goubau
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Siobhán B Carr
- Dept of Paediatric Respiratory Medicine, Imperial College and Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Cara J Bossley
- Dept of Paediatric Respiratory Medicine, Kings College Hospital, London, UK
| | - Caroline Pao
- Dept of Paediatric Respiratory Medicine, Royal London Hospital, London, UK
| | - Paul Aurora
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK.,Dept of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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5
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van Geyzel L, Arigliani M, Inusa B, Singh B, Kozlowska W, Chakravorty S, Bossley CJ, Ruiz G, Rees D, Gupta A. Higher oxygen saturation with hydroxyurea in paediatric sickle cell disease. Arch Dis Child 2020; 105:575-579. [PMID: 31871045 DOI: 10.1136/archdischild-2019-317862] [Citation(s) in RCA: 6] [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: 07/03/2019] [Revised: 11/11/2019] [Accepted: 12/05/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Sickle cell disease (SCD) is one of the most common inherited diseases worldwide. It is associated with lifelong morbidity and reduced life expectancy. Hydroxyurea (HU) has been shown to reduce the frequency and severity of vaso-occlusive episodes in SCD. Hypoxaemia and intermittent nocturnal oxygen desaturations occur frequently in children with SCD and contribute to the associated morbidity, including risk of cerebrovascular disease. OBJECTIVE To evaluate the effect of HU on oxygen saturation (SpO2) overnight and on daytime SpO2 spot checks in children with SCD. METHODS A retrospective review of children with SCD and respiratory problems who attended two UK tertiary sickle respiratory clinics and were treated with HU. Longitudinal data were collected from 2 years prior and up to 3 years after the commencement of HU. RESULTS Forty-three children, 23 males (53%) with a median age of 9 (range 1.8-18) years were included. In the 21 children who had comparable sleep studies before and after starting HU, mean SpO2 was higher (95.2% from 93.5%, p=0.01) and nadir SpO2 was higher (87.2% from 84.3%, p=0.009) when taking HU. In 32 of the children, spot daytime oxygen saturations were also higher (96.3% from 93.5%, p=0.001). CONCLUSION Children with SCD had higher oxygen saturation overnight and on daytime spot checks after starting HU. These data suggest HU may be helpful for treating persistent hypoxaemia in children with SCD pending more evidence from a randomised clinical trial.
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Affiliation(s)
- Lisa van Geyzel
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Michele Arigliani
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Baba Inusa
- Department of Paediatric Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Bethany Singh
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Wanda Kozlowska
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK.,Department of Paediatric Respiratory Medicine, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Subarna Chakravorty
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Cara J Bossley
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Gary Ruiz
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - David Rees
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
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Arigliani M, Zheng S, Ruiz G, Chakravorty S, Bossley CJ, Rees D, Gupta A. Comparison of pulse oximetry and earlobe blood gas with CO-oximetry in children with sickle cell disease: a retrospective review. BMJ Paediatr Open 2020; 4:e000690. [PMID: 32577536 PMCID: PMC7299039 DOI: 10.1136/bmjpo-2020-000690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/02/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To investigate the agreement between pulse oximetry (SpO2) and oxygen saturation (SaO2) measured by CO-oximetry on arterialised earlobe blood gas (EBG) in children and adolescents with sickle cell disease (SCD). DESIGN AND SETTING We retrospectively reviewed 39 simultaneous and paired SaO2 EBG and SpO2 measurements from 33 ambulatory patients with SCD (32 subjects with Haemoglobin SS and one with Haemoglobin Sß+, 52% male, mean±SD age 11.0±3.6, age range 5-18). Measurements were performed between 2012 and 2015 when participants were asymptomatic. Hypoxaemia was defined as SaO2 ≤93%. A Bland-Altman analysis was performed to assess the accuracy of SpO2 as compared with EBG SaO2. RESULTS The mean±SD SpO2 and SaO2 values in the same patients were, respectively, 93.6%±3.7% and 94.3%±2.9%. The bias SpO2-SaO2 was -0.7% (95% limits of agreement from -5.4% to 4.1%) and precision was 2.5%. In 9/39 (23%) cases, the difference in SpO2-SaO2 was greater than the expected error range ±2%, with SaO2 more often underestimated by SpO2 (6/9), especially at SpO2values ≤93%. Thirteen participants (33%) were hypoxaemic. The sensitivity of SpO2 for hypoxaemia was 100%, specificity 85% and positive predictive value 76%. CONCLUSIONS Pulse oximetry was inaccurate in almost a quarter of measurements in ambulatory paediatric patients with SCD, especially at SpO2values ≤93%. In these cases, oxygen saturation can be confirmed through EBG CO-oximetry, which is easier to perform and less painful than traditional arterial blood sampling.
