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Background: Time-varying exposures like pet ownership pose challenges for identifying critical windows due to multicollinearity when modeled simultaneously. The Distributed Lag Model (DLM) estimates critical windows for time-varying exposures, which are mainly continuous variables. However, applying complex functions such as high-order splines and nonlinear functions within DLMs may not be suitable for situations with limited time points or binary exposure, such as in questionnaire surveys. Objectives: (1) We examined the estimation performance of a simple DLM with fractional polynomial function for time-varying binary exposures through simulation experiments. (2) We evaluated the impact of pet ownership on childhood wheezing onset and estimate critical windows. Methods: (1) We compared logistic regression including time-varying exposure in separate models, in one model simultaneously, and using DLM. For evaluation, we employed bias, empirical standard error (EmpSE), and mean squared error (MSE). (2) The Japan Environment and Children's Study (JECS) is a prospective birth cohort study of approximately 100,000 parent-child pairs, registered across Japan from 2011 to 2014. We applied DLM to the JECS data up to age 3. The estimated odds ratios (OR) were considered to be within critical windows when they were significant at the 5% level. Results: (1) DLM and the separate model exhibited lower bias compared to the simultaneously model. Additionally, both DLM and the simultaneously model demonstrated lower EmpSEs than the separate model. In all scenarios, DLM had lower MSEs than the other methods. Specifically, where critical windows is clearly present and exposure correlation is high, DLM showed MSEs about 1/2 to 1/200 of those of other models. (2) Application of DLM to the JECS data showed that, unlike other models, a significant exposure effect was observed only between the ages of 0 and 6 months. During that periods, the highest ORs were 1.07 (95% confidence interval, 1.01 to 1.14) , observed between the ages of 2 and 5 months. Conclusions: (1) A simple DLM improves the accuracy of exposure effect and critical windows estimation. (2) 0–6 months may be the critical windows for the effect of pet ownership on the wheezing onset at 3 years. [ABSTRACT FROM AUTHOR]

Short-acting bronchodilators are a class of medications commonly used to treat asthma, chronic obstructive pulmonary disease, and other respiratory conditions. The use of these medications has evolved over time as we have gained a better understanding of their effectiveness and safety in the pediatric population. This comprehensive review synthesizes the current understanding of short-acting β2-agonists and short-acting anticholinergics in children. It addresses indications, contraindications, safety considerations, and highlights areas where further research is needed to guide the most effective use of short-acting bronchodilators. [ABSTRACT FROM AUTHOR]

Excessive water consumption is an extremely rare and potential asthma risk factor with very few cases reported in the literature. Common triggers of asthma include genetic factors, smoking, allergens, and viral respiratory infections. The adult patient with asthma reportedly drank too much water and was unable to get relief from his asthma while hospitalized. The patient's asthma was better controlled with the use of diuretics and control of the patient's fluid intake and output. This case explores asthma induced by excessive drinking of water. [ABSTRACT FROM AUTHOR]

