1
|
Wiik J, Værnesbranden MR, Jonassen CM, Staff AC, Carlsen KCL, Granum B, Haugen G, Hedlin G, Hilde K, Jacobsson B, Nilsson S, Nordlund B, Rangberg A, Rehbinder EM, Sengpiel V, Skjerven H, Sundet BK, Söderhäll C, Vettukattil R, Sjøborg K. Maternal human papillomavirus infection during pregnancy and preterm delivery: A mother-child cohort study in Norway and Sweden. Acta Obstet Gynecol Scand 2023; 102:344-354. [PMID: 36647213 PMCID: PMC9951315 DOI: 10.1111/aogs.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) infection is common in women of reproductive age. Infection and inflammation are leading causes for preterm delivery (PTD), but the role of HPV infection in PTD and prelabor rupture of membranes (PROM) is unclear. We aimed to explore whether HPV infection during pregnancy in general, and high-risk-HPV (HR-HPV) infection specifically, increased the risk of PTD, preterm prelabor rupture of membranes (PPROM), PROM at term, and/or chorioamnionitis. MATERIAL AND METHODS In pregnant women, who were participating in a prospective multicenter cohort study from a general population in Norway and Sweden (PreventADALL, ClinicalTrials.gov NCT02449850), HPV DNA was analyzed in available urine samples at mid-gestation (16-22 weeks) and at delivery, and in the placenta after delivery with Seegene Anyplex II HPV28 PCR assay. The risk of PTD, PPROM, PROM, and chorioamnionitis was analyzed using unadjusted and adjusted logistic regression analyses for any 28 HPV genotypes, including 12 HR-HPV genotypes, compared with HPV-negative women. Further, subgroups of HPV (low-risk/possibly HR-HPV, HR-HPV-non-16 and HR-HPV-16), persistence of HR-HPV from mid-gestation to delivery, HR-HPV-viral load, and presence of multiple HPV infections were analyzed for the obstetric outcomes. Samples for HPV analyses were available from 950 women with singleton pregnancies (mean age 32 years) at mid-gestation and in 753 also at delivery. RESULTS At mid-gestation, 40% of women were positive for any HPV and 24% for HR-HPV. Of the 950 included women, 23 had PTD (2.4%), nine had PPROM (0.9%), and six had chorioamnionitis (0.6%). Of the term pregnancies, 25% involved PROM. The frequency of PTD was higher in HR-HPV-positive women (8/231, 3.5%) than in HPV-negative women (13/573, 2.3%) at mid-gestation, but the association was not statistically significant (odds ratio 1.55; 95% confidence interval 0.63-3.78). Neither any HPV nor subgroups of HPV at mid-gestation or delivery, nor persistence of HR-HPV was significantly associated with increased risk for PTD, PPROM, PROM, or chorioamnionitis. No HPV DNA was detected in placentas of women with PTD, PPROM or chorioamnionitis. CONCLUSIONS HPV infection during pregnancy was not significantly associated with increased risk for PTD, PPROM, PROM, or chorioamnionitis among women from a general population with a low incidence of adverse obstetric outcomes.
