Restrictive pulmonary dysfunction and its predictors in young patients with β-thalassaemia major

BACKGROUND

Pulmonary dysfunction represents one of the most undervalued and less recognized complications in patients with β-thalassaemia.

OBJECTIVES

The aim of this study was to assess the pattern of pulmonary dysfunction and consequently to investigate possible associated factors that might contribute to lung impairment in young patients with β-thalassaemia major.

METHODS

Fifty-two children and young adults (mean age: 21.33 ± 6.24 years) with β-thalassaemia major on conventional treatment (transfusions and iron chelation therapy) were included in the study. A complete computerized pulmonary function testing (PFT) system for recording pulmonary diffusion capacity and simultaneous determination of alveolar volume and pulmonary volumes was equipped.

RESULTS

Results showed that 20 patients (38.46%) had restrictive pulmonary pattern that was preferentially observed in older and shorter patients. Serum ferritin levels were higher in the restrictive group (2,096 ± 1,831 ng/dl) compared to patients with normal pulmonary function (1,354 ± 942 ng/dl) (P = 0.066). Diffusional impairment characterized by significantly lower DLCO*% values, was observed in the restrictive group (P = 0.004), implicating the 62.5% of the population studied. Paired linear correlations showed that age was negatively correlated to DLCO*% (r = -0.548, P < 0.001) and SaO(2) % (r = -0.789, P < 0.001) and with most of the pulmonary functional parameters that determine a restrictive. Multivariate regression analysis identified age as the major predictor for restrictive pulmonopathy followed by serum ferritin levels.

CONCLUSIONS

Our study shows that pulmonary impairment is shown in a great proportion even among asymptomatic young thalassaemic patients, thus, regular screening of pulmonary function should be adopted in the routine clinical follow up of these patients.

Acute bronchiolitis in a paediatric emergency department of Northern Greece. Comparisons between two decades

INTRODUCTION

Acute bronchiolitis is the most common lower respiratory tract infection in infants and toddlers concerning small bronchi or bronchioli. This retrospective study aimed to evaluate the incidence of acute bronchiolitis and the use of β(2)-agonists between two different decades.

MATERIAL AND METHODS

During 1990-1991 and 2001-2002, the files of the 2(nd) Paediatric Emergency Department of Aristotle University of Thessaloniki, AHEPA Hospital were reviewed and cases of acute bronchiolitis were recorded and analysed.

RESULTS

During 1990-1991, 14 538 children were identified with respiratory infections and bronchiolitis was diagnosed in 519/14 538 children (3.56%). Only 34 out of 519 patients received nebulised salbutamol (6.6%) and 221/519 were hospitalized (42.6%). During 2001-2002, 9001 children were found to have respiratory tract infections and acute bronchiolitis was diagnosed in 641/9001 of them (7.12%). In total, 411/641 children (64.1%) received salbutamol and ipratropium, and 89/641 patients (13.88%) were hospitalized. There was a predominance of male sex in both decades (p = 0.509). There was a statistically significant difference (p < 0.001) concerning the use of nebulised salbutamol with nebulised ipratropium between the two decades. Finally, during 2001-2002, the use of bronchodilators with or without corticosteroids was more frequent and it appears to be correlated with the reduced number of admissions to hospital (p < 0.05) compared with 1990-1991.

CONCLUSIONS

There was an increase in the incidence of acute bronchiolitis during the last decade. The admission rate decreased probably due to the use of nebulized salbutamol and ipratropium, but further multicentre comparative trials are required to define the role of bronchodilators in the treatment of acute bronchiolitis.

Effect of passive smoking on lung function and respiratory infection

OBJECTIVE

To study the effect of environmental tobacco smoke to children's health and more specifically to the development of respiratory tract infections and also its influence to their respiratory function.

METHODS

We studied 586 children from the district of west Thrace in Greece aged 5-14 years, randomly selected from 20 primary and 10 secondary schools in regards their exposure to tobacco smoke, and its possible relation with respiratory tract infections. We assessed respiratory function by spirometry. Epidemiological data were also analysed.

RESULTS

Children who were exposed to environmental tobacco smoke had higher risk for upper and lower respiratory tract infections in comparison to children who lived in a smoke free environment (3 fold and 2 fold, respectively. Their lung function was also reduced with decreased values of FEV1, FEF50, PFR (values p<0.001).

CONCLUSION

Passive smoking has an unfavorable effect in respiratory function of children and predisposes them to respiratory tract infections. Every effort should be undertaken in order to avoid exposure of children to environmental tobacco smoke.