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Affiliation(s)
- Michele Arigliani
- Paediatric Respiratory Medicine and Lung Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sean Zheng
- Department of Paediatric Respiratory Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Gary Ruiz
- Department of Paediatric Respiratory Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Subarna Chakravorty
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Cara J Bossley
- Department of Paediatric Respiratory Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - David Rees
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, United Kingdom
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King’s College Hospital NHS Foundation Trust, London, UK
- King's College London, London, United Kingdom
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7
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Papalexopoulou N, Dassios TG, Lunt A, Bartlett F, Perrin F, Bossley CJ, Wyatt HA, Greenough A. Nutritional status and pulmonary outcome in children and young people with cystic fibrosis. Respir Med 2018; 142:60-65. [PMID: 30170803 DOI: 10.1016/j.rmed.2018.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nutrition is closely related to mortality and pulmonary and respiratory muscle function in cystic fibrosis (CF) patients. We initially validated results from a bioelectrical impedance device against dual energy x-ray absorptiometry (DEXA). We then determined whether fat free mass assessed by a portable impedance device rather than body mass index (BMI) better correlated with pulmonary function, respiratory muscle strength and exercise capacity in CF patients. METHODS Eighteen young people and adults (median age 19, range 12-39 years) with CF had dual energy X-ray absorptiometry and direct segmental multi-frequency impedance analysis. Body composition, pulmonary function, respiratory muscle function and exercise tolerance using the impedance device were measured in 29 young people with CF with median age 15 (range 12-19) years. MAIN FINDINGS There was a significant correlation between impedance and absorptiometry results (r2 = 0.947). Fat free mass correlated with the forced vital capacity z-score (r = 0.442, p = 0.016), maximal inspiratory pressure (r = 0.451, p = 0.014) and exercise tolerance (r = 0. 707, p < 0.001). BMI z-scores did not significantly correlate with pulmonary or respiratory muscle function. Subjects with a fat free mass z-score of ≤2 had a lower forced expiratory volume in 1 s z-score (p = 0.007), lower forced vital capacity z-score (p = 0.001), higher residual volume z-score (p = 0.042), lower maximal inspiratory pressure (p = 0.039), more days of intravenous antibiotics per year (p = 0.016) and a higher rate of chronic infections (p = 0.006). PRINCIPAL CONCLUSIONS Fat-free mass measured by impedance correlated better with pulmonary and respiratory muscle function and exercise capacity than BMI.
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Affiliation(s)
- Niovi Papalexopoulou
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom.
| | - Theodore G Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Alan Lunt
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom.
| | - Fiona Bartlett
- Paediatric Dietetic Department, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Felicity Perrin
- Respiratory Medicine and Adult Cystic Fibrosis Service, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Cara J Bossley
- Paediatric Respiratory Medicine, Kings College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Hilary A Wyatt
- Paediatric Cystic Fibrosis, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Anne Greenough
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom.