Aim This matched case–control study aimed to provide epidemiologic evidence of increased burden of respiratory symptoms and pulmonary function decline among people living with human immunodeficiency virus (HIV) and a history of heavy alcohol consumption. Methods Cases were participants with HIV (PWH; n  = 75, 33%), and controls were participants without HIV (PWoH; n  = 150, 67%). PWH were matched to PWoH by age and sex in the ratio of 1:2. Eligible participants responded to the respiratory health National Health and Nutrition Examination Survey questionnaire [prolonged coughs (≥3 months), bringing up of phlegm (≥3 months), and a history of wheezing or whistling in the chest (past year)]. The effects of both alcohol and HIV on participants' pulmonary function were determined using linear regression analysis. Results History of heavy alcohol consumption was more prevalent among PWH (40%) compared to PWoH (27%). PWH who had a history of heavy alcohol consumption had a higher prevalence of coughing most days (45% vs. 4%, P  = .0010), bringing up phlegm most days (31% vs. 0%, P  = .0012), and wheezing or whistling in the chest (40% vs. 20%, P  = .058) compared to participants who did not heavily consume alcohol. Furthermore, a history of heavy alcohol consumption was associated with decreased forced expiratory volume (ml) in 1 s/forced vital capacity among PWH (β = − 0.098 95% C.I. −0.16, −0.04, P  = .03) after adjusting for having smoked at least 100 cigarettes in life. Conclusion A history of heavy alcohol use increased respiratory symptoms and suppressed pulmonary function among people living with HIV. This study provides epidemiological evidence of the respiratory symptom burden of people living with HIV who have a history of heavy alcohol consumption. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that, although asthma is a common long-term condition, its management can be improved through consistent and timely care • To learn about the development of a nurse-led salbutamol weaning pathway for children and young people with acute asthma exacerbations • To be aware that nurses reported improved confidence after completing a nurse-led salbutamol weaning training, education and competency package. Acute asthma exacerbations and viral-induced wheeze are common presenting complaints on one general paediatric ward in a tertiary children’s hospital in England. An inhaled beta2 agonist, such as salbutamol, is the first-line treatment for these children and young people and they have frequent clinician reviews for salbutamol weaning before discharge. However, the informal salbutamol weaning practices used by nurses, as well as challenges in the recruitment and retention of paediatric trainee doctors, led to the development of a nurse-led salbutamol weaning pathway as a quality improvement project. Twelve nurses completed the associated nurse-led salbutamol weaning training, education and competency package and subsequently completed a questionnaire exploring their perceptions of the effect of the training package and pathway. After the training, all respondents reported feeling more confident in assessing the salbutamol requirements of children with wheeze. All of the respondents also felt that the introduction of the pathway and training would improve patient care and the confidence of children and young people, parents and carers in nurses’ ability to assess children’s salbutamol requirements. Time constraints were identified as a potential barrier to implementation of the pathway. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis, a syndrome of organ dysfunction caused by an unregulated host response to infection. This study aimed to develop a novel sepsis diagnostic model of hematological parameters and evaluate its effectiveness in the early identification and prognosis of sepsis in emergency departments. Methods: A retrospective study was conducted in Emergency Department. Cell population data parameters related to monocytes and neutrophils were obtained using the Mindary BC‐6800 plus hematology analyzer. Receiver operating characteristic (ROC) curve analysis, logistic regression analysis was performed to assess the performance of the parameters and establish a diagnostic and prognostic model of sepsis, which was then verified with a validation cohort. Results: Mon_XW exhibited the best diagnostic performance (area under the ROC curve [AUC] = 0.848, 95% confidence interval [CI]: 0.810–0.885, p < 0.001), followed by Neu_Y and Neu_YW (AUC = 0.777 95% CI: 0.730–0.824, p < 0.001). Logistic regression analysis identified Mon_XW and Neu_Y as independent predictors, which were used to establish a diagnostic model named hematological parameter for sepsis (HPS). HPS demonstrated the best diagnostic performance with an AUC of 0.862 (95% CI: 0.826–0.898, p < 0.001), sensitivity of 70.0%, and specificity of 87.1%, compared to C‐reactive protein (CRP) and procalcitonin (PCT). The validation cohort also found that the positive predictive value of HPS was 70.4% and the negative predictive value was 92.2%. Conclusion: The developed HPS model showed promising diagnostic efficacy for sepsis in the emergency department, which outperformed CRP and PCT in terms of sensitivity and specificity. By enabling early identification and prognosis of sepsis, that contributes to reducing sepsis‐related mortality. [ABSTRACT FROM AUTHOR]

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]

The article focuses on the prevalence and management of allergic diseases, such as asthma, eczema, and allergic rhinitis. Topics include understanding the allergic cascade and its relationship to various allergic diseases, the burden of allergic diseases on patients' quality of life, and guidelines and methods for testing allergens to guide pharmacological and non-pharmacological management.

