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Background: Structured light plethysmography (SLP) is a novel light-based method that captures chest wall movements to evaluate tidal breathing. Methods: Thirty-two children who underwent lung surgery were enrolled. Their clinical history was collected along with spirometry and SLP. Results: Median age of surgery was 9 months (interquartile range 4–30). Most frequent diagnosis was congenital pulmonary airway malformation (14/32), then pulmonary sequestration (9/32), tumor (5/32), and bronchogenic cyst (4/32). The most frequent surgical approach was lobectomy (59%), segmentectomy (38%), and complete resection (3%). More than 80% had surgery when younger than 3 years of age. Eight patients had short-term complications (pleural effusion was the most frequent), while long-term effects were reported in 15 patients (19% recurrent cough, 13% thoracic deformities, 13% airway infections, 9% wheezing, 6% reduced exercise tolerance, and 3% columnar deformities). Spirometry was normal in 9/22 patients. Nine patients had a restrictive pattern, while 4 showed a mild bronco-reactivity. Ten patients did not perform spirometry because of young age. SLP revealed the presence of obstructive pattern in 10% of patients (IE50 > 1.88) and showed a significant difference between the two hemithorax in 29% of patients. Discussion: SLP may be a new method to evaluate lung function, without collaboration and radiation exposure, in children who underwent lung resection, also in preschool age. [ABSTRACT FROM AUTHOR]

Background: Evidence has demonstrated that adding intermittent inhaled corticosteroids (ICS) to treatment with short-acting b2-agonists (SABAs) in children 5 years of age and younger who experience intermittent viral-induced wheezing (VIW) reduces the risk of severe exacerbations. However, there is concern about whether the extra benefit offered by this drug outweighs the additional cost. This study aimed to evaluate the cost-effectiveness of intermittent ICS in children 5 years of age and younger who experience intermittent VIW. Methods: We constructed a probabilistic Markov model to estimate the cost and quality-adjusted life-years (QALYs) of intermittent ICS compared with SABA reliever therapy in preschoolers with viral-triggered wheezing in Colombia. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $5,180. Results: In an analysis of the Markov cohort model, we estimated a gain of 0.2 QALYs per patient per year on intermittent ICS compared with SABA and a reduction of cost per patient of USD $37 per year. This position of dominance negated the need to calculate an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses, our base case results were robust to variations of all assumptions and parameters. Conclusion: Adding intermittent ICS to treatment with SABAs in children 5 years of age and younger who experience intermittent VIW was found to be cost effective. These results could improve the use of health care resources, especially in settings with limited economic resources. [ABSTRACT FROM AUTHOR]

Background: Cow's milk is one of the most common of the foods that cause food allergies in children. Here, we present a 10-month-old male who was diagnosed with having an allergy to cow's milk and who developed an anaphylactic reaction after being recently vaccinated with a measles vaccine. Case: The patient had been diagnosed with atopic dermatitis and cow's milk allergy at 40 days old after a rash appeared on his face and arms while exclusively breastfeeding. At 9 months, on his routine welfare outpatient appointment, he developed a facial rash and swelling, wheezing, difficulty breathing, and cyanosis within 10 min of having his first measles vaccination (M-VAC®; Serum Institute of India, Hadapsar, Pune, India). After an allergy evaluation and a physical examination that showed that he was otherwise healthy, he was diagnosed with an allergy to cow's milk, which was then eliminated from his diet. Laboratory evaluations were as follows: serum immunoglobulin E (IgE) to cow's milk: 36.2 kU/L, α-lactalbumin: 9.39 kU/L, β-lactoglobulin: 8.74 kU/L, casein: 34.2 kU/L, latex-specific (sp)IgE: 0.10 kU/L, gelatin spIgE: <0.35 kU/L (normal levels <0.35 kU/L; Pharmacia, Uppsala, Sweden). Results revealed lactalbumin hydrolysate as one of the M-VAC ingredients according to the manufacturer's package insert. Conclusion: In most cases with a cow's milk allergy, vaccines are administered without any problems because the amount of milk proteins contained in the vaccines is not sufficient to represent a risk factor for anaphylaxis; however, the vaccine content should be examined for possible allergens, particularly for children with food allergies, before vaccinating. We should keep in mind when determining the agent responsible for an allergic reaction that the risk from a residual component of milk protein in vaccines can differ according to the nutritional habits of the population. [ABSTRACT FROM AUTHOR]