Collapse
Affiliation(s)
- Johanna Wiik
- Department of Gynecology and ObstetricsØstfold Hospital TrustGralumNorway,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Obstetrics and GynecologySahlgrenska University HospitalGothenburgSweden
| | - Magdalena R. Værnesbranden
- Department of Gynecology and ObstetricsØstfold Hospital TrustGralumNorway,Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Christine M. Jonassen
- Department of Virology, Norwegian Institute of Public Health OsloOsloNorway,Genetic Unit, Center for Laboratory MedicineØstfold Hospital TrustGralumNorway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
| | - Karin C. L. Carlsen
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Division of Pediatric and Adolescent MedicineOslo University HospitalOsloNorway
| | - Berit Granum
- Department of Chemical Toxicology, Norwegian Institute of Public HealthOsloNorway
| | - Guttorm Haugen
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University HospitalStockholmSweden,Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Katarina Hilde
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Obstetrics and GynecologySahlgrenska University HospitalGothenburgSweden,Department of Genetics and Bioinformatics, Division of Health Data and Digitalization, Institute of Public HealthOsloNorway
| | - Staffan Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Mathematical SciencesChalmers University of TechnologyGothenburgSweden
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University HospitalStockholmSweden,Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Anbjørg Rangberg
- Genetic Unit, Center for Laboratory MedicineØstfold Hospital TrustGralumNorway
| | - Eva Maria Rehbinder
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Department of Dermatology and VenereologyOslo University HospitalOsloNorway
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Obstetrics and GynecologySahlgrenska University HospitalGothenburgSweden
| | - Håvard Skjerven
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Division of Pediatric and Adolescent MedicineOslo University HospitalOsloNorway
| | - Birgitte K. Sundet
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University HospitalStockholmSweden,Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Riyas Vettukattil
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Division of Pediatric and Adolescent MedicineOslo University HospitalOsloNorway
| | - Katrine Sjøborg
- Department of Gynecology and ObstetricsØstfold Hospital TrustGralumNorway
| |
Collapse
|
2
|
Gudmundsdóttir HK, Hilde K, Bains KES, Färdig M, Haugen G, LeBlanc M, Nordhagen LS, Nordlund B, Rehbinder EM, Skjerven HO, Staff AC, Vettukattil R, Carlsen KCL. Fetal thoracic circumference in mid-pregnancy and infant lung function. Pediatr Pulmonol 2023; 58:35-45. [PMID: 36097818 PMCID: PMC10091718 DOI: 10.1002/ppul.26153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Impaired lung function in early infancy is associated with later wheeze and asthma, while fetal thoracic circumference (TC) predicts severity of neonatal lung hypoplasia. Exploring fetal origins of lung function in infancy, we aimed to determine if fetal TC in mid-pregnancy was associated with infant lung function. METHODS From the prospective Scandinavian general population-based PreventADALL mother-child birth cohort, all 851 3-month-old infants with tidal flow-volume measurements in the awake state and ultrasound fetal size measures at 18 (min-max 16-22) weeks gestational age were included. Associations between fetal TC and time to peak tidal expiratory flow to expiratory time (tPTEF /tE ) were analyzed in linear regression models. To account for gestational age variation, we adjusted TC for simultaneously measured general fetal size, by head circumference (TC/HC), abdominal circumference (TC/AC), and femur length (TC/FL). Multivariable models were adjusted for maternal age, maternal asthma, pre-pregnancy body mass index, parity, nicotine exposure in utero, and infant sex. RESULTS The infants (47.8% girls) were born at mean (SD) gestational age of 40.2 (1.30) weeks. The mean (SD) tPTEF /tE was 0.39 (0.08). The mean (SD) TC/HC was 0.75 (0.04), TC/AC 0.87 (0.04), and TC/FL 4.17 (0.26), respectively. Neither TC/HC nor TC/AC were associated with infant tPTEF /tE while a week inverse association was observed between TC/FL and tPTEF /tE ( β ^ $\hat{\beta }$ = -0.03, 95% confidence interval [-0.05, -0.007], p = 0.01). CONCLUSION Mid-pregnancy fetal TC adjusted for fetal head or abdominal size was not associated with tPTEF /tE in healthy, awake 3-month-old infants, while a weak association was observed adjusting for fetal femur length.