Background: Intra-breath oscillometry has been proposed as a sensitive means of detecting airway obstruction in young children. We aimed to assess the impact of early life wheezing and lower respiratory tract illness on lung function, using both standard and intra-breath oscillometry in 3 year old children. Methods: History of doctor-diagnosed asthma, wheezing, bronchiolitis and bronchitis and hospitalisation for respiratory problems were assessed by questionnaires in 384 population-based children. Association of respiratory history with standard and intra-breath oscillometry parameters, including resistance at 7 Hz (R7), frequency-dependence of resistance (R7 − 19), reactance at 7 Hz (X7), area of the reactance curve (AX), end-inspiratory and end-expiratory R (ReI, ReE) and X (XeI, XeE), and volume-dependence of resistance (ΔR = ReE-ReI) was estimated by linear regression adjusted on confounders. Results: Among the 320 children who accepted the oscillometry test, 281 (88%) performed 3 technically acceptable and reproducible standard oscillometry measurements and 251 children also performed one intra-breath oscillometry measurement. Asthma was associated with higher ReI, ReE, ΔR and R7 and wheezing was associated with higher ΔR. Bronchiolitis was associated with higher R7 and AX and lower XeI and bronchitis with higher ReI. No statistically significant association was observed for hospitalisation. Conclusions: Our findings confirm the good success rate of oscillometry in 3-year-old children and indicate an association between a history of early-life wheezing and lower respiratory tract illness and lower lung function as assessed by both standard and intra-breath oscillometry. Our study supports the relevance of using intra-breath oscillometry parameters as sensitive outcome measures in preschool children in epidemiological cohorts. [ABSTRACT FROM AUTHOR]

Objective: To report our institutional experience in diagnosing and surveilling patients with infantile subglottic hemangioma (SGH) using in-office flexible fiberoptic laryngoscopy (FFL) with video technology, without requiring operative endoscopy in the era of propranolol use. Methods: A retrospective case series was conducted on 4 children diagnosed with SGH between 2016 and 2022 at our institution. Results: Awake FFL with video technology provided adequate visualization of SGH lesions for diagnosis, without any complications. Serial examinations of the airway were performed in the outpatient setting and each SGH gradually regressed, with marked improvement in respiratory symptoms within 48 hours of oral propranolol initiation. Conclusion: Our findings showed that in select patients, FFL with video technology can successfully identify SGH lesions without general anesthesia exposure. FFL may be used as a low-risk screening tool for propranolol therapy initiation in some patients, but operative endoscopy should remain the gold standard procedure for others. By utilizing FFL in this manner, it is possible to diagnose SGH lesions and start propranolol therapy without exposing all patients to the risks of operative endoscopy. [ABSTRACT FROM AUTHOR]

Early identification of respiratory irregularities is critical for improving lung health and reducing global mortality rates. The analysis of respiratory sounds plays a significant role in characterizing the respiratory system's condition and identifying abnormalities. The main contribution of this study is to investigate the performance when the input data, represented by cochleogram, is used to feed the Vision Transformer (ViT) architecture, since this input–classifier combination is the first time it has been applied to adventitious sound classification to our knowledge. Although ViT has shown promising results in audio classification tasks by applying self-attention to spectrogram patches, we extend this approach by applying the cochleogram, which captures specific spectro-temporal features of adventitious sounds. The proposed methodology is evaluated on the ICBHI dataset. We compare the classification performance of ViT with other state-of-the-art CNN approaches using spectrogram, Mel frequency cepstral coefficients, constant-Q transform, and cochleogram as input data. Our results confirm the superior classification performance combining cochleogram and ViT, highlighting the potential of ViT for reliable respiratory sound classification. This study contributes to the ongoing efforts in developing automatic intelligent techniques with the aim to significantly augment the speed and effectiveness of respiratory disease detection, thereby addressing a critical need in the medical field. [ABSTRACT FROM AUTHOR]

Background: Black rock, Kala Pathar or ParaPhenyleneDiamine (PPD), is an aromatic amine widely used as a hair dye ingredient and is also used in textile industries. However, when ingested, PPD is highly toxic resulting in angioneurotic edema, rhabdomyolysis, acute kidney injury, toxic hepatitis, and myocarditis with a high mortality rate. This study aimed to evaluate the incidence and outcome of laryngeal edema and rhabdomyolysis after ingestion of PPD. Patients and methods: The current research was a cross-sectional study that was conducted at Aswan University Hospital, Aswan, Egypt, from December 2021 to December 2022. It consisted of 100 people who attempted suicide by ingesting black rock. All patients underwent general examinations and investigations, including complete blood count, urea, creatinine, creatine phospho kinase, alanine aminotransferase, aspartate aminotransferase, calcium, uric acid, phosphorus, urine analysis, and electrocardiography. Results: The current study consisted of 15 males and 85 females; the most common presentation was stridor (88%) followed by muscle weakness (50%). Twelve percent of patients with stridor required tracheostomy while 14% required tracheal intubation. Regarding the complications of PPD ingestion, the incidence of hepatic injury was (97%) and acute kidney injury (14%) five of them required hemodialysis, with a mortality rate of 13%. Cardiac arrhythmias were noticed in the form of sinus tachycardia (24%), sinus bradycardia (3%), atrial fibrillation (5%), ventricular fibrillation (6%), and ventricular tachycardia (7%). Our study found a significant positive correlation between creatine phosphokinase, muscle weakness, and acute kidney injury (P = 0.005). Whereas a significant positive correlation was noted between stridor, hospital stay, and mortality rate (P = 0.000), (P = 0.003), respectively. Moreover, a significant positive correlation was found between tracheotomy, mortality rate, and hospital stay (P = 0.000). Conclusion: PDD toxicity is more frequent in younger females. The intoxication from the black rock is increasingly used in suicide attempts and vital organs are usually affected especially the kidney, liver, and heart causing morbidity and mortality. [ABSTRACT FROM AUTHOR]