Normal peak nasal inspiratory flow rate values in Greek children and adolescents

BACKGROUND AND AIM

Peak Nasal Inspiratory Flow Rate (PNIFR) is a clinical trial that has been instituted in clinical practice in order to determine the extent of nasal airway patency and it is used to assess the degree of nasal obstruction. This study attempts to provide tables referring to normal values of PNIFR in children and adolescents.

PATIENTS AND METHODS

Three thousand one hundred and seventy pupils aged between 5-18 years, were selected to enter the study. Children with acute or chronic upper airway obstruction, such as acute obstructive pulmonary disease or allergic rhinitis and children below the 3rd percentile for weight and/or height were excluded from the study. All children that took part in the study were subjected to PNIFR measurements by using a portable Youlten Peak Flow meter.

RESULTS

A continuous increase of PNIFR values for boys and girls in relation to age increase was recorded. PNIFR values were higher in boys compared to girls and this difference was statistically significant until the age of 12.

CONCLUSION

Normal ranges for PNIFR standards are of great importance for the study of nasal patency, evaluation of the degree of nasal obstruction and application of treatment. This is the first time that a detailed description of PNIFR standards becomes available for the Greek population of children and adolescents.

Asthma, lung function and sensitization in school children with a history of bronchiolitis

BACKGROUND

The purpose of the present retrospective study was to investigate the association of school-age asthma with acute-bronchiolitis and examine the influence of potential risk factors.

METHODS

One hundred and eighty-nine children aged 7.5 +/- 2.2 years consecutively hospitalized for respiratory syncytial virus (RSV)-positive acute bronchiolitis during infancy were evaluated by clinical examination and measurement of peak expiratory flow (PEFR), spirometry, IgE and skin-prick testing. Their pulmonary function was compared with that of 60 non-asthmatic matched controls.

RESULTS

Of the entire cohort 57.1% were diagnosed as asthmatic. PEFR, the 1-second forced expiratory volume and forced expiratory flow of 50% vital capacity of children with a history of acute bronchiolitis were statistically significantly lower than in the control group (all P < 0.001). All the aforementioned measurements of children with/without asthma were also significantly lower than controls, while values of asthmatics were significantly lower than those of non-asthmatics. The incidence of asthma in childhood was independently associated with breast-feeding <3 months (adjusted odds ratio [aOR], 8.4; 95% confidence interval [CI]: 3.1-22.4), at least one positive skin prick test (aOR, 7.1; 95%CI: 2.8-18.1), male gender (aOR, 5.0; 95%CI: 2.2-11.5), evidence of moisture in the home environment (aOR, 2.9; 95%CI: 1.3-6.3) and presence of more than one house-resident smoking indoors (aOR, 4.9; 95%CI: 1.8-9.2).

CONCLUSION

Children with a history of RSV-bronchiolitis during infancy have an increased risk for developing asthma in childhood, which was independently associated with male gender, breast-feeding <3 months, living in a home environment with moisture damage and/or tobacco smoke by two or more residents and sensitization to at least one aeroallergen. Children with a history of RSV bronchiolitis in infancy had lower spirometry in comparison to matched control group. The difference was more marked for asthmatic ones but remained significant even for non-asthmatic children.

Human neutrophil elastase in RSV bronchiolitis

Acute bronchiolitis is the most common lower respiratory tract infection in young children and may be life-threatening in those with underlying cardiac or respiratory conditions. We evaluated the nasal and serum levels of human neutrophil elastase (HNE) in patients with acute respiratory syncytial virus (RSV) bronchiolitis and investigated the correlation of these levels with illness severity. Fifty-one patients (28 boys, 23 girls) with acute bronchiolitis positive for RSV by direct immunoenzyme assay in nasal secretions (Group A) were studied. Thirty healthy children (17 boys, 13 girls) constituted the control group (Group B). Subjects in both groups were matched for age and gender. The ages (mean+/-SE) in Groups A and B were 4.5+/-0.41 and 5.0+/-0.65 mo, respectively. Venous blood and nasal secretions were taken from patients in group A on 1, 5, and 15 days after admission and once from controls (Group B) for determinations of HNE in nasal lavage and serum, as well as white blood counts (WBC). The peripheral blood eosinophil and neutrophil counts were elevated in 22/51 patients (43.1%) and 15/51 patients (29.4%), respectively. In nasal lavage specimens, neutrophils represented>or=75% and eosinophils>2% of all cells in 42/51 (82.0%) patients and 11/51 (21.5%) patients, respectively. There was strong correlation between the level of HNE and the percentage of neutrophils in nasal lavage (r=0.92). The mean nasal HNE concentrations of the patients on 1, 5, and 15 days after admission were higher than those of Group B (p<0.0001, p<0.001, p<0.001, respectively). Mean serum HNE concentrations on 1, 5, and 15 days after admission were higher in Group A than in Group B (p<0.0001, p<0.0001, p<0.0001, respectively). Nasal and serum HNE concentrations showed no correlations with the clinical score of disease severity (r=0.28 and r=0.29, respectively). This study shows that (a) serum and nasal HNE concentrations were significantly higher in RSV bronchiolitis patients than in controls, (b) they did not return to normal after the respiratory symptoms had improved, and (c) they showed no significant correlations with clinical score of severity. The results indicate that neutrophils contribute significantly to airway inflammation in these subjects and HNE levels in serum and nasal lavage may be useful markers of inflammation in acute RSV bronchiolitis.

