Konstantinos Douros

National and Kapodistrian University of Athens | uoa · 3rd Dept of Pediatrics, Allergy and Respiratory Unit

Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) is a new CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) modulator treatment, used over the last few years, which has shown an improvement in different clinical outcomes in patients with cystic fibrosis (CF). The objective of this study was a systematic research of the literature on the effi...

Background: Eczema (atopic dermatitis) is a major global public health issue with high prevalence and morbidity. Our goal was to evaluate eczema prevalence over time, using standardized methodology. Methods: The Global Asthma Network (GAN) Phase I study is an international collaborative study arising from the International Study of Asthma and Aller...

Background: The Pediatric Respiratory Assessment Measure (PRAM) score is a useful tool for the assessment of asthma exacerbations in children. This study aimed to estimate the risk of hospitalization in children, assessed with the PRAM score and having mild-moderate asthma exacerbation, who were treated with salbutamol delivered via a metered-dose...

To identify the differences between the RSV and non-RSV bronchiolitis in hospitalized infants in a Greek tertiary pediatric unit and the possible risk factors related to severe forms of the illness. We performed a retrospective cross-sectional data analysis by reviewing medical records of patients that were hospitalized for acute bronchiolitis from...

Background: Lung auscultation is an important tool for diagnosing respiratory diseases. However, the ability of observers to recognize respiratory sounds varies considerably and depends on the sound. The present study aimed to assess the auscultatory skills of health care professionals and medical students. Methods: A total of 295 physicians (18...

Children with chronic wet cough and without cystic fibrosis (non-CF) may suffer from chronic suppurative lung disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one of the offending microbes in these children. The present study aimed to describe the clinical course of children with the above two conditions who were infected with P...

The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Soci...

Cow’s milk allergy (CMA) is the most prevalent food allergy (FA) in infancy and early childhood and can be present with various clinical phenotypes. The significant increase in FA rates recorded in recent decades has been associated with environmental and lifestyle changes that limit microbial exposure in early life and induce changes in gut microb...

Aim: Lung ultrasound (LUS) has not been included in the current guidelines for the diagnosis of bronchiolitis so far, even though data concerning its effectiveness have been published. Methods: A systematic literature review was carried out to determine the role of LUS scores in the diagnosis and prognosis of patients aged 0 to 2 years with bron...

The gastrointestinal digestion of food and further gut microbial activity render a myriad of different molecules that could be responsible for the biological activities that are classically assigned to their parent compounds. This has been previously shown for some phytochemicals whose antioxidant capacity was either increased or decreased after be...

Introduction: The contribution of dietary patterns in the occurrence of atopic diseases, mainly asthma, allergic rhinits, and eczema is ambiguous. Our study examined the association between the level of adherence to the Mediterranean diet (MedDiet) and the prevalence of atopic diseases in adolescence. Methods: A total of 1934 adolescents (boys:...

Branded food composition databases (BFCDs) are valuable information tools that meet multiple user needs. Recently, recognising allergies and intolerances as an emerging concern for various stakeholders, BFCDs evolve to embed information on allergens. This study aims to expand the Greek BFCD, HelTH, to include allergen information for its 4002 produ...

Adult PAP patients experience similar #COVID19 rates to the general population, and high rates of hospitalisation and deaths, underscoring their vulnerability and the need for measures to prevent infection. The impact of iGM-CSF must be considered. https://bit.ly/3M0wKnZ.

Background Bronchiectasis is a cause of increased morbidity of the respiratory system. Exacerbations among patients with non-CF (cystic fibrosis) bronchiectasis result in reduced pulmonary function and poor quality of life. While the role of bacteria in triggering exacerbations in patients with non- CF bronchiectasis has been well studied, little i...

Background Lumacaftor/Ivacaftor (LUM/IVA) is an approved combination therapy for cystic fibrosis (CF) patients homozygous for F508del. Objective This study aimed to detect changes in liver stiffness measurement (LSM) in patients under this treatment. Methods The study population consisted of CF patients homozygous for F508del, 6 to 11 years old,...