We studied associations between fractional exhaled nitric oxide (FeNO), health and household exposure among school children (N = 348) in Penang, Malaysia. Multiple logistic regression and linear mixed models were applied. Overall, 46.0% had elevated FeNO (>20 ppb) and 10.6% diagnosed asthma. Male gender (p = 0.002), parental asthma or allergy (p = 0.047), cat allergy (p = 0.009) and seafood allergy (p < 0.001), diagnosed asthma (p = 0.001), wheeze (p = 0.001), ocular symptoms (p = 0.001), rhinitis (p = 0.002) and respiratory infections (p = 0.004) were all associated with FeNO. Students exposed to ETS had lower FeNO (p = 0.05). Dampness and mould was associated with wheeze (p = 0.038), especially in wooden homes (interaction p = 0.042) and among students with elevated FeNO (interaction p = 0.024). Cat keeping increased rhinitis (p = 0.041) and respiratory infections (p = 0.008) and modified the dampness associations. In conclusion, FeNO can be associated with ocular and respiratory symptoms. Elevated FeNO, cat keeping and a wooden house can enhance the risk of wheeze when exposed to dampness and mould. [ABSTRACT FROM AUTHOR]

The article focuses on a case of a 2-month-old male with recurrent stridor, ultimately diagnosed with a left subglottic hemangioma. It discusses the characteristics and diagnosis of infantile subglottic hemangiomas, highlighting the importance of differentiating them from croup, particularly in cases of persistent stridor during viral transmission.

Background: Prenatal alcohol exposure (PAE) is a known risk factor for a range of adverse outcomes, such as facial dysmorphism, adverse birth outcomes, and neurodevelopmental changes. Preclinical research shows that PAE also inhibits lung development, lowers surfactant protein expression, has detrimental effects on alveolar macrophages, and decreases both T and B cell numbers. However, clinical evidence of respiratory impacts from PAE is limited. This study explored whether lung function, wheeze, and incidence of respiratory infections differ in children with PAE compared with unexposed children. Methods: Data from the Barwon Infant Study (n = 1074) were examined. PAE data were extracted from maternal questionnaires at trimesters 1 and 2 (combined), and trimester 3, and included as "total standard drinks" during each trimester and total pregnancy intake, a binary yes/no for PAE, and binge drinking (>5 standard drinks in one session). Respiratory outcomes were parent‐reported wheeze, lung function (measured by multiple breath washout), and parent report and medical record indicators of health service attendances for respiratory conditions. Linear and logistic regressions were performed to quantify relationships between PAE and respiratory outcomes, controlling for socioeconomic status, birthweight, sex, gestational age, and maternal smoking. Results: Binge drinking was associated with increased health service attendance for respiratory condition(s) in the first 12 months of life (OR = 5.0, 95% CI (1.7, 20.7), p = 0.008). We did not find a relationship between binary PAE and binge drinking with lung function at 4 weeks of age or wheeze at 12 months. The number of standard drinks consumed in trimester two was associated with a lower lung clearance index (β = −0.011 turnovers, 95% CI (−0.0200, −0.0013), p = 0.03), and a small increase in functional residual capacity (β = 0.34 mL, 95% CI (0.02, 0.66), p = 0.04). Conclusions: We found an association between binge drinking and health service utilization for respiratory conditions in infancy, but no evidence that low‐level PAE was associated with adverse respiratory outcomes. [ABSTRACT FROM AUTHOR]