Collapse
Affiliation(s)
- Hrefna K Gudmundsdóttir
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Katarina Hilde
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Karen E S Bains
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Martin Färdig
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Guttorm Haugen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Marissa LeBlanc
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Live S Nordhagen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health, VID Specialized University, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva M Rehbinder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology and Venereology, Oslo University Hospital, Oslo, Norway
| | - Håvard O Skjerven
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne C Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Karin C L Carlsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
3
|
Tedner SG, Söderhäll C, Konradsen JR, Bains KES, Borres MP, Carlsen K, Carlsen KCL, Färdig M, Gerdin SW, Gudmundsdóttir HK, Haugen G, Hedlin G, Jonassen CM, Kreyberg I, Mägi CO, Nordhagen LS, Rehbinder EM, Rudi K, Skjerven HO, Staff AC, Vettukattil R, Hage M, Nordlund B, Asarnoj A. Extract and molecular-based early infant sensitization and associated factors-A PreventADALL study. Allergy 2021; 76:2730-2739. [PMID: 33751598 DOI: 10.1111/all.14805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND More knowledge about sensitization patterns in early infancy, including impact of molecular allergology, is needed to help predict future allergy development more accurately. OBJECTIVE We aimed to determine the prevalence and patterns of allergic sensitization at 3 months of age, and explore possible associated factors. METHODS From the Scandinavian antenatally recruited PreventADALL mother-child cohort, we included 1110 3-month infants with available serum. Sensitization was defined as s-IgE of ≥0.1 kUA /L by Phadiatop Infant® (ThermoFisher Scientific) including birch, cat, grass, dog, milk, egg, peanut and wheat. Further ImmunoCAP analyses to ovomucoid, casein, Ara h 1-3, omega-5-gliadin were performed in food extract s-IgE-positive children. Maternal sensitization was defined as s-IgE ≥ 0.35 kUA /L to Phadiatop® (inhalant allergen mix) and/or Fx5 (food allergen mix) at 18-week pregnancy. RESULTS Overall 79 (7.3%) infants had specific sensitization, many with low s-IgE-levels (IQR 0.16-0.81 kUA /L), with 78 being sensitized to food extract allergens; 41 to egg, 27 to milk, 10 to peanut, and 25 to wheat. A total of 62/78 were further analysed, 18 (29%) had s-IgE to ovomucoid, casein, Ara h 1-3 and/or omega-5-gliadin. Eight infants (0.7%) were sensitized to inhalant allergens. Maternal sensitization to food allergens was associated with infant sensitization, odds ratio 3.64 (95% CI 1.53-8.68). CONCLUSION Already at 3 months of age, 7% were sensitized to food, mostly without detectable s-IgE to food allergen molecules, and <1% to inhalant allergens. Maternal food sensitization was associated with infants' sensitization.
Collapse
Affiliation(s)
- Sandra G. Tedner
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Jon R. Konradsen
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Karen E. S. Bains
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Magnus P. Borres
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Kai‐Håkon Carlsen
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Karin C. L. Carlsen
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Martin Färdig
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Sabina W. Gerdin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Hrefna K. Gudmundsdóttir
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Guttorm Haugen
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Christine M. Jonassen
- Genetic Unit Centre for Laboratory Medicine Østfold Hospital Trust Kalnes Norway
- Faculty of Chemistry, Biotechnology and Food Science Norwegian University of Life Sciences Ås Norway
| | - Ina Kreyberg
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Caroline‐Aleksi O. Mägi
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Live S. Nordhagen
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
- VID Specialized University Oslo Norway
| | - Eva M. Rehbinder
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - Knut Rudi
- Faculty of Chemistry, Biotechnology and Food Science Norwegian University of Life Sciences Ås Norway
| | - Håvard O. Skjerven
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Anne C. Staff
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Riyas Vettukattil
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Marianne Hage
- Department of Medicine Solna Division of Immunology and Allergy Karolinska Institutet and University Hospital Stockholm Sweden
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Anna Asarnoj
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| |
Collapse
|
4
|
Liu NM, Carlsen KCL, Cunningham S, Fenu G, Fleming LJ, Gappa M, Karadag B, Midulla F, Petrarca L, Pijnenburg MWH, Reier-Nilsen T, Rutjes NW, Rusconi F, Grigg J. First analysis of the Severe Paediatric Asthma Collaborative in Europe registry. ERJ Open Res 2020; 6:00566-2020. [PMID: 33263064 PMCID: PMC7682719 DOI: 10.1183/23120541.00566-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 01/13/2023] Open
Abstract
New biologics are being continually developed for paediatric asthma, but it is unclear whether there are sufficient numbers of children in Europe with severe asthma and poor control to recruit to trials needed for registration. To address these questions, the European Respiratory Society funded the Severe Paediatric Asthma Collaborative in Europe (SPACE), a severe asthma registry. We report the first analysis of the SPACE registry, which includes data from 10 paediatric respiratory centres across Europe. Data from 80 children with a clinical diagnosis of severe asthma who were receiving both high-dose inhaled corticosteroid and long-acting β2-agonist were entered into the registry between January 2019 and January 2020. Suboptimal control was defined by either asthma control test, or Global Initiative for Asthma criteria, or ≥2 severe exacerbations in the previous 12 months, or a combination. Overall, 62 out of 80 (77%) children had suboptimal asthma control, of whom 29 were not prescribed a biologic. However, in 24 there was an option for starting a licensed biologic. 33 children with suboptimal control were prescribed a biologic (omalizumab (n=24), or mepolizumab (n=7), or dupilumab (n=2)), and for 29 there was an option to switch to a different biologic. We conclude that the SPACE registry provides data that will support the planning of studies of asthma biologics. Not all children on biologics achieve good asthma control, and there is need for new trial designs addressing biologic switching.