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8
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Hussein HR, Gupta A, Broughton S, Ruiz G, Brathwaite N, Bossley CJ. A meta-analysis of montelukast for recurrent wheeze in preschool children. Eur J Pediatr 2017; 176:963-969. [PMID: 28567533 PMCID: PMC5486554 DOI: 10.1007/s00431-017-2936-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED There is conflicting evidence of the effectiveness of montelukast in preschool wheeze. A recent Cochrane review focused on its use in viral-induced wheeze; however, such subgroups are unlikely to exist in real life and change with time, recently highlighted in an international consensus report. We have therefore sought to investigate the effectiveness of montelukast in all children with preschool wheeze (viral-induced and multiple-trigger wheeze). The PubMed, Cochrane Library, Ovid Medline and Ovid EMBASE were screened for randomised controlled trials (RCTs), examining the efficacy of montelukast compared with placebo in children with the recurrent preschool wheeze. The primary endpoint examined was frequency of wheezing episodes. Five trials containing 3960 patients with a preschool wheezing disorder were analysed. Meta-analyses of studies of intermittent montelukast showed no benefit in preventing episodes of wheeze (mean difference (MD) 0.07, 95% confidence interval (CI) -0.14 to 0.29; mean for montelukast 2.68 vs placebo 2.54 (p = 0.5)), reducing unscheduled medical attendances (MD -0.13, 95% CI -0.33 to 0.07; mean for montelukast 1.62 vs placebo 1.78 (p = 0.21)) and reducing oral corticosteroids (MD -0.06, 95% CI -0.16 to 0.02; mean for montelukast 0.35 vs placebo 0.36 (p = 0.25)). The pooled results of the continuous regimen showed no significant difference in the number of wheezing episodes between the montelukast and placebo groups (MD -0.40, 95% CI -1.00 to 0.19; mean for montelukast 2.05 vs placebo 2.37 (p = 0.18)). CONCLUSIONS This review highlights that the currently available evidence does not support the use of montelukast in preschool children with recurrent wheeze. We recommend further studies to investigate if a 'montelukast responder' phenotype exists, and how these can be easily identified in the clinical setting. What is Known: • Current guidelines recommend montelukast use in preschool children with recurrent wheeze. • A recent Cochrane review has found montelukast to be ineffective at reducing courses of oral corticosteroids for viral-induced wheeze. What is New: • This meta-analysis has examined all children with preschool wheeze and found that montelukast was not effective at preventing wheezing episodes or reducing unscheduled medical attendances. • A specific montelukast responder phenotype may exist, but such patients should be sought in larger multicentre RCTs.
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Affiliation(s)
- Hasan R. Hussein
- Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Department of Respiratory Paediatrics, Kings College Hospital, Denmark Hill, London, SE5 9RS UK
| | - Atul Gupta
- Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Department of Respiratory Paediatrics, Kings College Hospital, Denmark Hill, London, SE5 9RS UK
| | - Simon Broughton
- Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Gary Ruiz
- Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Department of Respiratory Paediatrics, Kings College Hospital, Denmark Hill, London, SE5 9RS UK
| | - Nicola Brathwaite
- Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Cara J. Bossley
- Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Department of Respiratory Paediatrics, Kings College Hospital, Denmark Hill, London, SE5 9RS UK
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9
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Bossley CJ, Fleming L, Ullmann N, Gupta A, Adams A, Nagakumar P, Bush A, Saglani S. Assessment of corticosteroid response in pediatric patients with severe asthma by using a multidomain approach. J Allergy Clin Immunol 2016; 138:413-420.e6. [PMID: 27061250 DOI: 10.1016/j.jaci.2015.12.1347] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/12/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is no agreed upon definition of systemic corticosteroid response in asthmatic children. Moreover, pediatric severe therapy-resistant asthma (STRA) is heterogeneous, and thus response to steroids is unlikely to be uniform in all patients. OBJECTIVE We sought to evaluate the utility of a multidomain approach incorporating symptoms, lung function, and inflammation to determine steroid responsiveness in pediatric patients with STRA. METHODS Eighty-two children (median age, 12 years) with STRA received a clinically indicated dose of intramuscular steroid. Changes in 4 separate domains were assessed 4 weeks after intramuscular triamcinolone acetonide: normalization of (1) symptoms (Asthma Control Test score, >19/25 or 50% increase), (2) spirometric results (FEV1 ≥80% of predicted value or ≥15% increase), (3) fraction of exhaled nitric oxide levels (<24 ppb), and (4) sputum eosinophil counts (<2.5%). Fifty-four of 82 children had complete data in all 4 domains. RESULTS Twenty-three (43%) of 54 children had a symptom response, 29 (54%) of 54 had a lung function response, 28 (52%) of 54 had a fraction of exhaled nitric oxide response, and 29 (54%) of 54 had a sputum eosinophil response. Although a similar proportion of children responded to systemic corticosteroids in each domain, there were no reliable predictors of a response pattern. Seven (13%) of 54 were complete responders (response in all domains), 8 (15%) of 54 were nonresponders (no response in any domain), and 39 (72%) of 54 were partial responders (response in ≥1 domain). CONCLUSIONS A multidomain evaluation of systemic steroid responsiveness using pragmatic clinical assessments confirms childhood STRA is heterogeneous and that a complete response in symptoms and inflammatory and physiologic parameters is rare. Individual response patterns to systemic steroids might be useful in guiding the choice of add-on therapies in each child as a step toward achieving personalized medicine.