The present study investigated the association between pre- and postnatal maternal hair dye use and the risk of wheeze and asthma in Japanese children aged 5 years. Study participants were 1199 mother-child pairs. Information on the variables under study was obtained using repeated questionnaires completed by parents. Prenatal maternal hair dye use was associated with an increased risk of current wheeze and ever doctor-diagnosed asthma; the adjusted odds ratios (ORs) (95% confidence intervals [CIs]) were 1.44 (1.02–2.02) and 1.51 (1.00–2.25), respectively. Postnatal maternal hair dye use was related to the risk of doctor-diagnosed asthma; the adjusted OR (95% CI) was 1.58 (1.03–2.40). Children who were exposed to maternal hair dye use both prenatally and postnatally had an increased risk of childhood current wheeze and ever doctor-diagnosed asthma; the adjusted ORs (95% CIs) were 1.59 (1.03–2.42) and 1.76 (1.06–2.88), respectively. Our findings suggest that perinatal maternal hair dye use is associated with the risk of wheeze and asthma in children. [ABSTRACT FROM AUTHOR]

Background: Severe laryngomalacia, characterized by apnea, hypoxia, and feeding difficulties, is an uncommon diagnosis that often requires surgical intervention with supraglottoplasty. Children who require surgery at a young age and those with additional comorbidities pose a special challenge and may require further surgical interventions. Posterior displacement of the epiglottis has been noted in some infants with congenital stridor and is commonly treated with epiglottopexy. The goal of our study is to review the outcomes of epiglottopexy combined with supraglottoplasty in our cohort of infants younger than 6 months old with severe laryngomalacia. Methods: A retrospective chart review of infants younger than 6 months old who underwent epiglottopexy combined with supraglottoplasty for severe laryngomalacia from January 2018 to July 2021 at a tertiary care children's hospital. Results: 13 patients (age 1.3 week-5.2 months) underwent supraglottoplasty and epiglottopexy for severe laryngomalacia and epiglottis retroflection. The patients were admitted to the intensive care unit and remained intubated for at least one night. All patients demonstrated subjective and objective improvement in upper airway respiratory signs and symptoms. Ten patients demonstrated aspiration immediately postoperatively, despite 4 of them having no concern for aspiration at preoperative evaluation. On follow-up, 1 patient required revision supraglottoplasty and epiglottopexy for persistent laryngomalacia, and 2 patients required tracheostomy tube placement due to cardiopulmonary comorbidities. Conclusion: Infants younger than 6 months old with medical comorbidities undergoing epiglottopexy with supraglottoplasty may demonstrate significant improvement in respiratory symptoms. Worsening dysphagia may complicate the postoperative period, particularly among children with medical comorbidities. [ABSTRACT FROM AUTHOR]

The article presents the case study of 6-week-old African American female concerning for laryngomalacia. Topics include past medical history was remarkable for stridor since birth, which was suspected by her Pediatrician to be laryngomalacia; and inspiratory stridor with associated increased work of breathing.

Parental mental health conditions appear to contribute to the development of childhood respiratory illness. We investigated the relationship between parental mental health and childhood respiratory illness using data from a 17-center prospective cohort study of infants hospitalized with bronchiolitis between 2011 and 2014 (n = 921). Among 779 (84.6%) participants with self-reported parental mental health history data, 184 (23.6%) had parental history of depression and 155 (19.9%) had anxiety. Multivariable analyses found that both parental history of depression (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.01-1.99) and anxiety (HR 1.28, 95% CI 1.08-1.52) were associated with an increased risk of recurrent wheezing by age 3 years. However, only parental history of anxiety was associated with asthma by age 5 years (odds ratio 1.79, 95% CI 1.25-2.55). Further research on exposure severity, other early life stressors, and effective methods of parental psychosocial support is needed to develop targeted risk factor prevention strategies to reduce the burden of childhood respiratory illness. [ABSTRACT FROM AUTHOR]

The article describes the case of a four-month-old female with a one-month history of progressive inspiratory stridor, respiratory distress, and feeding problems and was diagnosed with patent ductus arteriosus, on the first day of life. Topics discussed include the two episodes of sepsis suffered by the patient during her hospitalization, the intubation of the patient, and finding on histopathologic examination.