Collapse
Affiliation(s)
- Norrice M Liu
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Karin C L Carlsen
- Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Grazia Fenu
- Paediatrics Pulmonology Unit, Anna Meyer Children's Hospital, Florence, Italy
| | | | - Monika Gappa
- Children's Hospital, Evangelisches Krankenhaus Duesseldorf, Düsseldorf, Germany
| | - Bülent Karadag
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Fabio Midulla
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Laura Petrarca
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Marielle W H Pijnenburg
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tonje Reier-Nilsen
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Niels W Rutjes
- Dept of Paediatric Respiratory Medicine, Emma Children's Hospital/Amsterdam UMC, Amsterdam, The Netherlands
| | - Franca Rusconi
- Epidemiology Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|
5
|
Hov B, Andersen T, Toussaint M, Fondenes O, Carlsen KCL, Hovland V. Optimizing expiratory flows during mechanical cough in a pediatric neuromuscular lung model. Pediatr Pulmonol 2020; 55:433-440. [PMID: 31856413 DOI: 10.1002/ppul.24606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022]
Abstract
Mechanical insufflation-exsufflation (MI-E) is recommended for subjects of all ages with neuromuscular disorders (NMDs) and weak cough. There is a lack of knowledge on the optimal treatment settings for young children. This study aims to determine the MI-E settings providing high expiratory airflow while using safe inspiratory volumes, and to identify possible limits where the benefit of incrementing the MI-E settings to achieve a higher expiratory airflow, decreased. Using an MI-E device and a lung model imitating a 1-year-old child with NMD, we explored the impact of 120 combinations of MI-E pressure and time settings on maximal expiratory airflow and inspiratory volume. High expiratory airflows were achieved with several pressure and time combinations where the exsufflation pressure, followed by insufflation pressure and time, had the greatest impact. The benefit of incrementing the settings to increase the expiratory airflow leveled off for the insufflation pressure and time, but not for the exsufflation pressure. Given exsufflation pressure of -40 or -50 cmH2 O and insufflation time longer than 1 second, a plateau in the expiratory airflow curve was present at insufflation pressures from 25 cmH2 O, whereas a plateau in the inspired volume curve occurred at insufflation pressures from 35 cmH2 O. The present neuromuscular pediatric lung model study showed that expiratory pressure impacts expiratory airflow more than inspiratory pressure and time. An inspiratory and expiratory pressure set between 20 to 30 and -40 cmH2 O, respectively, and an inspiratory time longer than 1 second may be considered as a basis when titrating MI-E settings in young children with NMD. The findings must be confirmed in clinical trials.
Collapse
Affiliation(s)
- Brit Hov
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslðo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tiina Andersen
- Norwegian Advisory Unit on Long Term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.,Physiotherapy Department, Haukeland University Hospital, Bergen, Norway
| | - Michel Toussaint
- Centre for Neuromuscular Disorders and Home Mechanical Ventilation, UZ Brussel-Inkendaal, Vlezenbeek, Belgium
| | - Ove Fondenes
- Norwegian Advisory Unit on Long Term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
| | - Karin C L Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslðo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vegard Hovland
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslðo, Norway
| |
Collapse
|
6
|
Kreyberg I, Nordhagen LS, Bains KES, Alexander J, Becher R, Carlsen KH, Glavin K, Carlsen KCL. An update on prevalence and risk of snus and nicotine replacement therapy during pregnancy and breastfeeding. Acta Paediatr 2019; 108:1215-1221. [PMID: 30719748 DOI: 10.1111/apa.14737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/28/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/29/2022]
Abstract
AIM In parallel with falling smoking rates, use of the oral moist tobacco product snus increases among women in reproductive age. We report an update on prevalence and effects of maternal use of snus and nicotine replacement therapy (NRT) during pregnancy and breastfeeding. METHODS A literature search of human studies in Medline, PubMed and EMBASE was conducted from September 2016 to May 2018, with stepwise screening of abstracts and subsequent relevant full-text papers for inclusion in Scandinavian and English languages. RESULTS Based on three studies, the prevalence of snus use in pregnancy was up to 3.4% in the first trimester and 2.1% in the third trimester. In 12 studies, we found increased risk of several adverse effects, especially preterm delivery, stillbirth and small for gestational age associated with maternal snus use during pregnancy. Knowledge on effects of NRT during pregnancy was conflicting and inconclusive in 10 studies. We did not identify any studies on prevalence or potential health effects of snus or NRT during breastfeeding. CONCLUSION Few studies with updated data on the prevalence and adverse health effects of maternal use of snus and NRT during pregnancy were found. No studies during breastfeeding were identified.