Background: Atopic diseases, particularly asthma, eczema, and rhinitis, are among the most common chronic diseases in childhood, with several factors implicated in their pathogenesis. Our study examined the role of parental education in the association between diet, physical activity, and atopy in adolescents. Methods: 1934 adolescents (47.5% bo...

Introduction: The links between allergen exposure and sensitization are complex and depend not only on the type of allergen but on various genetic and environmental factors. Areas covered: This review discusses the link between allergen exposure and atopic sensitization for different types of allergens and the factors that mediate or affect this...

Dietary pattern may potentially impact on the pathogenesis of asthma and allergies. The Mediterranean Diet (MD) has significant health benefits due to its antioxidant and anti-inflammatory properties. The aim of this systematic review was to investigate the effectiveness of adherence to the MD against asthma and allergies in childhood. Hence, a sys...

Objective Asthma is a major contributor to childhood morbidity. Several environmental and socioeconomic status (SES) factors have been implicated in its etiopathogeneses such as indoor moisture and parental education level. Our study examined the association between exposure to indoor dampness and/or mould (IDM) with adolescent asthma and how paren...

Children with chronic wet cough and without cystic fibrosis (non-CF) may suffer from chronic suppurative lung disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one of the offending microbes in these children. The present study aimed to describe the clinical course of children with the above two conditions who were infected with P...

Protracted bacterial bronchitis is a syndrome that is among the most common causes of chronic cough. In order to understand its pathogenetic mechanisms, there is an increasing interest in the study of the immune microenvironment in the bronchial lumen. The aim of this retrospective study is the determination of the types and quantity of the inflamm...

Background Clinical presentations of coronavirus disease 2019 (COVID-19) among children with asthma have rarely been investigated. This study aimed to assess clinical manifestations and outcome of COVID-19 among children with asthma, and whether the use of asthma medications was associated with outcomes of interest. Methods The Global Asthma Netwo...

Objective: Acute viral bronchiolitis (AVB) is one of the most common viral infections and the most common lower respiratory tract infection in the first year of life. Current guidelines recommend that medical history and physical examination have the main role in the diagnosis of AVB. Lung ultrasound (LUS) has not been included in the diagnostic al...

Introduction: Diet and physical activity might be associated with the risk of allergic diseases in childhood. However, evidence in literature is sparse and diverse. We aim to examine the associations between four healthy dietary consumption pattern drinks, plus the adherence to a physically active lifestyle with atopic diseases (asthma, allergic r...

Background Asthma is the most common chronic disease in children globally. The Global Asthma Network (GAN) Phase I study aimed to determine if the worldwide burden of asthma symptoms is changing. Methods This updated cross-sectional study used the same methods as the International study of Asthma and Allergies in Childhood (ISAAC) Phase III. Asthm...

Spirometry is considered the gold standard method for monitoring lung function of patients with cystic fibrosis (CF) but it requires patients’ cooperation and therefore it is not useful for the majority of preschool-aged children. Oscillometry is an alternative modality for lung function monitoring that requires minimal cooperation and can be appli...

Importance Vitamin A (or retinol) has considerable antioxidative and anti-inflammatory attributes and it may have protective effects on the respiratory health of patients with cystic fibrosis (CF). This issue, however, remains controversial. Objective The purpose of the present study was to investigate the relationship between serum retinol levels...

In patients with cystic fibrosis (CF), despite the availability of many different pharmacologic agents, lung function deteriorates and lung disease progresses and leads to hypercapnic respiratory failure in some patients. In such cases, noninvasive ventilation (NIV) seems to be a promising technique that can be used on demand. This review summarize...

Background The timely and appropriate monitoring of pulmonary status is of utmost importance for patients with cystic fibrosis (CF). Computed tomography (CT) has been used in clinical and research settings for tracking lung involvement in CF patients. However, as CT delivers a considerable amount of radiation, its sequential use in CF patients rema...