Bilateral vocal cord paralysis can cause obstruction of glottic airflow, resulting in respiratory distress and the need for a surgical airway. We report a case of acute onset bilateral vocal cord paralysis in a healthy adolescent patient 9 days after a mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This 15-year-old patient presented with dyspnea, tachypnea, and stridor. A fiberoptic laryngoscopy revealed bilateral vocal fold paralysis with limited vocal cord abduction causing respiratory distress. A detailed set of diagnostic test results, including blood work, imaging, and a lumbar puncture, were all negative other than her new onset diagnosis of SARS-CoV-2 infection. The patient underwent tracheostomy placement with the subsequent resolution of her symptoms. Her vocal cord function remains impaired, and the patient continues to be tracheostomy-dependent 13 months after the initial presentation. SARS-CoV-2 infection has multiple well-established neurologic complications in children. The current case suggests that vocal cord paralysis may be an additional neuropathic sequela of the virus. Vocal cord pathology should be an important consideration when constructing a differential for children presenting with voice, swallowing, or breathing complaints after SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) is revolutionizing medical diagnosis and healthcare, providing constant support to medical practitioners. Intelligent systems alleviate workload pressure while optimizing practitioner performance. AI and deep learning have also improved medical imaging and audio analysis. Material and Methods: This research focuses on predicting respiratory diseases using audio recordings from an electronic stethoscope. A convolutional neural network (CNN) was trained on a Respiratory Sound Database, augmented to generate 1,428 audio files. Techniques such as pitch shifting, time stretching, noise addition, time and frequency masking, dynamic range compression, and resampling were employed to increase the diversity and size of the training data. Result: Features were extracted from mono audio files, creating a four layer CNN with 90% accuracy. The software, developed using the CNN model and Streamlit python library, offers a new tool for early and accurate diagnosis, reducing the burden on medical practitioners and enhanci ng their performance. The study highlights AI's potential in respiratory disease detection through audio analysis. Conclusion: The software, developed using the CNN model and Streamlit python library, offers a new tool for early and accurate diagnosis, reducing the burden on medical practitioners and enhancing their performance. [ABSTRACT FROM AUTHOR]

Recurrent croup is a common clinical entity afflicting the pediatric population, but is not well-characterized in the literature. We describe the largest series of recurrent croup in North America from a single tertiary care academic center, and differentiate subpopulations based on demographic characteristics and clinical presentation. We identified 114 patients for inclusion. Common symptoms included barky cough (86.0%) and inspiratory stridor (60.5%). Many (26.3%) experienced full symptom resolution within a day, and 41.2% reported onset of symptoms at any time of the day. Male patients had a higher number of prior croup episodes at presentation compared with female patients (mean of 9.8 ± 8.0 in males vs 6.6 ± 4.8 in females, P =.03). On multivariate regression, racial/ethnic minority patients were at higher risk for dyspnea (odds ratio [OR]: 58.6; 95% confidence interval [CI]: 7.2-475.4) and upper respiratory infection prodrome (OR: 7.6; 95% CI: 1.6-35.3) compared with non-Hispanic white patients. [ABSTRACT FROM AUTHOR]

Paediatric pharyngeal trauma is common and frequently occurs after falls or other accidents. Children with these injuries typically present to emergency departments with drooling, respiratory distress, stridor and hematemesis. Although most cases of pharyngeal trauma are minor, some can have rare, life‐threatening complications. [ABSTRACT FROM AUTHOR]

ST‐elevation myocardial infarction (STEMI) is a life‐threatening clinical condition that requires immediate intervention, mostly caused by complete occlusion of epicardial vessels. Other diseases such as myocarditis, pericarditis, electrolyte disturbance, and early repolarization may mimic. We present a rare case of atrial lead‐related atrial perforation which mimics inferior STEMI. [ABSTRACT FROM AUTHOR]