Collapse
Affiliation(s)
- I Kreyberg
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - L S Nordhagen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- VID Specialized University Oslo Norway
| | - K E S Bains
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - J Alexander
- Norwegian Institute of Public Health Oslo Norway
| | - R Becher
- Norwegian Institute of Public Health Oslo Norway
| | - K H Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - K Glavin
- VID Specialized University Oslo Norway
| | - K C L Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| |
Collapse
|
7
|
Liu NM, van Aalderen W, Carlsen KCL, Coleman C, Chalmers JD, Cunningham S, Fernandes RM, Fleming LJ, Gappa M, Karadag B, Midulla F, Pijnenburg MWH, Rutjes NW, Rusconi F, Grigg J. Severe Paediatric Asthma Collaborative in Europe (SPACE): protocol for a European registry. Breathe (Sheff) 2018; 14:93-98. [PMID: 29875828 PMCID: PMC5980472 DOI: 10.1183/20734735.002018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The development of new asthma biologics and receptor blockers for the treatment of paediatric severe asthma raises challenges. It is unclear whether there are sufficient children in Europe to recruit into randomised placebo-controlled trials to establish efficacy and safety in this age group. In February 2016, the European Respiratory Society funded a clinical research collaboration entitled "Severe Paediatric Asthma Collaborative in Europe" (SPACE). We now report the SPACE protocol for a prospective pan-European observational study of paediatric severe asthma. Inclusion criteria are: 1) age 6-17 years, 2) severe asthma managed at a specialised centre for ≥6 months, 3)clinical and spirometry evidence of asthma, and 4) reaching a pre-defined treatment threshold. The exclusion criterion is the presence of conditions which mimic asthma symptoms. Eligible children will be prospectively recruited into a registry, recording demographics, comorbidities, quality of life, family history, neonatal history, smoking history, asthma background, investigations, and treatment. Follow-up will provide longitudinal data on asthma control and treatment changes. The SPACE registry, by identifying well-phenotyped children eligible for clinical trials, and the amount of overlap in eligibility criteria, will inform the design of European trials in paediatric severe asthma, and facilitate observational research where data from single centres are limited.
Collapse
Affiliation(s)
- Norrice M Liu
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Wim van Aalderen
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Karin C L Carlsen
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Courtney Coleman
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - James D Chalmers
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Steve Cunningham
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Ricardo M Fernandes
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Louise J Fleming
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Monika Gappa
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Bülent Karadag
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Fabio Midulla
- For a full list of the authors' affiliations please see the Acknowledgements section
| | | | - Niels W Rutjes
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Franca Rusconi
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Jonathan Grigg
- For a full list of the authors' affiliations please see the Acknowledgements section
| |
Collapse
|
8
|
Kvenshagen BK, Carlsen KH, Mowinckel P, Berents TL, Carlsen KCL. Can early skin care normalise dry skin and possibly prevent atopic eczema? A pilot study in young infants. Allergol Immunopathol (Madr) 2014; 42:539-43. [PMID: 25201763 DOI: 10.1016/j.aller.2014.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atopic eczema (AE) affects approximately 20% of children in Northern countries. Onset during early infancy is common and is characterised by altered skin barrier, increased water loss and defective lipid layer. Restoration of skin barrier by emollients and/or oil baths is an important part of AE treatment, but its role in preventing xerosis and AE is unknown. The present pilot study aimed to assess if xerosis, and possibly AE, could be reduced at six months of age by early introduction of frequent oil baths/facial fat cream in infants with dry skin. METHODS A controlled intervention pilot study included 56 six-week-old infants with xerosis, but not AE. Skin quality score ranging from 0 (normal skin) to 4 (probable AE), was assessed at inclusion, three and six months of age, with skin quality at six months as main outcome. One well baby clinic was recruited for intervention, frequent skin care (oil bath (0.5 dl) and facial fat cream, five well baby clinics recruited for observation only. RESULTS The intervention group (n=24) had more often normal skin (75%) at six months than the observation group (37.5%) (p<0.001), and less often probable AE (4.0 vs. 19.0%, respectively, ns). Oil baths were performed regularly, 2-4 up to 5-7 times/week in the intervention group, vs. fewer oil baths with sparse volume of oil in the observation group. No adverse reactions were reported. CONCLUSION Regular oil baths in infants seem to reduce xerosis and may possibly reduce atopic eczema.
