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White D, Bush A, Smyth AR, Bhatt JM. Why and how should children be protected from the deluge of vaping related media and marketing overexposure? Breathe (Sheff) 2023; 19:230141. [PMID: 38125806 PMCID: PMC10729810 DOI: 10.1183/20734735.0141-2023] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023] Open
Abstract
E-cigarettes are products delivering nicotine via inhalation and are devised to mimic tobacco smoking. While they were initially introduced as a device putatively to aid with smoking cessation, their use is now far broader than that. Use by children is significantly increasing. There is growing evidence of the potential harms of vaping. E-liquids used for e-cigarettes contain a wide range of harmful substances, and the clinical consequences of this are now being increasingly demonstrated, such as the rise in cases of e-cigarette- or vaping-associated lung injury. In addition, early use may result in long-term nicotine addiction. Vaping companies utilise marketing methods that distinctly target young people, and weak legislation in the UK allows them free rein to expose children to vaping. In this review we demonstrate why children must be protected from vaping. We must have stringent legislation to prevent easy access to e-cigarettes, including banning the convenience and affordability disposable vapes provide, and prevent marketing that does not warn about the potential health effects. The Australia approach of prescription or pharmacy only access for smoking cessation should be considered to limit exposure of children and minimise use by nonsmokers.
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Affiliation(s)
- David White
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, London, UK
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Imperial Centre for Paediatrics and Child Health, London, UK
| | - Alan R. Smyth
- NIHR Biomedical Research Centre, Nottingham, UK
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Jayesh Mahendra Bhatt
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
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2
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Sareen A, Ramphul M, Bhatt JM. It's not all about inhaled treatment: challenges with oral therapy in paediatric respiratory medicine. Breathe (Sheff) 2021; 17:210005. [PMID: 34295409 PMCID: PMC8291910 DOI: 10.1183/20734735.0005-2021] [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] [Received: 01/05/2021] [Accepted: 03/30/2021] [Indexed: 12/02/2022] Open
Abstract
Advances in therapies and management of conditions encountered by paediatric respiratory specialists have led to improved outcomes and improved survival rates dramatically in chronic diseases such as cystic fibrosis. However, this has also meant an increase in treatment burden. A variety of inhaled treatments are crucial in managing paediatric respiratory diseases, but these patients also have to take many oral medications. It is widely recognised that developing oral formulations appropriate for the paediatric population can affect how well a product is received by patients and their families. Consideration should be given to palatability and the number of medicines to be administered as these can all contribute to treatment adherence. Polypharmacy specifically in the context of management of patients with cystic fibrosis is not a new concept, but the recently introduced cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies and their potential for interactions and adverse reactions create novel challenges. There are some strategies that families and healthcare professionals can implement to reduce treatment burden. This review will also provide some insight into the life of a teenager with cystic fibrosis and the relative complexities of her treatment and the impacts on daily life. In children, medications given by the oral route can be challenging to administer, add to the burden of care and contribute to poor adherence. Additionally, polypharmacy increases the chances of interactions between oral medications.https://bit.ly/3fxgXQU
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Affiliation(s)
- Anneka Sareen
- Pharmacy Dept, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Manisha Ramphul
- Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Jayesh Mahendra Bhatt
- Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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3
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Devaney R, Simpson T, Bush A, Jagani S, Nicholson AG, Semple T, Bhatt JM. Fructose 1,6-bisphosphatase deficiency as a cause of childhood interstitial lung disease. Pediatr Pulmonol 2021; 56:2362-2365. [PMID: 33730438 DOI: 10.1002/ppul.25362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Devaney
- ST8 Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Timothy Simpson
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Bush
- Imperial College, Consultant Paediatric Chest Physician, Royal Brompton & Harefield NHS Foundation Trust, NIHR Senior Investigator Emeritus, UK
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, UK
| | - Thomas Semple
