-
[show abstract]
[hide abstract]
ABSTRACT: To assess the diagnostic value of fractional exhaled nitric oxide (FE(NO)) in mild asthma.
Cross-sectional descriptive study in a group of patients with no history of respiratory or allergic illness (control group) and a group of patients with a history of mild asthma with no baseline treatment (asthma group), both aged 6 to 14 years. The following examinations were performed: measurement of FE(NO) using the portable NIOX MINO(®) device, allergy tests and spirometry. Repeatability of paired FE(NO) measurements was estimated with the intraclass correlation coefficient, the repeatability coefficient and the variation coefficient. The diagnostic value was assessed with the sensitivity, specificity, area under the ROC curve and positive likelihood ratio (LR+) for each cut-off point.
Eighty-seven patients were included in the control group and 57 in the asthma group. The mean FE(NO) value was 12.1 ppb (SD 13.5) in the control group and 42.9 ppb (SD 24.5) in asthmatics (P<.001). The intraclass correlation coefficient was 0.98 (95% CI: 0.96-0.99) and of 0.97 (95% CI: 0.92-0.99) in controls and asthmatics, respectively. The repeatability coefficient was 5.5 in controls and 9.2 in asthmatic children, and the median variation coefficient was 8.3% and 6.1%. The optimal cut-off value for FE(NO) was 19 ppb (sensitivity and specificity were 91.4% and 87.2%, respectively). The area under the ROC curve was 0.93 (95% CI: 0.88-0.97) (P<.001) and the LR+ was 7.1. Subclinical sensitisation to pneumoallergens accounted for most false positive cases.
The determination of FE(NO) with NIOX MINO(®) has an adequate repeatability, especially for healthy patients. For asthmatic patients we recommend determining the average of two measurements. The test has a high diagnostic value in mild asthma. Subclinical sensitisation to pneumoallergens can cause the FE(NO) value to rise to pathologic levels.
Anales de Pediatría 06/2011; 75(5):320-8. · 0.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the incidence of wheezing at 6 months of life in the town of Alzira (Valencia, Spain), and to analyse associated risk factors.
We included 636 newborns in a longitudinal birth cohort study between March 2007 and November 2008. Data were collected from hospital and primary care medical records and from questionnaires sent at 6 months post-natal. Bivariate and multivariate Cox regression analysis were performed to examine the risk factors associated with wheezing.
At 6 months, 25.2% of infants had had 1 or more episodes of wheezing, whereas 5.6% had had 3 or more episodes. Emergency visits were reported in 11.6% of the infants, treatment with oral corticosteroids in 6.6% and admission to hospital in 4%. Independent risk factors for wheezing were male sex (relative risk [RR]: 2.1, 95% confidence interval [95% CI]: 1.5 to 2.9), younger gestational age (RR: 1.1, 95% CI: 1.0 to 1.2), season of birth between July and September (RR: 3.5, 95% CI: 2.0 to 5.9) and between October and December (RR: 2.0, 95% CI: 1.1 to 3.6), younger maternal age (RR: 1.0, 95% CI: 1.0 to 1.1), having siblings (RR: 3.1, 95% CI: 2.2 to 4.5), exposure to smoke (RR: 1.4, 95% CI: 12.0 to 2.0) and history of maternal asthma (RR: 1.7, 95% CI: 1.0 to 3.0). Breast feeding for at least 3 months (RR: 0.6, 95% CI: 0.4 to 0.8) and having immigrant parents (RR: 0.6, 95% CI: 0.4 to 0.9) were protective against wheezing.
A high cumulative incidence of wheezing in the first 6 months of life was found in our population, in comparison with data reported in other cohort studies. Estimated risk factors were generally in accordance with those described by other authors. Having siblings and season of birth between July and September were the most important risk factors, reflecting the role of viral infections in the pathogenesis of wheezing in early childhood.
Anales de Pediatría 10/2009; 72(1):19-29. · 0.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our objectives were to determine the prevalence of alterations in lung function among pediatric cancer survivors with known risk factors and to establish clinical and imaging correlations, as well as to establish follow-up criteria.
Cancer survivors diagnosed at the Pediatric Oncology Unit between 1971 and 1997 who fulfilled at least one of the following criteria were eligible: 1) primary lung or thoracic wall neoplasm; 2) lung metastasis at diagnosis or later, or; 3) irradiation of mediastinum and/or lung fields. Assessment included respiratory symptomatology questionnaire, physical examination, forced spirometry, static lung volumes, maximal static respiratory pressures, single breath CO diffusing capacity, pulse oximetry and imaging studies.