Collapse
Affiliation(s)
- B K Kvenshagen
- Department of Paediatrics, Oestfold Hospital Trust, Fredrikstad, Norway.
| | - K-H Carlsen
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Paediatrics, Oslo University Hospital, Oslo, Norway
| | - P Mowinckel
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
| | - T L Berents
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - K C L Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Bertelsen RJ, Carlsen KCL, Granum B, Carlsen KH, Håland G, Devulapalli CS, Munthe-Kaas MC, Mowinckel P, Løvik M. Do allergic families avoid keeping furry pets? Indoor Air 2010; 20:187-195. [PMID: 20158528 DOI: 10.1111/j.1600-0668.2009.00640.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Studies addressing the relationship between pet keeping and development of asthma and allergies may be influenced by pet avoidance in families with a history of allergic disease. Following a cohort of 1019 children in Oslo till 10 years of age, we studied the association of pet keeping with socio-economic factors and allergic disease in the family. A family history of asthma and rhinoconjunctivitis was not significantly associated with pet ownership at birth or with pet removal by 10 years. Acquiring cats and dogs was less likely if the child had allergic rhinoconjunctivitis, whereas no association was seen with asthma (in any family member). Single parenthood increased the likelihood of acquiring a cat, smoking parents more often had cats or dogs, and having older siblings was associated with keeping dogs and other furry pets. Among 319 families reporting pet avoidance, 70% never had pets, 8% had given up pets, and 22% avoided a particular type of pet only. Twenty-four per cent of the parents failed to retrospectively report pet keeping during the child's first year of life. Overall, allergic rhinitis, but not asthma was associated with actual pet avoidance, whereas the strongest predictors for keeping pets were found to be socio-economic factors. PRACTICAL IMPLICATIONS Allergic disease in a child most often does not lead to the removal of the family's furry pet. Pet avoidance is associated with allergic symptoms, but not asthma. Socio-economic factors like parental education, single parenthood and smoking affects the families' decisions on pet keeping, including the type of pets the families will avoid or acquire. The large recall error demonstrated points to the need for prospective data regarding pet keeping.
Collapse
Affiliation(s)
- R J Bertelsen
- Department of Environmental Immunology, Division of Environmental Medicine, Norwegian Institute of Public Health, Nydalen, Oslo, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
BACKGROUND Evidence regarding habitual physical activity levels and aerobic fitness of asthmatic compared to nonasthmatic children and adolescents is contradictory, and it is unclear if low physical activity levels can contribute to asthma development. The present study therefore aimed to determine whether adolescents with asthma have reduced physical activity levels and aerobic fitness, or increased energy intake and body fat compared to controls. METHODS From the environment and childhood asthma study in Oslo, 174 (13- to 14-year old) adolescents, 95 (66 boys) with and 79 (41 boys) without asthma performed maximal running on a treadmill with oxygen consumption measurement (aerobic fitness) and had the sum of four skinfolds and waist circumference recorded (body fat), followed by wearing an activity monitor and registering diet for four consecutive days. Asthma was defined by at least two of the following three criteria fulfilled: (1) dyspnoea, chest tightness and/or wheezing; (2) a doctor's diagnosis of asthma; (3) use of asthma medication. Participants with asthma used their regular medications. RESULTS Neither aerobic fitness, total energy expenditure nor hours in moderate to very vigorous intensity physical activity during week and weekend differed between adolescents with and without asthma. Energy intake and body fat was similar in both groups. CONCLUSIONS Total energy expenditure, aerobic fitness and hours in moderate to very vigorous intensity physical activity were not reduced and energy intake and body fat measured with skinfolds not increased among Norwegian adolescents with asthma.