- Royal Brompton And Harefield Hospitals NHS Foundation Trust, Royal Brompton Hospital, London, UK
| | - Jayesh Mahendra Bhatt
- Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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4
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Ramphul M, Gallagher K, Warrier K, Jagani S, Bhatt JM. Why is a paediatric respiratory specialist integral to the paediatric rheumatology clinic? Breathe (Sheff) 2020; 16:200212. [PMID: 33447294 PMCID: PMC7792836 DOI: 10.1183/20734735.0212-2020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
Systemic connective tissue diseases (CTDs) are characterised by the presence of autoantibodies and multiorgan involvement. Although CTDs are rare in children, they are associated with pulmonary complications, which have a high morbidity and mortality rate. The exact pathophysiology remains unclear. The pleuropulmonary complications in CTD are diverse in their manifestations and are often complex to diagnose and manage. The most common CTDs are discussed. These include juvenile systemic lupus erythematosus, juvenile dermatomyositis, juvenile systemic sclerosis, Sjögren's syndrome and mixed connective tissue disease. We describe the clinical features of the pleuropulmonary complications, focusing on their screening, diagnosis and monitoring. Treatment strategies are also discussed, highlighting the factors and interventions that influence the outcome of lung disease in CTD and pulmonary complications of treatment. Early detection and prompt treatment in a multidisciplinary team setting, including respiratory and rheumatology paediatricians and radiologists, is paramount in achieving the best possible outcomes for these patients.
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Affiliation(s)
- Manisha Ramphul
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Kathy Gallagher
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Kishore Warrier
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Sumit Jagani
- Dept of Radiology, Nottingham University Hospitals, Nottingham, UK
| | - Jayesh Mahendra Bhatt
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
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5
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Abstract
We report a case of hypersensitivity pneumonitis (HP) in a young person secondary to vaping. He presented with a putative diagnosis of asthma and required extracorporeal membrane oxygenationbecause of intractable respiratory failure. He developed a critical illness and steroid myopathy and required prolonged rehabilitation. Our patient fulfils diagnostic criteria for HP secondary to e-cigarettes with a positive exposure history, deterioration after skin prick testing, specific serum IgM antibodies against the implicated liquid raising the possibility that the relevant antigen was present in that liquid and radiological and histopathological features compatible with acute HP. There are two learning points. The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. The second is that we consider e-cigarettes as 'much safer than tobacco' at our peril.
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Affiliation(s)
- Nisha Nair
- Paediatric Therapy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Hurley
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Simon Gates
- Paediatric Therapy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Patrick Davies
- Department of Paediatric Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - I-Ling Chen
- Academic Immunology, School of Life Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ian Todd
- Academic Immunology, School of Life Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Lucy Fairclough
- Academic Immunology, School of Life Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
E-cigarettes are electronic nicotine delivery systems (ENDS) which mimic tobacco smoking without the combustion of tobacco. These devices have been misleadingly marketed as "less harmful" alternatives to conventional smoking tobacco products. The e-liquid in e-cigarettes include nicotine, a humectant and other additives including flavourings, colourants, or adulterants such as bacterial and fungal products. In this review, we discuss the contrasting views of the tobacco lobby and most professional societies. We describe the epidemiology of the use of these devices, with a widespread and significant rise in youth e-cigarette use seen in both the USA and Europe. We also describe what is known about the toxicity and mechanisms of EVALI (e-cigarette or vaping associated lung injury). This characterised by respiratory failure with an intense inflammatory response. The presentations are diverse and clinicians should consider vaping as a possible cause of any unusual respiratory illness in patients who have a history of vaping or other use of e-cigarette-related products. Second hand exposure to e-cigarettes is also harmful through respiration and transdermal absorption. E-cigarettes have a worse acute toxicity than tobacco and their long-term toxicity is unknown, and we advocate for the immediate, most vigorous anti-vaping legislation possible.