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Affiliation(s)
- Cara J Bossley
- Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Respiratory Paediatrics, Kings College Hospital, London, United Kingdom
| | - Louise Fleming
- Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Nicola Ullmann
- Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Atul Gupta
- Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Alexandra Adams
- Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Prasad Nagakumar
- Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew Bush
- Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Sejal Saglani
- Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
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10
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Fleming L, Koo M, Bossley CJ, Nagakumar P, Bush A, Saglani S. The utility of a multidomain assessment of steroid response for predicting clinical response to omalizumab. J Allergy Clin Immunol 2016; 138:292-294. [PMID: 26924468 DOI: 10.1016/j.jaci.2015.12.1317] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 12/08/2015] [Accepted: 12/18/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Louise Fleming
- Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
| | - Maria Koo
- Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Cara J Bossley
- Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Respiratory Paediatrics, King's College Hospital, London, United Kingdom
| | - Prasad Nagakumar
- Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew Bush
- Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Sejal Saglani
- Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, United Kingdom
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11
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Castanhinha S, Sherburn R, Walker S, Gupta A, Bossley CJ, Buckley J, Ullmann N, Grychtol R, Campbell G, Maglione M, Koo S, Fleming L, Gregory L, Snelgrove RJ, Bush A, Lloyd CM, Saglani S. Pediatric severe asthma with fungal sensitization is mediated by steroid-resistant IL-33. J Allergy Clin Immunol 2015; 136:312-22.e7. [PMID: 25746970 PMCID: PMC4534777 DOI: 10.1016/j.jaci.2015.01.016] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 11/16/2022]
Abstract
Background The mechanism underlying severe asthma with fungal sensitization (SAFS) is unknown. IL-33 is important in fungus-induced asthma exacerbations, but its role in fungal sensitization is unexplored. Objective We sought to determine whether fungal sensitization in children with severe therapy-resistant asthma is mediated by IL-33. Methods Eighty-two children (median age, 11.7 years; 63% male) with severe therapy-resistant asthma were included. SAFS (n = 38) was defined as specific IgE or skin prick test response positivity to Aspergillus fumigatus, Alternaria alternata, or Cladosporium herbarum. Clinical features and airway immunopathology were assessed. Chronic exposure to house dust mite and A alternata were compared in a neonatal mouse model. Results Children with SAFS had earlier symptom onset (0.5 vs 1.5 years, P = .006), higher total IgE levels (637 vs 177 IU/mL, P = .002), and nonfungal inhalant allergen-specific IgE. Significantly more children with SAFS were prescribed maintenance oral steroids (42% vs 14%, P = .02). SAFS was associated with higher airway IL-33 levels. In neonatal mice A alternata exposure induced higher serum IgE levels, pulmonary IL-33 levels, and IL-13+ innate lymphoid cell (ILC) and TH2 cell numbers but similar airway hyperresponsiveness (AHR) compared with those after house dust mite exposure. Lung IL-33 levels, IL-13+ ILC numbers, TH2 cell numbers, IL-13 levels, and AHR remained increased with inhaled budesonide during A alternata exposure, but all features were significantly reduced in ST2−/− mice lacking a functional receptor for IL-33. Conclusion Pediatric SAFS was associated with more oral steroid therapy and higher IL-33 levels. A alternata exposure resulted in increased IL-33–mediated ILC2 numbers, TH2 cell numbers, and steroid-resistant AHR. IL-33 might be a novel therapeutic target for SAFS.
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Affiliation(s)
- Susana Castanhinha
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Rebekah Sherburn
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Simone Walker
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Atul Gupta
- Department of Respiratory Paediatrics, Kings College Hospital, London, United Kingdom
| | - Cara J Bossley
- Department of Respiratory Paediatrics, Kings College Hospital, London, United Kingdom
| | - James Buckley
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Nicola Ullmann
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Ruth Grychtol
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Gaynor Campbell
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Marco Maglione
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Sergio Koo
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Louise Fleming
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Airways Disease, NHLI, Imperial College London, London, United Kingdom
| | - Lisa Gregory
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Robert J Snelgrove
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Andrew Bush
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Airways Disease, NHLI, Imperial College London, London, United Kingdom
| | - Clare M Lloyd
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Sejal Saglani
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom.