Collapse
Affiliation(s)
- S Berntsen
- Department of Paediatrics, Woman-Child Division, Ullevål University Hospital, Oslo, Norway
| | | | | | | | | | | | | |
Collapse
|
11
|
Bjørnvold M, Munthe-Kaas MC, Egeland T, Joner G, Dahl-Jørgensen K, Njølstad PR, Akselsen HE, Gervin K, Carlsen KCL, Carlsen KH, Undlien DE. A TLR2 polymorphism is associated with type 1 diabetes and allergic asthma. Genes Immun 2009; 10:181-7. [PMID: 19148143 DOI: 10.1038/gene.2008.100] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Type 1 diabetes (T1D) and allergic asthma are immune-mediated diseases. Pattern recognition receptors are proteins expressed by cells in the immune system to identify microbial pathogens and endogenous ligands. Toll-like receptors (TLRs) and CD14 are members of this family and could represent a molecular link between microbial infections and immune-mediated diseases. Diverging hypotheses regarding whether there exists a common or inverse genetic etiology behind these immune-mediated diseases have been presented. We aimed to test whether there exist common or inverse associations between polymorphisms in the pattern recognition receptors TLR2, TLR4 and CD14 and T1D and allergic asthma. Eighteen single nucleotide polymorphisms (SNPs) were genotyped in TLR2 (2), TLR4 (12) and CD14 (4) in 700 T1D children, 357 nuclear families with T1D children and 796 children from the 'Environment and Childhood Asthma' study. Allele and haplotype frequencies were analyzed in relation to diseases and in addition transmission disequilibrium test analyses were performed in the family material. Both T1D and allergic asthma were significantly associated with the TLR2 rs3804100 T allele and further associated with the haplotype including this SNP, possibly representing a susceptibility locus common for the two diseases. Neither TLR4 nor CD14 were associated with T1D or allergic asthma.
Collapse
Affiliation(s)
- M Bjørnvold
- Institute of Medical Genetics, Faculty Division Ullevål University Hospital, University of Oslo, Blindern, Norway.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Devulapalli CS, Carlsen KCL, Håland G, Munthe-Kaas MC, Pettersen M, Mowinckel P, Carlsen KH. Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age. Thorax 2007; 63:8-13. [PMID: 17615086 DOI: 10.1136/thx.2006.060616] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Predicting school-age asthma from obstructive airways disease (OAD) in early life is difficult, even when parental and children's atopic manifestations are taken into consideration. OBJECTIVE To assess if the severity of OAD in the first 2 years of life predicts asthma at 10 years of age. METHODS From a nested case control study within the Environment and Childhood Asthma study, 233 2-year-old subjects with recurrent (> or = 2 episodes) bronchial obstruction (rBO+) and 216 subjects without bronchial obstruction (rBO-) underwent clinical examination, parental interview, treadmill test and metacholine bronchial hyperresponsiveness (BHR) measurement at 10 years. A severity score at 2 years was calculated by frequency, persistence of bronchial obstruction and hospital admissions because of OAD. MAIN OUTCOMES Current asthma at 10 years (asthma with symptoms and/or asthma medication during the past year and/or positive treadmill test). Secondary outcome was metacholine BHR at 10 years. RESULTS Compared with rBO- subjects, adjusted odds ratio (95% CI) of current asthma among rBO+ was 7.9 (4.1, 15.3), and among rBO+ with a severity score of > 5, 20.2 (9.9, 41.3). In receiver operated characteristic analysis, positive and negative predictive values demonstrated the applicability and value of the score, with an optimal cut-off at severity score 5. Children with severity score > 5 had severe BHR more often (PD20 metacholine < 1 micromol) than children with a lower or 0 score (p = 0.0041). CONCLUSION Using a simple scoring system, a high severity score of OAD by 2 years of age is a strong risk factor for, and may predict, current asthma at 10 years of age.