Background: Recurrent wheeze (RW) is frequent in preschool children. Wheezing phenotypes, asthma predictive index (API), and modified API (mAPI) have been described for clinical purposes. Our aim was to examine whether inflammatory markers including serum angiopoietin (Ang)-1, Ang-2, and periostin levels differ according to wheezing phenotypes and mAPI. Materials and Methods: Ninety-eight children who were <4 years of age with history of at least 4 episodes of wheezing during the past 12 months and 51 age-matched healthy controls were included in the study. Children with RW were classified according to wheezing phenotypes as episodic viral wheeze or multitrigger wheeze, and positive or negative mAPI. Blood for Ang-1, Ang-2, and periostin levels was drawn during wheezing episode-free periods. Results: Atopic children with RW (31.4 ± 34.4 ng/mL) demonstrated higher serum Ang-1 levels than nonatopic children (16.5 ± 13.8 ng/mL) with RW (P = 0.03). When we compared children according to wheezing phenotypes, we could not find any difference in serum Ang-1, Ang-2, and periostin levels between groups. Children with positive mAPI showed similar Ang-1, Ang-2, and periostin levels with children having negative API and healthy children. Conclusions: We have found higher serum Ang-1 levels in atopic children with RW, and this result might be explained by increased inflammation. The evidence was not strong enough to associate serum Ang-1, Ang-2, or periostin and asthma in preschool children with RW. However, Ang-1 can be a candidate for investigating its role in predicting atopic children and diagnosing atopic childhood asthma. [ABSTRACT FROM AUTHOR]

In asthmatic patients, allergen-specific immunoglobulin E (IgE) plays a role in the pathogenesis of asthma, and studies are in progress on the characteristics of specific IgE in airways. We measured specific IgE in sputum via induced sputum and evaluated the clinical characteristics of specific IgE in sputum in 51 children who visited Kyungpook National University Children's Hospital from October 2015 to March 2017 with symptoms of chronic cough, dyspnea, and/or wheezy breathing sounds. We examined sputum total IgE and specific IgE in sputum to Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Alternaria. We also examined total IgE, specific IgE in serum, eosinophil counts, eosinophil cationic protein, and pulmonary function tests. There was a positive correlation between specific IgE in sputum and in serum to D. farinae (r = 0.587, P < 0.001) and to D. pteronyssinus (r = 0.587, P < 0.001). The skin prick test revealed significantly higher levels of specific IgE in sputum to D. pteronyssinus in the skin prick test-positive group than in the skin prick test-negative group (P = 0.020). There was no correlation between specific IgE in sputum to house dust mites (HDMs) and forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, or 20% fall in FEV1. Our cutoff point of specific IgE in sputum to D. farinae was 0.095 IU/mL and to D. pteronyssinus was 0.105 IU/mL. Based on our specific IgE in sputum cutoff points, 3 patients had local sensitization to HDMs in airways without systemic allergy. We reported correlations between specific IgE in sputum and in serum and proposed evidence for local allergic sensitization in airways in pediatric patients. [ABSTRACT FROM AUTHOR]

In this study, we present 2 pediatric cases with different responses to inhaled isoflurane therapy for refractory life-threatening bronchospasm. Case 1, a 1-year-old boy with chronic lung disease of infancy was admitted with severe dyspnea and wheezing. Since he became unresponsive to conventional therapies, namely, nebulized albuterol and ipratropium bromide, intravenous corticosteroids, and magnesium with mechanical ventilation, inhalation of 1% isoflurane was initiated. After 2 h of isoflurane inhalation therapy, his respiratory acidosis resolved and he was successfully weaned. Case 2, a 5-year-old girl with bronchiolitis obliterans syndrome, following allogeneic peripheral stem cell transplantation for B cell acute lymphoblastic leukemia, was admitted after 1 day of sudden-onset dyspnea. Along with severe bronchospasm, her hypercapnia and high peak airway pressure did not improve with conventional therapies. Therefore, isoflurane was started at 1.5%, but discontinued within 1 h due to aggravation of hypercapnia. She was eventually placed on extracorporeal membrane oxygenation. These cases highlight that isoflurane inhalation could be lifesaving for those with refractory bronchospasm, but that it should be used carefully since the patient response can vary based on the underlying disease. [ABSTRACT FROM AUTHOR]

Background: Preschool wheezing is common and many children experience exacerbations and are well in between. Raised blood eosinophils in older children are associated with exacerbation-prone wheeze, but there are currently no biomarkers to predict near-future exacerbations in preschoolers. There is evidence suggesting that eosinophils are acutely activated during an exacerbation using urinary markers, however, it is unknown whether blood eosinophil numbers fluctuate between the time of an exacerbation and stable disease. Objective: To investigate whether, in children with preschool wheeze, blood eosinophil numbers are different during an acute wheezing episode compared with periods of stable disease. Methods: Blood samples were taken from children aged 10 months to 6 years, presenting with acute, doctor-diagnosed wheeze, and tested for absolute leukocyte differential cell numbers. A repeat blood sample was obtained in a subset of children after full recovery. Main Outcome Measure: Difference between blood eosinophil counts during an acute wheezing episode and after recovery (stable disease) was also obtained. Results: Eighty-five children participated in this study, with 68 recruited during an acute wheezing episode (median absolute blood eosinophil numbers 0.10 × 109/L [range 0.00-2.41]) and 17 healthy controls. There was no significant difference in absolute blood eosinophil numbers between the acutely wheezy children when compared with the controls (median 0.17 × 109/L range 0.00-0.83). Absolute blood eosinophil numbers during stable disease were significantly greater (median 0.43 × 109/L; range 0.12 × 1.25 × 109/L) compared with periods of exacerbation (median 0.11 × 109/L range 0.01-1.10) in 20 children in whom paired blood samples were available. Absolute blood lymphocyte numbers were also higher during periods of stable disease, whereas absolute blood neutrophil numbers were higher during the exacerbation. Conclusions: Greater numbers of blood eosinophils are present during stable disease compared with the exacerbation state. This is an important consideration when planning future studies using blood eosinophils as a biomarker in wheezy preschool children. [ABSTRACT FROM AUTHOR]