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Saglani S, Lui S, Ullmann N, Campbell GA, Sherburn RT, Mathie SA, Denney L, Bossley CJ, Oates T, Walker SA, Bush A, Lloyd CM. IL-33 promotes airway remodeling in pediatric patients with severe steroid-resistant asthma. J Allergy Clin Immunol 2013; 132:676-685.e13. [PMID: 23759184 DOI: 10.1016/j.jaci.2013.04.012] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 04/08/2013] [Accepted: 04/09/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND TH2 cytokines are not responsible for the ongoing symptoms and pathology in children with severe therapy-resistant asthma (STRA). IL-33 induces airway hyperresponsiveness, but its role in airway remodeling and steroid resistance is unknown. OBJECTIVE We sought to investigate the relationship between IL-33 and airway remodeling in pediatric patients with STRA. METHODS IL-33 levels were quantified in neonatal mice given inhaled house dust mite (HDM), and the effect of blocking IL-13 on remodeling and IL-33 levels was assessed. HDM-induced allergic airways disease (AAD) in neonatal ST2(-/-) mice lacking the IL-33 receptor was assessed, together with collagen production after IL-33 administration. The effect of steroid therapy on IL-33 levels in patients with neonatal AAD was explored. IL-33 expression was quantified in endobronchial biopsy (EB) specimens from children with STRA and related to remodeling, and collagen production by airway fibroblasts from pediatric patients stimulated with IL-33 and budesonide was quantified. RESULTS Blocking IL-13 after AAD was established in neonatal mice and did not reduce remodeling or IL-33 levels; airway hyperresponsiveness was only partially reduced. IL-33 promoted collagen synthesis both from asthmatic fibroblasts from pediatric patients and after intranasal administration in mice. Increased cellular expression of IL-33, but not IL-13, was associated with increased reticular basement membrane thickness in EB specimens from children with STRA, whereas remodeling was absent in HDM-exposed ST2(-/-) mice. IL-33 levels were maintained, whereas IL-13 levels were abrogated by steroid treatment in neonatal HDM-exposed mice and in EB specimens from children with STRA. CONCLUSION IL-33 is a relatively steroid-resistant mediator that promotes airway remodeling in patients with STRA and is an important therapeutic target.
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Affiliation(s)
- Sejal Saglani
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Respiratory Paediatrics, Royal Brompton Hospital, and National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Stephen Lui
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nicola Ullmann
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Respiratory Paediatrics, Royal Brompton Hospital, and National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Gaynor A Campbell
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rebekah T Sherburn
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sara A Mathie
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Laura Denney
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Cara J Bossley
- Respiratory Paediatrics, Royal Brompton Hospital, and National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Timothy Oates
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Simone A Walker
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew Bush
- Respiratory Paediatrics, Royal Brompton Hospital, and National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Clare M Lloyd
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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Sharples J, Gupta A, Fleming L, Bossley CJ, Bracken-King M, Hall P, Hayward A, Puckey M, Balfour-Lynn IM, Rosenthal M, Bush A, Saglani S. Long-term effectiveness of a staged assessment for paediatric problematic severe asthma. Eur Respir J 2013; 40:264-7. [PMID: 22753835 DOI: 10.1183/09031936.00209511] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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O'Reilly R, Ullmann N, Irving S, Bossley CJ, Sonnappa S, Zhu J, Oates T, Banya W, Jeffery PK, Bush A, Saglani S. Increased airway smooth muscle in preschool wheezers who have asthma at school age. J Allergy Clin Immunol 2012; 131:1024-32, 1032.e1-16. [PMID: 23069488 DOI: 10.1016/j.jaci.2012.08.044] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increased airway smooth muscle (ASM) is a feature of established asthma in schoolchildren, but nothing is known about ASM in preschool wheezers. OBJECTIVE We sought to determine endobronchial biopsy specimen ASM area fraction in preschool wheezers and its association with asthma at school age. METHODS ASM area, reticular basement membrane thickness, and mucosal eosinophil and ASM mast cell values were quantified in endobronchial biopsy specimens previously obtained from preschool children undergoing clinically indicated bronchoscopy: severe recurrent wheezers (n=47; median age, 26 months) and nonwheezing control subjects (n=21; median age, 15 months). Children were followed up, and asthma status was established at age 6 to 11 years. Preschool airway pathology was examined in relation to asthma at school age. RESULTS Forty-two (62%) of 68 children had 1 or more evaluable biopsy specimens for ASM. At school age, 51 of 68 children were followed up, and 15 (40%) of 37 preschool wheezers had asthma. Children who had asthma and an evaluable biopsy specimen had increased preschool ASM area fraction (n=8; median age, 8.2 years [range, 6-10.4 years]; median ASM, 0.12 [range, 0.08-0.16]) compared with that seen in children without asthma (n=24; median age, 7.3 years [range, 5.9-11 years]; median ASM, 0.07 [range, 0.02-0.23]; P=.007). However, preschool reticular basement membrane thickness and mucosal eosinophil or ASM mast cell values were not different between those who did or did not have asthma at school age. CONCLUSION Increased preschool ASM is associated with those children who have asthma at school age. Thus a focus on early changes in ASM might be important in understanding the subsequent development of childhood asthma.