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Affiliation(s)
- Jayesh Mahendra Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Manisha Ramphul
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, United Kingdom; Paediatric Chest Physician, Royal Brompton & Harefield NHS Foundation Trust, United Kingdom; Imperial Centre for Paediatrics and Child Health, United Kingdom; Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
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7
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Bush A, Bhatt JM, Carroll W, Child F, Connett G, Doull I, Gilchrist F, Grigg J, Langton-Hewer S, Legg J, Lenney W, Paton J, Shields M, Sinha I. The ERS approach to e-cigarettes is entirely rational. Eur Respir J 2020; 55:2000413. [PMID: 32381632 DOI: 10.1183/13993003.00413-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew Bush
- Imperial College, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Will Carroll
- Paediatrics, Derby Hospitals NHS Trust, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Frances Child
- Dept of Respiratory Paediatrics, Central Manchester and Manchester Children, Manchester, UK
| | - Gary Connett
- University Hospital Southampton NHS Foundation Trust, University Hospital Southampton, Southampton, UK
| | - Iolo Doull
- Children's Hospital for Wales, Cardiff, UK
| | - Francis Gilchrist
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Queen Mary University London, London, UK
| | | | - Julian Legg
- Southampton University Hospitals NHS Trust, Southampton, UK
| | - Warren Lenney
- Academic Department of Child Health, University Hospital of North Staffordshire and Keele University, Stoke-on-Trent, UK
| | - James Paton
- Royal Hospital for Sick Children, Glasgow, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Ian Sinha
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Ramphul M, Bush A, Chang A, Prifits KN, Wallis C, Bhatt JM. The role of the pediatrician in caring for children with tracheobronchomalacia. Expert Rev Respir Med 2020; 14:679-689. [DOI: 10.1080/17476348.2020.1750374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Manisha Ramphul
- Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - Andrew Bush
- Imperial College, London, UK
- Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, London, UK
| | - Anne Chang
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Children Centre for Health Research, Queensland University of Technology, Brisbane, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kostas N Prifits
- Allergy - Pulmonology Unit, 3rd Dept Paediatrics, Athens University Medical School, Chaidari, Greece
| | - Colin Wallis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham Children’s Hospital, Nottingham University Hospitals, Queens Medical Centre, Nottingham, UK
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9
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Walsh R, Batra D, Dixit A, Bhatt JM. Clues beyond the lung: an unusual diagnosis in an infant with chronic lung disease. Breathe (Sheff) 2020; 16:190319. [PMID: 32494305 PMCID: PMC7249791 DOI: 10.1183/20734735.0319-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Gan HW, Bhatt JM, Denvir L, Randell T, Sachdev P. Monogenic diabetes mellitus in cystic fibrosis. Arch Dis Child 2019; 104:887-889. [PMID: 30269055 DOI: 10.1136/archdischild-2018-316141] [Citation(s) in RCA: 5] [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: 08/30/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 01/02/2023]
Abstract
We present a non-consanguineous family of three siblings who presented with diabetes mellitus (DM), two of whom had genetically confirmed cystic fibrosis (CF), with one pancreatic-sufficient mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene (ΔF508/R117H;IVS8-5T). A detailed history revealed family members from three successive generations diagnosed with 'type 1' or 'type 2' diabetes, leading to genetic investigations for monogenic DM. A heterozygous frameshift mutation in the hepatocyte nuclear factor 1 homeobox alpha (HNF1A) gene (c.404delA) was subsequently confirmed in all three siblings, which is known to cause monogenic diabetes and is exquisitely sensitive to sulfonylurea therapy. Following this diagnosis, both siblings with CF and HNF1A monogenic diabetes were started on gliclazide therapy, while their older brother who had been wrongly diagnosed with type 1 diabetes was switched from insulin to gliclazide, all with excellent therapeutic responses.