As the COVID-19 pandemic is still evolving, guidelines on pulmonary function testing that may dynamically adapt to sudden epidemiologic changes are required. This paper presents the recommendations of the Hellenic Pediatric Respiratory Society (HPRS) on pulmonary function testing in children and adolescents during the COVID-19 era. Following an ext...

During the first wave of the coronavirus pandemic in 2020, Greece adopted strict lockdown measures. We aimed to investigate the effects of lockdown and the resultant changes in the standard of care, on the lung function and somatic growth of cystic fibrosis (CF) patients. We analyzed data on body mass index and lung function of 103 CF patients 5.0-...

Background: Evidence suggests that nutritional factors, such as consumption of fruits and vegetables, along with socioeconomic factors such as parental education level, are associated with asthma prevalence. Our study examined the role of parental education in the association between fruit and vegetable consumption and adolescent asthma. Methods:...

Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of d...

Large airway diseases" is being used as an all-encompassing phrase to describe a broad spectrum of pathological entities, which involves the trachea, main, lobar, and segmental bronchi of up to 3 mm diameter. Imaging modalities such as radiography, computed tomography, and magnetic resonance imaging contribute to the identification and diagnosis of...

The rising prevalence in allergies over the last few decades appears to be a global epidemic. Although we still lack a concise, robust model to adequately interpret this phenomenon, the available evidence points to the role of an increasingly urban and westernised lifestyle. This includes vitamin D deficiency, which is due to staying indoors most o...

Ivacaftor (IVA) and lumacaftor (LUM) modulate the cystic fibrosis (CF) transmembrane conductance regulator protein. IVA targets gating defects and LUM improves the conformational stability of the F508del mutation. This combined drug was approved for homozygous F508del CF patients aged 12 years or more in 2015 and was extended to children aged 6‐11...

Meconium ileus (MI) roughly affects 15% of cystic fibrosis (CF) patients. Although the mortality from MI has been eliminated there remain questions regarding its consequences in the prognosis of CF. Τhe aim of this study was to investigate whether CF patients presenting with MI at birth differ in respiratory function and z‐score of body mass index...

The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as “bronchiolitis,...

Objective: Τo investigate the effect of an asthma care educational program for children and adolescents with asthma, on adherence to asthma control treatment and on clinical indices. Methods: Individuals newly diagnosed with asthma, aged 4–16 years, randomized to the intervention and control group. The participants were monitored for 6 weeks. At ba...

Food allergy (FA) is a growing health problem that affects ∼8% of the children worldwide. Although the prevalence of FA is increasing, the underlying genetic mechanisms responsible for the onset of this immune disorder are not yet clarified. Genetic factors seem to play a leading role in the development of FA, though interaction with environmental...

Most patients with cystic fibrosis (CF) need daily fat‐soluble vitamins, but are not always able to achieve the optimal serum levels. The activity of vitamin E is the cumulative function of eight naturally occurring tocopherols. The most potent is alpha‐tocopherol and vitamin E deficiency is diagnosed when the serum concentration of this tocopherol...

Asthma prevalence has been increasing dramatically during the last few decades, mainly in the Western world, and one of the many proposed explanations for this trend is the change in dietary habits. Mediterranean diet (MD) that is based on a high intake of fruits, vegetables, cereals, and olive oil seems to be involved in the reduction of airway in...

Congenital anomalies of the lower airways and lung parenchyma are rare conditions and they encompass a wide spectrum of abnormal developmental disorders. They are due to aberrations during embryological lung development occurring at different stages of intrauterine life. They may present as an acute respiratory failure early in life or they may hav...

Background: The combination of lumacaftor and ivacaftor (LUM/IVA) is a recently approved CFTR modulator treatment for homozygous F508del CF patients. Our study aimed at evaluating the change in the rate of lung function decline after one-year treatment with LUM/IVA. Methods: The study evaluated patients homozygous for F508del, 12 to 23 years old...