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Affiliation(s)
- Ruth O'Reilly
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Bossley CJ, Cramer D, Mason B, Hayward A, Smyth J, McKee A, Biddulph R, Ogundipe E, Jaffé A, Balfour-Lynn IM. Fitness to fly testing in term and ex-preterm babies without bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed 2012; 97:F199-203. [PMID: 21785127 DOI: 10.1136/adc.2011.212001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND During air flight, cabin pressurisation produces an effective fraction of inspired oxygen (FiO(2)) of 0.15. This can cause hypoxia in predisposed individuals, including infants with bronchopulmonary dysplasia (BPD), but the effect on ex-preterm babies without BPD was uncertain. The consequences of feeding a baby during the hypoxia challenge were also unknown. METHODS Ex-preterm (without BPD) and term infants had fitness to fly tests (including a period of feeding) at 3 or 6 months corrected gestational age (CGA) in a body plethysmograph with an FiO(2) of 0.15 for 20 min. A 'failed' test was defined as oxygen saturation (SpO(2)) <90% for at least 2 min. RESULTS 41 term and 30 ex-preterm babies (mean gestational age 39.8 and 33.1 weeks, respectively) exhibited a significant median drop in SpO(2) (median -6%, p<0.0001); there was no difference between term versus ex-preterm babies, or 3 versus 6 months. Two term (5%) and two ex-preterm (7%) babies failed the challenge. The SpO(2) dropped further during feeding (median -4% in term and -2% in ex-preterm, p<0.0001), with transient desaturation (up to 30 s) <90% seen in 8/36 (22%) term and 9/28 (32%) ex-preterm infants; the ex-preterm babies desaturated more quickly (median 1 vs 3 min, p=0.002). CONCLUSIONS Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO(2) of 0.15 leads to a further fall in SpO(2), which is significant but transient.
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Bossley CJ, Fleming L, Gupta A, Regamey N, Frith J, Oates T, Tsartsali L, Lloyd CM, Bush A, Saglani S. Pediatric severe asthma is characterized by eosinophilia and remodeling without T(H)2 cytokines. J Allergy Clin Immunol 2012; 129:974-82.e13. [PMID: 22385633 PMCID: PMC3381727 DOI: 10.1016/j.jaci.2012.01.059] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [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: 08/05/2011] [Revised: 01/17/2012] [Accepted: 01/23/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The pathology of pediatric severe therapy-resistant asthma (STRA) is little understood. OBJECTIVES We hypothesized that STRA in children is characterized by airway eosinophilia and mast cell inflammation and is driven by the T(H)2 cytokines IL-4, IL-5, and IL-13. METHODS Sixty-nine children (mean age, 11.8 years; interquartile range, 5.6-17.3 years; patients with STRA, n = 53; control subjects, n = 16) underwent fiberoptic bronchoscopy, bronchoalveolar lavage (BAL), and endobronchial biopsy. Airway inflammation, remodeling, and BAL fluid and biopsy specimen T(H)2 cytokines were quantified. Children with STRA also underwent symptom assessment (Asthma Control Test), spirometry, exhaled nitric oxide and induced sputum evaluation. RESULTS Children with STRA had significantly increased BAL fluid and biopsy specimen eosinophil counts compared with those found in control subjects (BAL fluid, P < .001; biopsy specimen, P < .01); within the STRA group, there was marked between-patient variability in eosinophilia. Submucosal mast cell, neutrophil, and lymphocyte counts were similar in both groups. Reticular basement membrane thickness and airway smooth muscle were increased in patients with STRA compared with those found in control subjects (P < .0001 and P < .001, respectively). There was no increase in BAL fluid IL-4, IL-5, or IL-13 levels in patients with STRA compared with control subjects, and these cytokines were rarely detected in induced sputum. Biopsy IL-5(+) and IL-13(+) cell counts were also not higher in patients with STRA compared with those seen in control subjects. The subgroup (n = 15) of children with STRA with detectable BAL fluid T(H)2 cytokines had significantly lower lung function than those with undetectable BAL fluid T(H)2 cytokines. CONCLUSIONS STRA in children was characterized by remodeling and variable airway eosinophil counts. However, unlike in adults, there was no neutrophilia, and despite the wide range in eosinophil counts, the T(H)2 mediators that are thought to drive allergic asthma were mostly absent.
