Pediatric Pulmonology (Pediatr Pulmonol )

Publisher: John Wiley and Sons

Description

Pediatric Pulmonology publishes reports on laboratory research and clinical investigations or observations concerning the respiratory system during its entire development from the fetal stage throughout childhood and adolescence.

  • Impact factor
    2.38
  • 5-year impact
    2.18
  • Cited half-life
    7.40
  • Immediacy index
    0.57
  • Eigenfactor
    0.01
  • Article influence
    0.73
  • Website
    Pediatric Pulmonology website
  • Other titles
    Pediatric pulmonology (Online), Pediatric pulmonology
  • ISSN
    1099-0496
  • OCLC
    39030100
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

John Wiley and Sons

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    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
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    • See Wiley-Blackwell entry for articles after February 2007
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    • Deposit in institutional repositories is not allowed
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    • Non-commercial
    • Pre-print must be accompanied with set phrase (see individual journal copyright transfer agreements)
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    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'John Wiley and Sons' is an imprint of 'Wiley'
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aerosol drug delivery via high flow nasal cannula (HFNC), bubble continuous positive airway pressure (CPAP), and synchronized inspiratory positive airway pressure (SiPAP) has not been quantified in spontaneously breathing premature infants. Objectives: The purpose of this study was to compare aerosol delivery via HFNC, bubble CPAP, and SiPAP in a model of a simulated spontaneously breathing preterm infant. Working hypothesis: The types of CPAP systems and nebulizer positions used during aerosol therapy will impact aerosol deposition in simulated spontaneously breathing infants. Study design: Quantitative, comparative, in-vitro study. Methodology: A breath simulator was set to preterm infant settings (VT : 9 ml, RR: 50 bpm and Ti: 0.5 sec) and connected to the trachea of an anatomical upper airway model of a preterm infant via collecting filter distal to the trachea. The HFNC (Optiflow; Fisher & Paykel), Bubble CPAP (Fisher & Paykel), and SiPAP (Carefusion) were attached to the nares of the model via each device's proprietary nasal cannula and set to deliver a baseline of 5 cm H2 O pressure. Albuterol sulfate (2.5 mg/0.5 ml) was aerosolized with a mesh nebulizer (Aeroneb Solo) positioned(1) proximal to the patient and(2) prior to the humidifier (n = 5). The drug was eluted from the filter with 0.1 N HCl and analyzed via spectrophotometry (276 nm). Data were analyzed using descriptive statistics, t-tests, and one-way analysis of variance (ANOVA), with P < 0.05 significant. Results: At position 1, the trend of lower deposition (mean ± SD%) across devices was not significant (0.90 ± 0.26, 0.70 ± 0.16 and 0.59 ± 0.19, respectively; P = 0.098); however, in position 2, drug delivery with SiPAP (0.79 ± 0.11) was lower compared to both HFNC (1.30 ± 0.17; P = 0.003) and bubble CPAP (1.24 ± 0.24; p = 0.008). Placement of the nebulizer prior to the humidifier increased deposition with all devices (P < 0.05). Conclusions: Aerosol can be delivered via all three devices used in this study. Device selection and nebulizer position impacted aerosol delivery in this simulated model of a spontaneously breathing preterm infant. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: To determine the prevalence of main inspiratory asynchrony events during non-invasive intermittent positive-pressure ventilation (NIV) for severe bronchiolitis. Ventilator response time and asynchrony were compared in neurally adjusted ventilator assist (NAVA) and in pressure assist/control (PAC) modes. This prospective physiological study was performed in a university hospital's paediatric intensive care unit and included 11 children (aged 35.2 ± 23 days) with respiratory syncytial virus bronchiolitis with failure of nCPAP. Patients received NIV for 2 hr in PAC mode followed by 2 hr in NAVA mode. Electrical activity of the diaphragm and pressure curves were recorded for 10 min. Trigger delay, main asynchronies (auto-triggering, double triggering, or non-triggered breaths) were analyzed, and the asynchrony index was calculated for each period. The asynchrony index was lower during NAVA than during PAC (3 ± 3% vs. 38 ± 21%, P < 0.0001), and the trigger delay was shorter (43.9 ± 7.2 vs. 116.0 ± 38.9 ms, P < 0.0001). Ineffective efforts were significantly less frequent in NAVA mode (0.54 ± 1.5 vs. 21.8 ± 16.5 events/min, P = 0.01). Patient respiratory rates were similar, but the ventilator rate was higher in NAVA than in PAC mode (59.5 ± 17.9 vs. 49.8 ± 8.5/min, P = 0.03). The TcPCO2 baselines values (64 ± 12 mmHg vs. 62 ± 9 mmHg during NAVA, P = 0.30) were the same and their evolution over the 2 hr study period (-6 ± 10 mmHg vs. -12 ± 17 mmHg during NAVA, P = 0.36) did not differ. Patient-ventilator inspiratory asynchronies and trigger delay were dramatically lower in NAVA mode than in PAC mode during NIV in infants with severe bronchiolitis. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: This study aimed to assess the effectiveness of the Lung Flute in obtaining a sputum sample from children with cystic fibrosis (CF) that were not productive of sputum with coughing alone. Children attending an outpatient CF clinic who were not able to provide a sample with coughing alone were eligible. Each child used the Lung Flute on two occasions at least one month apart. The primary outcome was expectoration of a sputum sample. Secondary outcomes were sputum microbiology, time taken for the procedure, and ease of use of the device as assessed by the patient using a visual analogue scale (VAS), with 0/10 representing very easy and 10/10 representing very hard. Twenty-five children participated (15 males, mean age 12.7 range 6.5-17.9). Overall, a sputum sample was obtained on 26/50 (52%) uses of the device. In children that presented with a moist cough, a sample was obtained on 17/17 (100%) occasions, compared to 9/33 (27%) occasions when a child presented with a dry cough. A positive culture result for at least one known CF pathogen was found in 24/26 samples. Culture results from obtained samples resulted in management changes in 12 cases. Mean time taken to obtain a sample was 9.8 min (SD 2.2). Mean ease of use on the VAS was 1.5 (SD 1.6). Conclusion: The lung flute appears to be a clinically useful and easy device for sputum induction in children with CF. Further research comparing its effectiveness to other sputum induction methods is warranted. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Rationale: While infants who are born extremely premature and develop bronchopulmonary dysplasia (BPD) have impaired alveolar development and decreased pulmonary diffusion (DLCO ), it remains unclear whether infants born less premature and do not develop BPD, healthy premature (HP), have impaired parenchymal development. In addition, there is increasing evidence that pro-angiogenic cells are important for vascular development; however, there is little information on the relationship of pro-angiogenic cells to lung growth and development in infants. and Methods Determine among healthy premature (HP) and fullterm (FT) infants, whether DLCO and alveolar volume (VA ) are related to gestational age at birth (GA), respiratory support during the neonatal period (mechanical ventilation [MV], supplemental oxygen [O2 ], continuous positive airway pressure [CPAP]), and pro-angiogenic circulating hematopoietic stem/progenitor cells (CHSPCs). We measured DLCO , VA , and CHSPCs in infants between 3-33 months corrected-ages; HP (mean GA = 31.7 wks; N = 48,) and FT (mean GA = 39.3 wks; N = 88). DLCO was significantly higher in HP than FT subjects, while there was no difference in VA , after adjusting for body length, gender, and race. DLCO and VA were not associated with GA, MV and O2 ; however, higher values were associated with higher CHSPCs, as well as treatment with CPAP. Our findings suggest that in the absence of extreme premature birth, as well as BPD, prematurity per se, does not impair lung parenchymal development. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Objective To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program.Study designOne-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit).ResultsOverall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054).Conclusions There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Background Tracheal follicular pattern or so-called tracheal cobblestoning is a poorly described entity in the literature and is depicted as a nodular or lumpy appearance of the tracheal wall mucosa suggesting tracheal irritation from factors like gastro-esophageal reflux (GERD) or pulmonary infection. The aim of the present study was to investigate the prevalence and characteristics of tracheal cobblestones in a large pediatric population.MethodsA large database of rigid tracheoscopies recorded in children (0–6 years of age) undergoing general anesthesia with planned tracheal intubation for elective surgical procedures was retrospectively analyzed. Tracheoscopy records were reviewed by five pediatric airway experts (authors 3–7). Data were compared using the Mann–Whitney test, chi-square or Fisher exact test as appropriate (P < 0.05).ResultsA total of 971 rigid tracheoscopy records were analyzed. The median age of the patients was 3.3 years (range 0.4–6.0 yrs). Cobblestones were present in 377 out of 971 patients (38.8%) with a male to female prevalence of 254 (40.6%)/123 (35.5%). None of the children under four months of age showed the presence of cobblestones. The prevalence of cobblestones was significantly less in patients under 3 years of age compared to over 3 years (P < 0.01). There was no association between prevalence of cobblestones and GERD, current or recent respiratory infection or concomitant enlarged tonsils.Conclusion The prevalence of tracheal cobblestones in otherwise healthy children is high and is not associated with GERD or respiratory infection. The gender and age related differences are novel interesting findings that require further investigations. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Children with severe neurological impairment (NI) are at risk for recurrent respiratory illness with risk for associated distressing respiratory symptoms as respiratory exacerbations become more frequent. Evidence for treating dyspnea in adults with severe pulmonary disease offers interventions for consideration, including morphine sulfate. This case series of four individuals with severe NI reviews the benefit from morphine for respiratory distress. Information includes descriptors of distress, starting dose, and dose increases. This is the first report to review the use of morphine for the treatment of dyspnea in nonverbal children with severe impairment of the central nervous system. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Objectives To determine the prevalence of sleep-disordered breathing (SDB) in children with asthma compared to non-asthmatic children and to determine if behavior problems are associated with asthma and SDB.Study DesignCross-Sectional.Methods Parents of 263 children with asthma and 266 controls ages 2 to 15 years attending routine pediatric office visits completed the Pediatric Sleep Questionnaire (PSQ) and the Child Behavior Checklist. Asthma severity was classified based on NIH guidelines.ResultsThe prevalence of snoring was significantly higher in asthmatic children (35.5%) than controls (15.7%) and the prevalence of a positive PSQ was significantly higher in asthmatic children (25.9%) than controls (10.6%) (P < 0.001 for both). The effect of asthma was “dose-dependent“ as children with more severe asthma had increased odds ratios for snoring and a positive PSQ. On multivariate analysis, there were significant interactions of gender with asthma and age with gender. A positive modified PSQ along with measures of socioeconomic status and age were the only independent predictors of abnormal Child Behavior Checklist scores and score classifications.Conclusions There was a higher prevalence of SDB in asthmatic children compared to non-asthmatic children and the prevalence of SDB increased with increasing asthma severity. In multivariate analysis the role of asthma was much less clear as it predicted a positive PSQ in girls but not boys. SDB, but not asthma, was an independent predictor of behavioral problems. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Background Antibiotic treatment of cystic fibrosis pulmonary exacerbations is inconsistent. Previous research has indicated that intravenous antibiotics are used more frequently at sites with better pulmonary function but it is not clear under what circumstances they are prescribed.Method Pediatric care sites enrolled in the Epidemiologic Study of Cystic Fibrosis were ranked by median FEV1 % predicted of children they followed. Reported presence of new signs and symptoms of a pulmonary exacerbation (PEx) and antibiotic treatment within 21 days were compared between those in the highest vs. those in the other quartiles, and adjusted for sociodemographic and clinical characteristics of patients.ResultHighest quartile sites had a total of 2,454 children eligible for this analysis; lower quartile sites had a total of 5,487. The odds of having a PEx at highest vs. lower sites varied with how the PEx was defined, but high quartile sites were uniformly more likely to treat PEx with antibiotics. The adjusted odds ratio for treatment with any antibiotics of a PEx defined by the occurrence of one or two new signs and symptoms was 1.24 (95% CI 1.10, 1.40); for treatment of a PEx defined by the occurrence of three or four new signs and symptoms was 1.50 (95% CI 1.06, 2.11); and for treatment of a PEx defined by a drop of FEV1 by ≥–15% was 1.33 (1.10, 1.60). The adjusted OR for treatment of these PEx with IV antibiotics was 1.11 (0.94, 1.32), 1.90 (1.32, 2.72), and 1.33 (1.10, 1.60), respectively.ConclusionESCF care sites in the highest quartile for FEV1 were more likely to prescribe antibiotics when patients present with either mild or overt evidence of PEx. While this may not be the only reason that their patients have superior median FEV1, it is likely an important contributor. Pediatr Pulmonol. 2014; 9999:1–9. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Hydroxychloroquine (HCQ) is one of the drugs frequently used for the treatment of interstitial lung disease (ILD) in children (chILD). This use is off-label and studies to analyze the effect and safety of HCQ in chILD are lacking. Therefore, a literature research on the usage of chloroquine (CQ) and HCQ in these conditions was done.Eighty-five case reports and small series in the period from 1984 to 2013 were identified in which children with different diagnoses of ILD were treated with CQ or HCQ, sometimes in combination with other medication including steroids. A favorable response to HCQ or CQ was reported in 35 cases, whereas in the other cases the effect was negative or not clear. The dose of HCQ used was between 5 and 10 mg/kg body weight/day (bw/d). No pharmacokinetic studies have been done.The side effect profile in children seemed to be similar to that in adults. Most often gastrointestinal symptoms were reported. Three patients were found developing retinal changes during the treatment with CQ, whereas in none of the patients treated with HCQ retinal changes were reported.Based on retrospective case reports and small series likely to be reported with bias, the use of HCQ in chILD might be classified as safe. As no prospective data on efficacy and safety of HCQ in chILD are available, systematic collection is necessary. This may be achieved by web-based registers like the European Management Platform for Childhood Interstitial Lung Diseases. Prospective and controlled investigations of HCQ in patients with chILD are mandatory. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2014;
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    ABSTRACT: Recent guidance has suggested that immunoprophylaxis with monoclonal antibody against respiratory syncytial virus (RSV) should be extended to ex-preterm infants who are moderate-to-late-preterm and discharged home during the RSV season. Noninvasive respiratory support (NIV) for infants with bronchiolitis is becoming widespread with little supporting evidence for efficacy over nonpressure support methods. We used multicentre prospective audit and service evaluation to evaluate whether extension of current practice in line with the guidance would provide a clinical or cost benefit, and whether NIV provides any benefits in the ex-preterm population. The prevalence of bronchiolitic illness requiring admission in our population was similar to other studies (2.5%). We found that the majority of ex-preterm infants with RSV positive bronchiolitis who required NIV did not meet the extended criteria for immunisation. Our data suggest that extending RSV prophylaxis as recommended would be unlikely to reduce numbers of infants requiring respiratory support for RSV. NIV use has been widely adopted (9% of 'bronchiolitic' admissions) in our region but the data do not support it as a useful adjunct for ex-preterms with RSV positive illness requiring respiratory support: it does not appear to reduce the need for subsequent formal ventilation. Our study does not support a case for change to more widespread, protocol driven immunisation for RSV. Further research is needed in a randomised, controlled setting to examine the use of NIV in bronchiolitis in a wider context. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: Background The nutritional status of patients with cystic fibrosis (CF) is strongly associated with pulmonary function, respiratory status and survival. Malnutrition could result from a discrepancy between energy needs and food intake while malabsorption results from pancreatic insufficiency which occurs in 85% of people with CF.MethodsA quality improvement (QI) project was designed to improve the nutritional status of patients with CF with low Body Mass Index (BMI) between 3 and 19 years of age. An algorithm was developed which included clinic-based assessments of patients' nutritional status and periodic assessment by a dietitian, social worker and/or psychologist during the project. Gastrostomy tube placement and feeding was offered as a last resort to improve caloric intake.Results173 patients seen during January–June, 2010, were included in this project. They were classified into four BMI groups and data were collected quarterly through June, 2012. The project target population (BMI percentile ≤24) had a median BMI percentile at the start of the project of 11.8. At the end of the project median BMI percentile was 22 (46% improvement).Conclusion Improving nutrition and BMI for patients with CF is achievable. There must be a motivated, multi-disciplinary team that includes patients and families. A patient-specific combination of interventions must be used. These interventions could be quite basic for patients with BMI percentile ≥25, yet more elaborate for patients with BMI percentile <25. Clinic-based algorithms such as ours can successfully improve the BMI percentile in patients with CF. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: Background Evidence suggests infection is present in the lower airways of young children with cystic fibrosis (CF), even when clinically stable. Oropharyngeal samples (OPS) are typically used for airway surveillance in these children but have been shown to have low positive predictive values and low sensitivity in detecting lower airway infection when compared with the reference standard, bronchoalveolar lavage (BAL).Methods The aim of this study was to determine the prevalence of pathogens in lower airway samples detected as part of a pilot clinical BAL surveillance programme, in young children aged from one to six years old, and to ascertain if their detection resulted in a change in treatment.ResultsDuring the study 78 bronchoscopies were performed on 38 patients. The average age at the time of bronchoscopy was 2.7 years (range 0.3–7.0 year). A significant organism was detected in 58 (74.5%) BALs. Haemophilus influenzae was detected in 27 (34.6%) samples, 16 (20.5%) samples had Staphylococcus aureus, and nine (11.5%) had Pseudomonas aeruginosa. Change in treatment occurred after 46 (58.9%) BALs.Conclusions This study suggests that, in young non-expectorating children with CF, routine surveillance bronchoscopy allows the detection of significant lower airway pathogens and provides the opportunity for targeted treatment of sub-clinical infection. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: IntroductionBronchopulmonary dysplasia (BPD) is the primary respiratory complication of premature birth. Some preterm newborns develop chronic respiratory failure, requiring home ventilator support. While physiologic measures have been described for prematurely born children, little is known about spirometric indices in patients with severe BPD who were previously ventilator dependent at home.Methods We retrospectively reviewed medical charts of patients with severe BPD who were ventilator dependent at home. We excluded patients with other comorbidities that could contribute to the severity of BPD. Spirometry was performed when the patient was able to follow commands.ResultsBetween 1984 and 2012, within our severe BPD cohort who previously required home ventilator support, 19 patients were able to perform reproducible spirometry meeting ATS/ERS acceptability criteria. Ten (52.6%) were females, 13 (68.4%) were Caucasians. Mean age at liberation from ventilation was 2.4 years (C.I. 2.0, 2.9) and at decannulation was 3.5 years (C.I. 2.9, 4.0); median age at first reproducible spirometry measurement was 6.6 years (IQR: 4.9, 8.3). Spirometry results revealed significant airway obstruction, as demonstrated by Z-scores values of −1.5 (C.I. −2.5, −0.4) for FVC, −2.7 (C.I. −3.3, −1.9) for FEV1, and −3.6 (C.I. −4.3, −2.9) for FEF25–75. More so, serial spirometric measurements' slopes revealed that the airway obstruction remained static over time (FEV1 slope: −0.07, P-value: 0.2624; FVC slope: −0.01, P-value: 0.9064; and FEF25–75: 0.0, P-value: 0.8532).Conclusions Extreme prematurity associated with severe BPD requiring home ventilator support carries significant risks of morbidity. These patients had substantially diminished respiratory function reflecting airflow abnormalities that remained static over time. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: Background The forced oscillation technique (FOT) may be affected by the upper airway artifact in children with airway obstruction. The aim was to test the impact of the artifact on FOT ability to diagnose asthma in children as recommended by current guidelines. Methods: The FOT was performed in 58 asthmatics and 27 controls before and after salbutamol. Respiratory resistance (Rrs) was measured at 8 Hz with a standard generator (SG), and a head generator (HG) that minimizes the upper airway artifact. The response to salbutamol was computed as change in respiratory resistance (Δ%Rrs) and admittance (Δ%Ars) that almost cancels the effect of the upper airway artifact. Results: Rrs and Δ%Rrs were significantly larger in patients than controls by HG (respectively P < 0.001 and P = 0.002) but not SG, while Δ%Ars was larger in asthma than control by both (P < 0.04). Best discriminators between patients and controls were Rrs or Δ%Rrs by HG and Δ%Ars by SG. Conclusion: In asthmatic children, the upper airway artifact significantly impacts FOT measurements. The diagnostic value may be improved by minimization of the shunt, such as the computation of Δ%Ars. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: RATIONALEAs there are no evidence based guidelines for the diagnosis and/or management of pulmonary nodules in children, there is an over reliance on the adult based algorithms when dealing with pulmonary nodules in children. We present our experience of pediatric patients evaluated for incidentally found pulmonary nodules.METHODS Retrospective chart review of patients diagnosed with a pulmonary nodule and evaluated at Goryeb Children's Hospital between January 2000 and December 2012. Primary outcome: change in the size of the pulmonary nodule between the initial and follow-up imaging.RESULTSThirty six patients with pulmonary nodule (21 male/15 female; Median [range] age 15 [5–20] years.) were included in the study. Chest CT was obtained for respiratory symptoms and/or abnormal chest radiograph in 19 (52%). Nine pulmonary nodules (25%) were identified on abdominal CT obtained for abdominal symptoms. A total of 46 nodules were identified in 36 patients. Nine of the pulmonary nodules (9 patients) were ≤4 mm in size, 37 of the pulmonary nodules (27 patients) were >4 mm in size. Twenty-two of the 27 (81%) patients with nodule size >4 mm had follow-up CT: 14 nodules (54%) remained unchanged in size, 5 nodules (19%) decreased in size, and 7 nodules (27%) were not detected.CONCLUSION Our review of 36 patients with pulmonary nodules shows no obvious growth of the nodules over the study period, suggesting low risk of malignancy. Routine follow-up chest computer tomography using ACCP/Fleischner Society guidelines may not apply in children without known malignancy. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: Panting majors turbulent flow and contribution of larger airways to the measurement of specific airway resistance (sRaw). The hypothesis was tested that the difference between asthmatic and healthy children is enhanced by narrowing the flow interval to compute sRaw.sRaw was measured during panting in 40 asthmatic and 25 healthy children and computed using all data points (full scale flow) and limited to the flow intervals ± 1L/sec and ± 0.5 L/sec. sRaw was not different between asthmatics (0.87 ± 0.20 kPa.s) and controls (0.80 ± 0.25 kPa.s) when computed full scale, while it was significantly larger in asthmatics than controls within ± 1L/sec (0.77 ± 0.16 kPa.s vs 0.65 ± 0.15 kPa.s, P < 0.004) or ± 0.5 L/sec (0.77 ± 0.21 kPa.s vs 0.61 ± 0.17 kPa.s, P < 0.002). On the other hand, the within subject coefficient of variation was significantly larger when sRaw was computed within ± 1L/sec (13.7 ± 7.2%) or ± 0.5 L/sec (28.3 ± 18.1%) than full scale (11.0 ± 6.7%), respectively P < 0.002 and P < 0.0001.It is concluded that narrowing the flow interval to compute sRaw is associated with better discrimination between asthma and health in children, although the short term variability of sRaw is increased. Pediatr Pulmonol. 2014;9999:1–6. ©2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: Background The concavity of the descending limb of the maximum expiratory flow-volume loop (MEFVL) is the earliest change associated with airflow obstruction in small airways (ATS/ERS Task Force). The shape of the MEFVL changes with age but there are no reference values for shape indices for preschool and school children. Objectives: To define pediatric reference values for spirometric data and 3 shape indices of MEFVL: 2 geometric indices: the β angle i.e., the angle between the first ½ part and the 2nd part of the MEFVL and the forced expiratory flow after 50% of the forced vital capacity (FVC) has been exhaled/peak expiratory flow (FEF50/PEF) ratio; and a ratio that describes relative growth between airway and lung parenchyma, the forced expiratory flow between 25 and 75% of FVC/FVC ratio (FEF25–75/FVC ratio). Methods: Data were obtained from 446 Caucasian children (2.5 to 15-year-old). The lambda, mu, sigma method was applied. Results: References for spirometric parameters and 3 shape indices. The geometric indices decreased with age from 3 years of age (mean β angle was 215° and FEF50/PEF ratio was 0.82) until 8 years of age (mean β angle was 191° and FEF50/PEF ratio was 0.60) and then remained constant. The FEF25–75/FVC ratio also decreased with age. Sex was a significant determinant for FEF25–75/FVC ratio predicted values. Conclusions: This study provides standard reference equations for indices of mid-expiratory flows in children and we suggest using the FEF50/PEF index. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 11/2014;
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    ABSTRACT: Background Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is demonstrating promise as an inflammatory biomarker of acute infection in various pulmonary conditions; including community acquired pneumonia, ventilator associated pneumonia and non-tuberculous mycobacterial infection.IntroductionThe expression of sTREM-1 has been poorly studied in all forms of bronchiectasis, both in the context of cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis.Method: Induced sputum samples were collected for sTREM-1 determination in children with HIV-associated bronchiectasis and CF-bronchiectasis. The presence or absence of an exacerbation was noted at study entry. Lung function parameters (FEV1, FVC, FEV1/FVC, FEF25–75) were measured using the Viasys SpiroPro Jaeger Spirometer (Hoechberg, Germany).Result: A total of twenty-six children with HIV-associated bronchiectasis and seventeen with CF were included. With respect to sTREM-1, the levels were readily detected in both groups, but were significantly higher in children with HIV-associated bronchiectasis (1244.0 pg/ml (iqr 194.5; 3755.3 pg/ml) and 204.9 pg/ml (iqr 66.9; 653.6 pg/ml) P = 0.003. There was a positive correlation between sTREM-1 and IL-8 as well as sputum neutrophil elastase in the HIV-bronchiectasis group (r = 0.715 and r = 0.630), respectively both P < 0.005. sTREM-1 was not further increased in subjects presenting with an acute pulmonary exacerbation in the HIV-associated bronchiectasis and in CF participants (P = 0.971 and P = 0.481), respectively. In the CF group sTREM-1 strongly correlated with FVC% predicted and FEV1% predicted (r = 0.950 and r = 0.954), both P < 0.005.Conclusion The pulmonary innate immune functions are over-active in HIV-associated bronchiectasis, with readily detected sTREM-1 values, which were higher than those in CF. sTREM-1 does not correlate with markers of HIV-disease activity but does correlate with markers of neutrophilic inflammation. In CF sTREM-1 has a negative correlation with pulmonary function parameters. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 10/2014;