Objective: To explore a possible association between the month of birth and the final adult height in men and see if this could be described in terms of periodicity. Materials and methods: We used anthropometric data of 15,109 young male conscripts of the Greek Army. The data were collected from May 2006 until May 2010 and included men who had b...

Background: Vitamin D status is considered a potential determinant of lung function in cystic fibrosis (CF). The aim of this retrospective longitudinal study was to investigate the decline of spirometric values in association with vitamin D status. Methods: The data regarding 25-hydroxy vitamin D (25OHD) serum levels, spirometric measurements (F...

Cystic fibrosis (CF) is an inherited genetic disorder with multiorgan involvement. Gastrointestinal tract dysfunction leads to fat and fat-soluble vitamins (A,D,E,K) malabsorption and deficiency of these vitamins. Subclinical vitamin K (VK) deficiency seems to be a common problem in CF patients. However, despite the rest of fat-soluble vitamins bei...

A sensitive, reproducible and feasible measure of lung function for monitoring the respiratory health is a prerequisite for the optimization of management of the patients with cystic fibrosis (CF). Spirometry has been considered the method of choice, although it is applicable only in children older than 6 years of age, as good cooperation is necess...

Aim Food protein–induced enterocolitis syndrome (FPIES) is a non‐immunoglobulin E (IgE) mediated food allergy, which is confined to the gastrointestinal tract and occurs most frequently in the first year of life. Our aim was to examine the clinical features, causative agents and outcomes of Greek children with FPIES. Methods This was a five‐year (...

We report a rare case of non–cystic fibrosis bronchiectasis accompanied by protracted infection with Aggregatibacter aphrophilus in a 12-year-old boy with haemoptysis.

Background/Aims Tracheomalacia (TM) is not an unusual diagnosis in pediatric respiratory clinics. The aim of this study was to assess the accuracy of paired static end‐inspiratory/end‐expiratory helical multi‐detector CT scan (MDCT) in detecting TM. Methods FB was performed in 28 children suspected of TM on the grounds of presence of recurrent epi...

Introduction: Poor adherence to inhaled medication is a commonly encountered problem among children with asthma. However, there is a relatively paucity of data regarding the adherence of children with severe asthma, as well as the merit of any interventions to improve this adherence. Objectives: The aim of this systematic review was to identify the...

Introduction: There is accumulated evidence supporting a beneficial role of Mediterranean diet (MD) in the control of asthma symptoms. The aim of this study was to investigate the relationships between adherence to MD and serum levels of certain cytokines namely, interleukin (IL)-4, and IL-17 known to have a pathogenetic role in the airway changes...

Overweight and obesity are highly prevalent in developed and developing countries among children and adolescents. During the last two decades, it became evident that excess weight is adversely related to respiratory health in childhood and adolescence mainly in terms of asthma occurrence. Additionally, there is a mounting body of evidence that over...

Crackles are intermittent, nonmusical, and brief adventitious lung sounds that can be heard on inspiration and sometimes during expiration. They are classified as fine or coarse depending on their frequency and duration; fine crackles have high frequency and short duration, whereas coarse crackles have lower frequency and longer duration. They are...

Background: Epidemiological evidence suggests the existence of a direct link between allergic rhinitis (AR) and asthma. Several studies also support the presence of small-airway dysfunction (SAD) in non-asthmatic children with AR. However, it remains unknown whether SAD can predict the progression of AR to asthma. Our objective was to explore the...

The increase in asthma and allergies prevalence that has been recorded in many countries during the last decades, and the reemergence of vitamin D (VD) deficiency in many populations worldwide, renders fairly plausible the assumption of an underlying association between these two conditions and justifies the research effort invented in this issue....