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Affiliation(s)
- Hoong-Wei Gan
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Genetics and Genomic Medicine Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Louise Denvir
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pooja Sachdev
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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11
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Batey N, Batra D, Dorling J, Bhatt JM. Impact of a protocol-driven unified service for neonates with bronchopulmonary dysplasia. ERJ Open Res 2019; 5:00183-2018. [PMID: 30918896 PMCID: PMC6431751 DOI: 10.1183/23120541.00183-2018] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
Aim A new specialised service for preterm infants with bronchopulmonary dysplasia requiring long-term oxygen therapy (LTOT) was established in 2007, led by the paediatric respiratory team, transitioning from neonatal-led follow-up. The new service included the utilisation of a clear protocol. Our objective was to review whether this service initiation led to a reduction of time in LTOT and hospital readmissions. Methods We performed a retrospective cohort study of infants born at <32 weeks’ gestation requiring LTOT in a single tertiary neonatal service. Cases were identified from hospital records, BadgerNet and a local database for two cohorts, 2004–2006 and 2008–2010. Data collected for infants requiring LTOT included demographic details, length of neonatal stay, time in oxygen and hospital attendance rates. Results The initiation of the service led to an increase in the number of discharges in LTOT: 13.1% of infants born alive before 32 weeks’ gestation in comparison to 3.5% (p<0.001). However, the length of time in LTOT reduced from 15 to 5 months (p=0.01). There was no difference in hospital readmission rates (p=0.365). Conclusions In our experience the increase in neonates requiring LTOT is likely to be due to enhanced provision of overnight oximetry studies prior to discharge. Structured monitoring and weaning led to a shorter duration of home oxygen therapy. The implementation of a clear protocol for assessment and management of neonates with bronchopulmonary dysplasia may lead to more infants being discharged in home oxygen, but has potential to reduce overall healthcare costs and improve long-term outcomeshttp://ow.ly/fYcv30nIc2c
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Affiliation(s)
- Natalie Batey
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dushyant Batra
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jon Dorling
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Dept of Academic Child Health, University of Nottingham, Nottingham, UK
| | - Jayesh Mahendra Bhatt
- Paediatric Respiratory Dept, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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12
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Khetan R, Hurley M, Neduvamkunnil A, Bhatt JM. Fifteen-minute consultation: An evidence-based approach to the child with preschool wheeze. Arch Dis Child Educ Pract Ed 2018; 103:7-14. [PMID: 28667045 DOI: 10.1136/archdischild-2016-311254] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/02/2016] [Accepted: 04/04/2017] [Indexed: 11/04/2022]
Abstract
Preschool wheeze is very common and its prevalence is increasing. It consumes considerable healthcare resources and has a major impact on children and their families due to significant morbidity associated with acute episodes.History taking is the main diagnostic instrument in the assessment of preschool wheeze. Diagnosis and management is complicated by a broad differential and associations with many other diseases and conditions that give rise to noisy breathing, which could be misinterpreted as wheeze. Several clinical phenotypes have been described but they have limitations and do not clearly inform therapeutic decisions. New insights in aetiopathogenesis modify treatment options and lay foundation for further research. An understanding of the approach and available evidence to assess and manage wheeze informs best patient care and use of resources.Our objective is to demonstrate a focused history, examination and management options in a preschool child with wheeze.
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Affiliation(s)
- Renu Khetan
- Department of Paediatrics, Nottingham Children's Hospital, Nottingham, UK
| | - Matthew Hurley
- Department of Paediatrics, Nottingham Children's Hospital, Nottingham, UK.,Division of Child Health, University of Nottingham, Nottingham, UK
| | | | - Jayesh Mahendra Bhatt
- Department of Paediatrics, Nottingham Children's Hospital, Nottingham, UK.,Nottingham Children's Hospital, National Paediatric Ataxia Telangiectasia Clinic, Nottingham, UK
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Hurley M, Bhatt JM. Where Are We Now with the Role of Steroids in the Management of Bronchopulmonary Dysplasia in Extremely Premature Babies? Front Pediatr 2016; 4:85. [PMID: 27559539 PMCID: PMC4979046 DOI: 10.3389/fped.2016.00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/29/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Matthew Hurley
- Nottingham Children's Hospital, Nottingham, UK; University of Nottingham Division of Child Health, Nottingham, UK
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