Miles Weinberger

Rady Children's Hospital

Two recent publications in Pediatric Pulmonology had methodological limitations in evaluating exercise-induced dyspnea (EID). Testing that does not include concurrence of dyspnea with an abnormality may provide misleading information to the detriment of the patient. Reproducing the patient’s dyspnea during cardiopulmonary monitoring provides the et...

Functional respiratory disorders (FRDs) are those characterized by respiratory symptoms without anatomic or organic etiology. Clinicians caring for children encounter these disorders and should be familiar with diagnosis and treatment. FRDs encompass the habit cough syndrome and its variants, vocal cord dysfunction, hyperventilation disorders, func...

The evaluation of exercise-induced dyspnea (EID) in otherwise healthy children and adolescents is often limited to a specific cause such as exercise-induced asthma or vocal cord dysfunction. However, modest degrees of bronchospasm or vocal cord dysfunction may occur in the absence of dyspnea. Testing that does not include concurrence of dyspnea wit...

Bronchiectasis and other suppurative bronchitic disorders including protracted bacterial bronchitis, primary ciliary dyskinesia and cystic fibrosis are among the important causes of chronic wet cough in children. These suppurative disorders share a common feature of chronic airway inflammation (bronchitis) although the pathogenesis leading to lung...

Cough is a natural process that protects the airway. Cough can occur spontaneously or voluntarily. It is considered chronic when it is present for longer than 4 weeks in children or 8 weeks in adults. In both, chronic cough causes patient distress and increased healthcare utilization. Etiologies of pediatric chronic cough include asthma, protracted...

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in...

Background: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastroi...

Exercise-induced dyspnea in children and adolescents can occur for many reasons. Although asthma is the common cause, failure to prevent exercise-induced asthma by pretreatment with a bronchodilator, such as albuterol, indicates that other etiologies should be considered. Other causes of exercise-induced dyspnea include exercise-induced vocal cord...

Background: There are many nonprescription (over-the-counter [OTC]) medications available on pharmacy shelves marketed for relief of respiratory symptoms. The number of such medications has been increasing. Objective: This review provides an evidence-based examination of OTC products used for respiratory symptoms. Methods: Antihistamines, deco...

Background: Acute bronchiolitis is common in young children and some children develop chronic cough after their bronchiolitis. We thus undertook systematic reviews based on key questions (KQs) using the PICO format. The KQs were: Among children with chronic cough (>4 weeks) after acute viral bronchiolitis, how effective are the following intervent...

We describe a 7-year-old girl with recurrent prolonged periods of coughing since 2 weeks of age. First seen at the University of Iowa Pediatric Pulmonary Clinic at 5 months of age, a flexible bronchoscopy and bronchoalveolar lavage found tracheomalacia (TM) and protracted bacterial bronchitis (PBB). A repeat bronchoscopy at 4 years of age performed...

Background: In children (aged ≤14-years) there is no published systematic review on the etiologies of chronic cough or, the relationship between obstructive sleep apnea (OSA) and chronic cough. We thus undertook systematic reviews based on key questions (KQs) using the PICO format. The KQs were: Among children with chronic (>4 weeks) cough: (1) ar...

Key points: Habit cough is most commonly characterised by a repetitive loud barking cough that persists for prolonged periods.The cough interferes with normal activity and substantially decreases the quality of life.The sine qua non is the total absence of this troublesome cough once asleep.The age distribution ranges from 4 years to late adolesce...

Initially described as hysteria and then Munchausen’s stridor, we now recognise vocal cord dysfunction as several disorders. Exercise-induced and spontaneously occurring phenotypes exist that benefit from different treatments. The former appears to respond to pharmacological pre-treatment with an anticholinergic aerosol; vocal cord training is the...

Background: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews relating to the management of chronic wet cough in children (aged ≤14-years) based on key questions (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2...

Background: Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤14-years) based on key questions using the PICO format. Methods: We used the CHEST...

Asthma includes several different phenotypic disorders. The complexity of defining asthma is addressed. There is potential for both under- and overdiagnosis of asthma. Respiratory disorders frequently misdiagnosed as asthma, essentially pseudo-asthmas, need to be recognized and not treated as asthma.

The article in this issue of Respiratory Care by Burnett et al[1][1] reports that 34 of 80 college athletes had exercise-induced bronchoconstriction (EIB), most in the absence of symptoms. The authors further suggest that these athletes are at risk and that the identification of those with EIB may

Asthma is the leading cause of hospitalization among children. Recognition of inadequate control of asthma stimulated the development of Guidelines by an Expert Panel convened by the National Asthma and Prevention Program of the National Institute of Health. Those Guidelines with several revisions spanning 24 years were well-intentioned but ineffec...

BACKGROUND: Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks' duration) wet or productive cough not related to bronchiectasis: KQ1-How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2-When should they be referre...

Background: We undertook systematic reviews to examine key questions (KQs) related to pediatric chronic wet cough. In children with chronic (>4-weeks) wet/productive cough not related to bronchiectasis; (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2)-when should they be referred fo...

Background: Use of appropriate cough pathways or algorithms may reduce the morbidity of chronic cough, lead to earlier diagnosis of chronic underlying illness and reduce the unnecessary costs and medications. We undertook 3 systematic reviews to examine three related key questions (KQ). In children aged ≤ 14 years with chronic cough (>4 weeks dura...

We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. We followed the CHEST methodological guidelines and the GRADE framework. The Expert Cough Panel based their recommendations on data from the systematic review, patient...