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Affiliation(s)
- Cara J. Bossley
- Respiratory Paediatrics, the Royal Brompton and Harefield NHS Trust, Sydney Street, London
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London
| | - Louise Fleming
- Respiratory Paediatrics, the Royal Brompton and Harefield NHS Trust, Sydney Street, London
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London
| | - Atul Gupta
- Respiratory Paediatrics, the Royal Brompton and Harefield NHS Trust, Sydney Street, London
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London
| | - Nicolas Regamey
- Division of Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital and University of Bern
| | - Jennifer Frith
- Respiratory Paediatrics, the Royal Brompton and Harefield NHS Trust, Sydney Street, London
| | - Timothy Oates
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London
| | - Lemonia Tsartsali
- Respiratory Paediatrics, the Royal Brompton and Harefield NHS Trust, Sydney Street, London
| | - Clare M. Lloyd
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London
| | - Andrew Bush
- Respiratory Paediatrics, the Royal Brompton and Harefield NHS Trust, Sydney Street, London
| | - Sejal Saglani
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London
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Hunninghake GM, Soto-Quirós ME, Avila L, Kim HP, Lasky-Su J, Rafaels N, Ruczinski I, Beaty TH, Mathias RA, Barnes KC, Wilk JB, O'Connor GT, Gauderman WJ, Vora H, Baurley JW, Gilliland F, Liang C, Sylvia JS, Klanderman BJ, Sharma SS, Himes BE, Bossley CJ, Israel E, Raby BA, Bush A, Choi AM, Weiss ST, Celedón JC. TSLP polymorphisms are associated with asthma in a sex-specific fashion. Allergy 2010; 65:1566-75. [PMID: 20560908 DOI: 10.1111/j.1398-9995.2010.02415.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [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: 11/30/2022]
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) in thymic stromal lymphopoietin (TSLP) have been associated with IgE (in girls) and asthma (in general). We sought to determine whether TSLP SNPs are associated with asthma in a sex-specific fashion. METHODS We conducted regular and sex-stratified analyses of association between SNPs in TSLP and asthma in families of children with asthma in Costa Rica. Significant findings were replicated in whites and African-American participants in the Childhood Asthma Management Program, in African-Americans in the Genomic Research on Asthma in the African Diaspora study, in whites and Hispanics in the Children's Health Study, and in whites in the Framingham Heart Study (FHS). MAIN RESULTS Two SNPs in TSLP (rs1837253 and rs2289276) were significantly associated with a reduced risk of asthma in combined analyses of all cohorts (P values of 2 × 10(-5) and 1 × 10(-5) , respectively). In a sex-stratified analysis, the T allele of rs1837253 was significantly associated with a reduced risk of asthma in males only (P = 3 × 10(-6) ). Alternately, the T allele of rs2289276 was significantly associated with a reduced risk of asthma in females only (P = 2 × 10(-4) ). Findings for rs2289276 were consistent in all cohorts except the FHS. CONCLUSIONS TSLP variants are associated with asthma in a sex-specific fashion.
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Affiliation(s)
- G M Hunninghake
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Abstract
Dysfunctional swallowing is an uncommon, but important cause of bronchiectasis. We describe a child with a brainstem tumor, who developed bronchiectasis caused by chronic aspiration secondary to a dysfunctional swallow. The case highlights the importance of thorough and repeated evaluation before a diagnosis of idiopathic bronchiectasis is made. If dysfunctional swallow is found further investigation to ascertain the cause is indicated.