Vocal cord dysfunction (VCD)-associated symptoms are not rare in pediatric patients. Dyspnea, wheezing, stridor, chest pain or tightness and throat discomfort are the most commonly encountered symptoms. They may occur either at rest or more commonly during exercise in patients with VCD, as well as in asthmatic subjects. The phase of respiration (in...

Background and objectives: Maternal prenatal stress (MPS) may result in a range of long-term consequences in the offspring among which is susceptibility to allergic diseases. This review presents the current knowledge on the pathways through which MPS may affect the fetus, and the existing evidence regarding the association between MPS and develop...

Emerging evidence indicate that maternal prenatal stress (MPS) can result in a range of long-term adverse effects in the offspring. The underlying mechanism of MPS is not fully understood. However, its complexity is emphasized by the number of purportedly involved pathways namely, placental deregulated metabolism of maternal steroids, impaired matu...

Bronchiectasis is usually classified as cystic fibrosis (CF) related or CF unrelated (non-CF); the latter is not considered an orphan disease any more, even in developed countries. Irrespective of the underlying etiology, bronchiectasis is the result of interaction between host, pathogens, and environment. Vitamin D is known to be involved in a wid...

The burden of asthma in childhood is considerable worldwide, although some populations are much more affected than others. Many attempts have been made by different investigators to identify the factors that could predict asthma development or persistence in childhood. In this review, the relation between atopic sensitization as an indicator of all...

The worldwide increase in asthma prevalence during the last decades and the re-emergence of vitamin D deficiency in many populations hinted toward an underlying association between these two conditions. Since asthma is presented with high incidence in childhood and neonatal vitamin D stores depend on maternal vitamin levels, a possible programming...

The purpose of this retrospective study is to present the clinical experience of a single institution on the recovery of ABR thresholds in a large population of neonates and infants at risk of hearing loss. Potential prognostic factors associated with this phenomenon were also investigated. Out of 2248 high risk infants, 384 had abnormal ABR at ini...

Food protein-induced proctocolitis (FPIP) is the most common colonic manifestation of food allergy in infants, accounting for up to 60% of exclusively breast-fed children. The causative foods derive from the mother's diet that are then excreted in her milk. The suggested risk factors for the development of FPIP are an immature immune system, altere...

Introduction PBB is defined as chronic wet cough that responds to antibiotics, in the absence of any alternative diagnoses. We aimed to explore the clinical course of the disease after therapeutic interventions. Methods 71 children (M/F 36/35) with PBB, during the 2011-2014 period were studied. Children with CF, humoral immunodeficiency and PCD wer...

Introduction: Child Friendly Healthcare Initiative (CFHI) aims to improve quality of experience and health care given to children and families by improving realisation of children's rights and reducing unnecessary fear, anxiety and suffering during and because of health care. Aim: To present results of preliminary CFH assessment. Methods: Impl...

Introduction: Primary Cilia Dyskinesia (PCD) is a rare, genetically heterogeneous disease that causes chronic pulmonary inflammation and progressive loss of lung function due to the dysfunction of cilia. Aim: To present the Greek experience in development and implementation of standardized operational procedures (SOP) in diagnostic testing of PC...

Cystic fibrosis is the most common life-threatening genetic disorder among Caucasians and, as such, there is immense research interest in various aspects of its pathogenicity. It has been obvious for a long time that the mutated cystic fibrosis transmembrane conductance regulator (CTFR) genes have a wider influence on the pathway of the disease tha...

Background: Primary respiratory syncytial virus (RSV) infections are characterised by high levels of IL-8 and an intense neutrophilia. Little is known about the cytokine responses in secondary infections. Pre-school children experiencing a RSV secondary infections were recruited from the siblings of infants admitted to hospital with RSV acute bron...

NREM sleep is the distinct stage of sleep during which essential brain functions related to neonates' neurodevelopmental outcome, take place. The multisensory environment of Neonatal Intensive Care Unit (NICU) often interrupts or inhibits neonatal NREM affecting its quality and duration. The purpose of this study was to investigate the relation bet...