Growth and other factors affecting peak expiratory flow in Greek children

AIM

The estimation of peak expiratory flow (PEF) in children is a very easy and practical way to check lung function and helps in the diagnosis, treatment follow-up and evaluation of the development of chronic obstructive pulmonary disease.

METHODS

Using a Mini-Wright flowmeter (Clement Clarke International Ltd, England), we studied the Peak Expiratory Flow (PEF) of 7,067 healthy Greek children of age range 6-17 years. All the children have a height ranging between mean value+/-2 Standard Deviations for age and sex.

RESULTS

The results were correlated with age, weight, height and triceps skinfold thickness. The mean value of PEF was higher in boys than in girls at all ages, except from the age of 12-13 years. Our results have shown a very strong relationship between PEF and age up to the age of 11 years (P<0.005) but we didn't find such a relationship in older children as regards PEF and height (P<0.001). No positive correlation between PEF and weight or between PEF and triceps skinfold, was found (P > or =0.05). Moreover, a considerable difference in PEF values was found in the various groups of every age and sex according to height.

CONCLUSIONS

These results indicate that height should always be considered in order to estimate PEF value. The values of this study (mean and percentiles) were compared to those of other studies. Finally, we recommend that the results of this study should be used as standards for Greek children.

Clinical evaluation and changes of the respiratory epithelium function after administration of Pidotimod in Greek children with recurrent respiratory tract infections

BACKGROUND

Several studies have been conducted on young children with recurrent respiratory infections using several compounds (synthetic derivates or lyophilized bacterial extracts) causing improvement in the clinical process.

METHODS

We conducted a prospective, randomized study comparing the clinical results and the changes of the respiratory epithelium function after the administration of immunostimulating drug (Pidotimod) to children with respiratory infections over a 9 month period. A total of 32 children (group A) were randomly assigned to receive Pidotimod therapy while a second group of 18 children (group B) weren't. All the children in group A received Pidotimod (400 mg x 2 daily) for fifteen days and 400 mg daily for the next twenty days. The proper function of the ciliary respiratory epithelium in all children was checked, using the Edicol Orange and CaH PO4 2H2O, coloring method before the therapeutic intervention and after the first and the sixth month.

RESULTS

87.5% of group A, responded exceptionally well to treatment presenting two or less infections in the nine month period, whereas only 33.3% of group B showed improvement (p<0.001). In group A, the clearance of the respiratory epithelium, from a primary 37 minutes decreased to 32 minutes in the first month and 19'5" six months after the therapy. In group B, the corresponding time was decreased from a primary 36'4" to 34'2" and 31' respectively (p=0.01).

CONCLUSIONS

Our results suggest that Pidotimod therapy is a reliable, simple and safe approach to treat children with recurrent respiratory infections and it can reduce the frequency of such infections as a result of improvement of the ciliary respiratory epithelium.

Ultrastructural study of bronchial epithelium in chronic respiratory diseases

The fine structure of bronchial epithelium in thirty-six patients, thirty-one men and five women, suffering from chronic obstructive pneumonopathy or bronchial carcinoma was studied. No remarkable alterations were found with electron microscopy, in most non-smokers in contrast to the smokers who presented destruction of the epithelial cells and loss of the cilia or many pathological cilia with an abnormal microtubular configuration and irregular orientation. The severity, however, of the alterations was not related to the severity of smoking and to the presence of bronchial cancer.

Arterial blood pressure serum lipids and cardiovascular complications in families of hypertensive children

The arterial blood pressure (B.P.), the cardiovascular complications and the type of hyperlipoproteinemia were studied in 98 families of hypertensive children (group A) and in 100 families of normotensive children (group B). In group A, hypertension was found in 27% of the parents and 47.4% of grandparents, whereas in group B in 7.5% and 22.5% respectively. In siblings of hypertensive children hypertension was found in 13.5% as apposed to 5.4% of those of normotensive children. Cardiovascular complications were recorded in 27.5% in the parents and grandparents of group A and in 12% in group B. Hyperlipoproteinemia with obvious preponderance of type II (IIa, IIb) and IV was found in 58.5% of parents in group A and 21.1% in group B.