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Affiliation(s)
- C J Bossley
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
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Bossley CJ, Saglani S, Kavanagh C, Payne DNR, Wilson N, Tsartsali L, Rosenthal M, Balfour-Lynn IM, Nicholson AG, Bush A. Corticosteroid responsiveness and clinical characteristics in childhood difficult asthma. Eur Respir J 2009; 34:1052-9. [PMID: 19541710 DOI: 10.1183/09031936.00186508] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (F(eNO)) and no bronchodilator responsiveness (BDR <12%)) is uncommon in paediatric DA. We report on 102 children, mean+/-sd age 11.6+/-2.8 yrs, with DA in a cross-sectional study. 89 children underwent spirometry, BDR and F(eNO) before and after 2 weeks of systemic corticosteroids (corticosteroid response study). Bronchoscopy was performed after the corticosteroid trial. Of the 102 patients in the cross-sectional study, 88 (86%) were atopic, 60 (59%) were male and 52 (51%) had additional or alternative diagnoses. Out of the 81 patients in the corticosteroid response study, nine (11%) were complete responders. Of the 75 patients with symptom data available, 37 (49%) responded symptomatically, which was less likely if there were smokers in the home (OR 0.31, 95% CI 0.02-0.82). Of the 75 patients with available spirometry data, 35 (46%) had normal spirometry, with associations being BAL eosinophilia (OR 5.43, 95% CI 1.13-26.07) and high baseline forced expiratory volume in 1 s (FEV(1)) (OR 1.08, 95% CI 1.02-1.12). Of these 75 patients, BDR data were available in 64, of whom 36 (56%) had <12% BDR. F(eNO) data was available in 70 patients, of whom 53 (75%) had normal F(eNO). Airflow limitation data was available in 75 patients, of whom 17 (26%) had persistent airflow limitation, which was associated with low baseline FEV(1) (OR 0.93, 95% CI 0.90-0.97). Only 11% of DA children exhibited complete corticosteroid responsiveness. The rarity of complete corticosteroid responsiveness suggests alternative therapies are needed for children with DA.
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Affiliation(s)
- C J Bossley
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
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Abstract
Degenerative changes of the first carpometacarpal joint commonly cause pain, weakness and adduction deformity. Many patients respond to conservative treatment, but in resistant cases an abduction wedge osteotomy of the base of the first metacarpal has been found to relieve symptoms with less complications than other operations. Twenty-one patients with 23 osteotomies have been reviewed, with a follow-up from 2 to 17 years. All have had lasting relief from pain and consider that they have full function, with no stiffness or limited abduction. Osteotomy is indicated mainly for cases where the arthritis is confined to the carpometacarpal joint, but also relieves pain in cases of peritrapezial arthritis.
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Abstract
The intermetatarsophalangeal bursa was investigated by dissection, radiography and injection. In the web spaces between the second and third and the third and fourth digits the bursa lies superior to the transverse metatarsal ligament but projects distally to it, closely applied to the neurovascular bundle. Tissue from the web spaces of patients with classical Morton's metatarsalgia often shows lymphocytic infiltration, with additional fibrinoid necrosis of the bursal wall. It is suggested that inflammatory changes in this bursa could account for the pathological and histological findings in this condition. The bursa in the most lateral web space does not extend beyond the ligament and is not in contact with the neurovascular bundle, which may explain the rarity of symptoms in this space.
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Bossley CJ. Congenital dislocation of the hips. N Z Med J 1977; 85:348. [PMID: 271824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bossley CJ. Conservative treatment of digit amputations. N Z Med J 1975; 82:379-80. [PMID: 1062717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A conservative regime for distal digit amputations allowing healing under vaseline gauze has much to recommend it, being simple and allowing rapid healing with few complications. Secondary distal amputations for gangrene and sepsis also heal rapidly if left open. A consecutive series of 55 amputations treated in this way is described.
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Bossley CJ. Proceedings: Terminal digit amputations. J Bone Joint Surg Br 1975; 57:254. [PMID: 1141324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bossley CJ. Industrial hand injuries in Pacific Island immigrants. N Z Med J 1975; 81:191-3. [PMID: 1055938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is a disturbingly high incidence of heavy machinery, industrial hand mutilation, involving recent Pacific Island immigrants many of whom have a poor comprehension of English. A survey of cases admitted to the Hutt Hospital during eight monts of 1973, showed a proportionately greater incidence of severe injuries amongst these immigrants, and indicates that one causative factor is unsuitable selection of works for this dangerous machinery, coupled with inadequate instruction in its use and safety precautions.
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