Thirty-five (14 females and 21 males) out of 41 survivors were assessed. Mean age at diagnosis, evaluation and follow-up were 9 (1-14), 18 (10-28) and 9 (3-27) years, respectively. The diagnoses included pleuropulmonary blastoma (1), chest wall Ewing's sarcoma (1), Hodgkin's disease (18), nephroblastoma (7), yolk-sac tumor (2), acute leukemia2), non-Hodgkin's lymphoma (1), rhabdomyosarcoma (1), coriocarcinoma of the ovary (1) and osteosarcoma (1). Thirteen patients presented lung metastasis at diagnosis or later. All were administered chemotherapy. Irradiated fields were the mediastinum (dose 20-56 Gy) in 20 cases, the lung (8-30 Gy) in 6 and the spine (24 Gy) in one. Eight underwent thoracotomy. Fourteen percent were dyspneic when walking at the same rate as a person of the same sex and age (grade 2). Twenty percent had a restrictive ventilatory disorder, but none were obstructive. The presence of dyspnea had sensitivity, specificity, positive predictive values and negative predictive value for the diagnosis of restrictive ventilatory disorder of 67%, 96%, 80% and 93%, respectively. Lung irradiation was associated with an increased risk for the development of restrictive disease. Excluding those who received lung irradiation, survivors under 6 years of age at diagnosis obtained lower spirometric values, lung volumes and DLCO values than survivors aged 6 years or older at diagnosis. There were no differences in pulmonary function values between survivors who received mediastinum irradiation and those who did not. The cumulative dose of cyclophosphamide significantly correlated with FVC, FEV1 and FRC. Pulse oximetry values were > or = 95% in all survivors. Maximal static respiratory pressures were within normal limits in all but one survivors whose other pulmonary function results were normal. Thirty-two percent (11 out of 34) had KCO (diffusing capacity adjusted to alveolar volume) values lower than 80% of reference values. Two survivors of nephroblastoma with pulmonary metastasis and who underwent lung irradiation had radiological signs of lung fibrosis.
Pediatric cancer survivors who were administered intensive chemotherapy and/or lung irradiation are eligible for follow-up of lung function. Those diagnosed before 6 years of age and/or with moderate dyspnea are at high risk of having pulmonary restrictive disease. Imaging studies (chest X-ray) have a low sensitivity that prevents their use as a screening method in the follow-up of cancer survivors.
Anales espanoles de pediatria 12/1999; 51(5):505-11.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to assess the clinical status and respiratory function of infants with premature birth-related pulmonary sequelae and their correlation.
We studied 23 patients with a mean postnatal age of 32 weeks. All infants were born prematurely and developed respiratory disease with radiological features of bronchopulmonary dysplasia. The neonatal clinical status and evolution were quantified by using clinical scoring systems described previously. Parameters of tidal flow volume curves were assessed by pneumotachography. Static compliance and resistance of the respiratory system were obtained using the single-breath occlusion technique. Results were compared with reference values available in the medical literature.
Both the neonatal and evolutive clinical status were given a score of moderate severity. Mean values for weight adjusted compliance and resistance and those for respiratory rate and tidal volume were within the normal range. The mean value for time to peak expiratory flow as a ratio of total expiratory time was under the normal range, showing obstructive airway disease. There was a significant correlation (p < 0.05) between the evolutive clinical score and neonatal clinical score (r = 0.48), compliance (r = 0.50) and respiratory rate (r = 0.67).
Measuring pulmonary function is useful in the follow-up of infants with respiratory disease, providing additional information about the clinical findings, evolution of the illness and subsequent outcome. The development of simple and noninvasive methods explains their increasing application to clinical uses and not exclusively research purposes.
Anales espanoles de pediatria 09/1999; 51(2):175-80.
-
Anales espanoles de pediatria 11/1998; 49(4):339-47.
-
[show abstract]
[hide abstract]
ABSTRACT: Objetivos Determinar la incidencia de bronquitis sibilantes (BS) en los primeros 6 meses de vida en la población de Alzira (Valencia) y analizar los factores de riesgo asociados. Métodos Estudio longitudinal prospectivo basado en una cohorte de 636 niños, incluidos consecutivamente entre marzo de 2007 y noviembre de 2008 tras el nacimiento. Revisión de historias clínicas hospitalarias y ambulatorias a los 6 meses de vida y envío de cuestionarios por correo. Análisis bivariante y multivariante de los distintos factores de riesgo registrados mediante regresión de Cox. Resultados A los 6 meses, el 25,2% de los niños había presentado al menos un episodio de BS, y el 5,6% había presentado 3 o más episodios. El 11,6% de los niños recibió atención en urgencias en alguna ocasión, el 6,6% recibió corticoides orales y el 4% precisó ingreso hospitalario. Se comportaron como factores de riesgo independientes de BS el sexo masculino (riesgo relativo [RR]: 2,1; intervalo de confianza [IC] del 95%: 1,5-2,9), la menor edad gestacional (RR: 1,1; IC del 95%: 1,0-1,2), el nacimiento en el tercer trimestre (RR: 3,5; IC del 95%: 2,0-5,9), el cuarto trimestre (RR: 2,0; IC del 95%: 1,1-3,6) del año, la menor edad materna (RR: 0,9; IC del 95%: 1,0-1,1), la existencia de hermanos mayores (RR: 3,1; IC del 95%: 2,2-4,5), la exposición al tabaco (RR: 1,4; IC del 95%: 1,0-2,0) y el antecedente de asma en la madre (RR: 1,7; IC del 95%: 1,0-3,0); lo hicieron como factores protectores la lactancia materna durante un período igual o superior a 3 meses (RR: 0,6; IC del 95%: 0,4-0,8) y el origen inmigrante de los padres (RR: 0,6, IC del 95%: 0,4- 0,9). Conclusiones La incidencia acumulada de BS en los primeros 6 meses de vida en nuestra población es elevada, y supera la descrita en otros estudios. La mayor parte de los factores de riesgo coinciden con los que señalan otros autores. Destacan como más importantes la existencia de hermanos mayores y el nacimiento en el tercer trimestre del año, lo que refleja el importante papel de las infecciones víricas en la patogenia de las BS a estas edades.
Anales españoles de pediatría: Publicación oficial de la Asociación Española de Pediatría (AEP), ISSN 1695-4033, Vol. 72, Nº. 1, 2010, pags. 19-29.