Pediatric recurrent wheezing is a common disorder with potential asthma risk; however, its diagnosis much relies on physician's subjective evaluation. Hence, efficient noninvasive biomarkers are in great need. In this retrospective study, blood routine test was analyzed in 143 wheezing children and 137 control individuals, and various cell types were discriminated and counted. Total IgE in plasma was detected using enzyme-linked immunosorbent assay. Receiver operating characteristic curve was plotted and area under curve (AUC) was calculated to evaluate the clinical potential of both indexes for diagnosing pediatric recurrent wheezing. The theoretical cutoff values for both indexes were also calculated using a Youden index. The results showed that neutrophil significantly increased in wheezing children, whereas lymphocyte decreased sharply. Total IgE, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were significantly elevated in wheezing patients. Besides, NLR and PLR were found unchanged in different genders. The results showed that NLR (AUC = 0.647) and PLR (AUC = 0.628) were able to discriminate recurrent wheezing. Cutoff for NLR was 0.98 (Youden index 24.8%) and cutoff for PLR was 116.4 (Youden index 19.4%). The mentioned evidence supported NLR and PLR as potential diagnostic indexes for pediatric recurrent wheezing. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine whether atopy and other clinical and environmental variables predict the risk of childhood habitual snoring (HS) in a birth cohort born to atopic parents. Participants completed clinical evaluations and questionnaires at ages 1-4 and age 7. HS was defined as snoring ≥3 nights/week. Traffic-related air pollution (TRAP) exposure was estimated using land-use regression. The association between early (≤age 4) and current (age 7) allergic disease, environmental exposures, and snoring at age 7 was examined using adjusted logistic regression. Of the 609 children analyzed the prevalence of HS at age 7 was 21%. Early tobacco smoke exposure [environmental tobacco smoke (ETS)] [odds ratio (OR) 1.79, 95% CI (confidence interval) 1.12-2.84], rhinitis (OR 1.74, 95% CI 1.06-2.92), wheezing (OR 1.63, 95% CI 1.05-2.53), maternal HS (OR 2.08, 95% CI 1.36-3.18), and paternal HS (OR 1.83, 95% CI 1.14-3.00) were significantly associated with HS at age 7. Current TRAP (OR 1.93, 95% CI 1.13-3.26), respiratory infections (OR 1.16, 95% 1.03-1.35), maternal HS (OR 2.86, 95% CI 1.69-4.84), and paternal HS (OR 3.01, 95% CI 1.82-5.09) were significantly associated with HS at age 7. To our knowledge, this is the largest birth cohort examining longitudinal predictors of snoring in children born to atopic parents. Parental HS was the only variable consistently associated with childhood HS from ages 1 to 7. Early rhinitis, early ETS exposure, and concurrent traffic pollution exposure increased the risk of HS at age 7, while aeroallergen sensitization did not. Children with these characteristics should be considered for screening of sleep disorders. [ABSTRACT FROM AUTHOR]

Phenotypic variation in asthma, especially early childhood asthma, is increasingly recognized. Although inhaled corticosteroids are recommended as first-line therapy, it has less efficacy in controlling intermittent wheeze due to viral-induced symptoms in early childhood. This article reviews 2 emerging therapies in particular for early childhood wheeze: azithromycin and bacterial lysate therapy. Azithromycin's effects are both antibacterial and anti-inflammatory, and it has been shown in 2 studies in preschoolers to prevent progression to severe respiratory tract infection and decrease duration of wheeze. Bacterial lysates work at multiple stages in the innate and adaptive immune response and have been shown to decrease mean wheeze duration in particular in the preschool age. More research is required although both therapies offer a promising future approach, in particular in the nonatopic preschool wheezer, as we move toward a more personalized approach to childhood asthma. [ABSTRACT FROM AUTHOR]

A growing body of literature has investigated optimizing asthma management by identifying phenotypes and biomarkers to guide the treatment. In particular, management of asthma in preschool children remains challenging due to different phenotype presentation in early life. The focus of this review is to summarize the recent data on personalized medicine in management of preschool children with wheezing. [ABSTRACT FROM AUTHOR]