Diffuse panbronchiolitis is a progressive fatal respiratory disease of unknown cause seen predominantly in Southeast Asian adults. We report this condition in a 10-year-old child of Korean birth because of the uncommon presentation at this age and the favorable outcome associated with early diagnosis. Our objective was also to demonstrate the gradu...

Tracheomalacia (TM) occurs in approximately 1 in 2,100 children. Because the trachea develops abnormally in animal models of cystic fibrosis (CF), we hypothesized this may also occur in children with CF, increasing their risk of TM. To examine the prevalence and clinical consequences of TM in children with CF. We studied children with CF born betwe...

Background Chronic idiopathic urticaria, daily hives that last >6 weeks, can be resistant to antihistamines, even when higher than conventional doses are used. Other pharmacologic agents have been associated with inconsistent benefit. Objective We examined the relationship of clinical characteristics and the presence of autoimmune antibodies to an...

A cough is considered chronic when it lasts >4 weeks. Chronic cough can be from a variety of causes. This article provides a structured approach to evaluating the child with chronic cough. Beginning with the disturbing cough that is absent once asleep, consistent with the habit cough syndrome, the diagnostic criteria for 10 causes of chronic cough...

Data on the effects of inhaled corticosteroid (ICS) on linear growth in children <5 years old are limited with conflicting results from existing studies. This study was designed to investigate growth effects of inhaled corticosteroid use in children <5 years of age treated for asthma with ICS administered through a valved holding chamber (VHC). A r...

Mounier-Kuhn syndrome is a rare disorder characterized by tracheobronchomegaly. Most commonly presenting in adults, a broad spectrum of clinical abnormalities has been described. We report a young woman followed since 4 years of age for respiratory symptoms who was eventually found to have tracheobronchomegaly and multiple tracheal diverticulae. Pe...

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Del-Rio-Navarro BE, Espinosa-Rosales FJ, Flenady V, Sienra-Monge JJL. Immunostimulants for preventing respiratory tract infection in children. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004974. DOI: 10.1002/14651858.CD004974.pub2....

Initially described as hysteria and then Munchausen’s stridor, we now recognize vocal cord dysfunction as a functional group of disorders. Exercise and spontaneously occurring phenotypes exist that benefit from different treatments. The former appears to respond to pharmacological pretreatment with an anticholinergic aerosol and the latter may requ...

Involuntary cough without an identi fi ed underlying organic reason has been given various names and recommended treatments. Current experience suggests that "habit cough" best describes this clinical entity and that various forms of suggestion therapy including hypnotic methods are the treatment of choice. Suggestion therapy is effective when it i...

When asthma is not asthma requires first an understanding of what asthma is, how to diagnose it, and what to expect when its treated. Asthma is an exceedingly common disorder manifested by varying degrees of cough, wheeze, and dyspnea. Familiarity with asthma, in contrast to lack of familiarity with the less common disorders described in this revie...

To examine associated findings and clinical outcome in young children with prolonged cough, wheeze, and/or noisy breathing in whom high colony counts of potentially pathogenic bacteria were cultured from bronchoalveolar lavage (BAL) during diagnostic flexible fiberoptic bronchoscopy. This was a retrospective review of all medical records of childre...

Involuntary cough without an identified underlying organic reason has been given various names and recommended treatments. Current experience suggests that "habit cough" best describes this entity. Suggestion therapy in its various forms is the treatment of choice. Successful therapy is directed at demonstrating to the patient that he/she has the a...

Asthma is the most common chronic disease of childhood. Asthma has been a common cause of hospitalization, a major cause of emergency care requirements, and an occasional cause of death.1 Since 1991, extensively distributed guidelines for asthma have been published, revised, and updated at regular intervals.2- 4 Nevertheless, national statistics ha...

Involuntary cough without an identified underlying organic reason has been given various names and recommended treatments. Current experience suggests that "habit cough" best describes this clinical entity and that "suggestion therapy" is the treatment of choice. Suggestion therapy is effective when it is directed at demonstrating to the patients t...

The identification of an autoimmune mechanism for many patients with chronic idiopathic urticaria (CIU) was used as a rational for a controlled clinical trial of cyclosporine for adults with CIU not responsive to usual measures. That randomized placebo controlled clinical trial demonstrated clinical efficacy, acceptable safety, and a suggestion of...

Dyspnea is a complex psychophysiologic sensation that requires intact afferent and efferent pathways for the full perception of the neuromechanical dissociation between the respiratory effort attempted and the work actually accomplished. The sensation is triggered or accentuated by a variety of receptors located in the chest wall, respiratory muscl...

The natural history of a disease is defined as a set of interactive processes that involves the underlying defect, the susceptible individual, and the environment. These three variables influence the global process that results in the human response. The result is persistence of the pathophysiology, recovery, or death [1]. Two sequential phases can...

Two patients with intractable chronic cough were found to have tonsillar tissue impinging on their epiglottis. In both case, tonsillectomy was curative. The observations in these patients are consistent with a previous report indicating chronic cough from the uvula in contact with the epiglottis with cough cessation following uvulectomy.

Asthma is the most common medical diagnosis among hospitalized children. In the USA, asthma has accounted for approximately 15% of nonsurgical admissions to hospital in the pediatric age group. Asthma is also one of the leading causes for emergency care requirements, one of the leading causes for missed school, and a cause for considerable morbidit...

Theophylline has been marketed in many formulations. Fixed-dose combinations with ephedrine have been popular, but synergistic toxicity with only a modest degree of added effect has been demonstrated. The formulation of theophylline with strong bases as so-called ‘salts’ has been inappropriately claimed to improve absorption and/or decrease adverse...