Collapse
Affiliation(s)
- C S Devulapalli
- Department of Paediatrics, Division of Woman and Child, Ullevål University Hospital, Oslo, Norway
| | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
AIM To explore the prevalence of symptoms suggestive of gastro-oesophageal reflux disease (GERD) in asthmatics and controls, and to control for the possible effect of overweight. METHODS The prevalence of GERD symptoms was assessed using a questionnaire about reflux symptoms in children with asthma (n=872, mean age 10.4 y, 65% males) compared to non-asthmatic controls (n=264, mean age 10.8 y, 48% males), and a symptom score was calculated. The association between GERD symptoms and overweight (age-adjusted BMI > 25) was assessed independently. RESULTS A positive reflux symptom score was found in 19.7% of the asthmatics compared to 8.5% of the non-asthmatic control group (odds ratio (OR) 2.6, 95% CI 1.7-4.2). Overweight children reported GERD symptoms more frequently than children with normal weight (OR 1.8, 95% CI 1.2-2.6). Asthma and obesity remained significant predictors when analysed simultaneously by logistic regression analysis. One hundred and fifty-two children with asthma consented to an oesophageal pH study, and an abnormal pH study result (reflux index > 5.0) correlated positively with overweight (OR 4.9, 95% CI 2.2-11.0). CONCLUSION The prevalence of symptoms associated with gastro-oesophageal reflux was increased in children with asthma and in overweight children. Overweight and asthma were independently associated with GERD symptoms, and overweight did not explain the higher frequency of GERD in asthma patients.
Collapse
Affiliation(s)
- Ketil Størdal
- Department of Paediatrics, Sykehuset Østfold Fredrikstad, Fredrikstad, Norway.
| | | | | | | | | |
Collapse
|
14
|
Størdal K, Johannesdottir GB, Bentsen BS, Knudsen PK, Carlsen KCL, Closs O, Handeland M, Holm HK, Sandvik L. Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease. Arch Dis Child 2005; 90:956-60. [PMID: 16113133 PMCID: PMC1720585 DOI: 10.1136/adc.2004.068890] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven. AIM To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD. METHODS Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29 males) with asthma and a reflux index > or =5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg daily or placebo. The groups were similar in age, gender, mean reflux index, and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) and quality of life (PAQLQ). Secondary endpoints were changes in lung function and the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression. RESULTS The change in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95% CI -0.1 to 2.65) and 1.28 (95% CI -0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index <5.0) under omeprazole treatment. CONCLUSION Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD.
Collapse
Affiliation(s)
- K Størdal
- Dept of Paediatrics, Østfold County Hospital, 1602 Fredrikstad, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Carlsen KH, Carlsen KCL. Case 3: assessment. Exercise-induced inspiratory laryngeal stridor. Paediatr Respir Rev 2002; 3:162, 164. [PMID: 12465603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- K-H Carlsen
- Voksentoppen National Hospital and Research Institute of Asthma, Allergy and Chronic Lung Diseases in Children, Oslo, Norway
| | | |
Collapse
|
16
|
Carlsen KH, Carlsen KCL. Exercise-induced asthma. Paediatr Respir Rev 2002; 3:154-60. [PMID: 12297065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Exercise-induced asthma (EIA) is common in asthmatic children and adolescents. Since it may cause limitations to daily life activities in up to 30%, mastering EIA is important in asthma management. EIA consists of bronchial obstruction occurring immediately, or soon after, physical exercise as a result of increased respiratory water and heat loss due to increased ventilation during exercise, with the subsequent release of mediators and stimulation of airways receptors. Diagnosis is best made by standardised exercise tests, preferably running on a treadmill for 6-8 minutes at an exercise load of 95% of maximum. The sensitivity of the test may be increased by cold air inhalation. EIA is best treated by inhaled steroids in addition to pre-treatment before exercise by inhaled beta(2)-agonists, short or long acting, and/or leukotriene antagonists. Physical training may improve physical fitness and quality of life in asthmatic children but baseline lung function and bronchial responsiveness are not improved.
Collapse
Affiliation(s)
- Kai-Håkon Carlsen
- Voksentoppen National Hospital and Research Institute of Asthma, Allergy and Chronic Lung Diseases in Children, Voksentoppen, Ullveien 14, Oslo, Norway
| | | |
Collapse
|