The association between breathing sounds and respiratory health or disease has been exceptionally useful in the practice of medicine since the advent of the stethoscope. Remote patient monitoring technology and artificial intelligence offer the potential to develop practical means of assessing respiratory function or dysfunction through continuous assessment of breathing sounds when patients are at home, at work, or even asleep. Automated reports such as cough counts or the percentage of the breathing cycles containing wheezes can be delivered to a practitioner via secure electronic means or returned to the clinical office at the first opportunity. This has not previously been possible. The four respiratory sounds that most lend themselves to this technology are wheezes, to detect breakthrough asthma at night and even occupational asthma when a patient is at work; snoring as an indicator of OSA or adequacy of CPAP settings; cough in which long-term recording can objectively assess treatment adequacy; and crackles, which, although subtle and often overlooked, can contain important clinical information when appearing in a home recording. In recent years, a flurry of publications in the engineering literature described construction, usage, and testing outcomes of such devices. Little of this has appeared in the medical literature. The potential value of this technology for pulmonary medicine is compelling. We expect that these tiny, smart devices soon will allow us to address clinical questions that occur away from the clinic. [ABSTRACT FROM AUTHOR]

Occupational exposure to aluminum has been reported to be related to the development of many different lung diseases. This study aimed to compare the employees of a factory producing Al profile with controls working in the same workplace in terms of working conditions, respiratory complaints, pulmonary function tests and urine Al levels. Objective: This prospective case-control study aimed to investigate the forms and conditions of respiratory effects in workers working in an Aluminum Profile Factory. Methods: All male (42 person, mean age: 32.2 ± 6.9) workers working in an Aluminum Profile Factory were compared with 33 controls. Results: The urinary aluminum levels of the workers were significantly higher than the control group. Complaints of cough, sputum, shortness of breath and wheezing were statistically significantly higher than the control group. In aluminum workers, those with dyspnea had a significantly higher urinary Al level than those without dyspnea. Conclusions: It is thought that primary and secondary prevention are both important in the workplaces with aluminum exposure. Urinary aluminum level monitoring could be key to protecting the respiratory health of the workers. [ABSTRACT FROM AUTHOR]

The article discusses the stridor medical condition in children manifested by partial upper airway obstruction that is most commonly caused by viral croup. Topics covered include signs and symptoms of stridor and viral croup, evidence-based assessment criteria and treatments, the use of oral dexamethasone and close observation as first line treatment, and criteria for admission or discharge. Also given is a case study on the diagnosis and treatment of stridor.

The objective of this study was to compare the risk of developing respiratory symptoms in farmers and other occupational groups over a period of 11 to 23 years. The study includes data from questionnaires and interviews in HUNT1-3 in The Trøndelag Health study (HUNT). In all three surveys, farmers can be identified. Two control groups are used. Control group 1 consists of all HUNT participants who are not farmers or fishermen. Control group 2 consists of occupational groups who presumably have low exposure to dust, chemicals or gases, but similar educational status as farmers. The data are analysed in SPSS 25 (IBM, Armonk NY), with use of frequency analyses and multiple binary logistic regressions. Our main finding is that healthy farmers have increased risk of developing respiratory symptoms as wheezing or breathlessness over a period of 11 and 23 years. This increased risk is statistically significant after 11 years of follow-up (HUNT1 to HUNT2), and also after 23 years (HUNT1 to HUNT3). Corresponding results regarding wheezing and breathlessness are found for healthy farmers in HUNT2 after 12 years of follow-up in HUNT3. In a subgroup analysis, we find a highly significant difference in both wheezing and shortness of breath when at work, in believing that the symptoms are caused by work, and in having to change jobs or quit because of breathing problems. Farmers have more respiratory symptoms than controls, and the main symptom is attacks of wheezing or breathlessness. Preventive measures such as ventilation and respiratory protection should be implemented on the farm. [ABSTRACT FROM AUTHOR]

The author calls for a reconsideration of the approach to teaching auscultation, a diagnostic tool for identifying pneumonia, bronchial obstruction and pleurisy, to reduce training and learning time. He points out the confusion for medical students when using everyday or musical sounds as basis for identifying breathing sounds such as pleural friction rub. He suggests improvements like determining sound characteristics such as amplitude, pitch and dominant frequency when teaching auscultation.

An 81-year-old Japanese male patient was treated for asthma. He complained of persistent cough and wheezing. Chest computed tomography scan revealed atelectasis in the right middle lobe. Fiberoptic bronchoscopy was performed. Results showed a calcified stone with filamentous fungi with septa in the right middle lobe bronchus, which was subsequently removed. Ceriporia lacerata was detected repeatedly on sputum culture. Thus, the filamentous fungi were suspected as C. lacerata. Broncholithiasis possibly caused mucous membrane damage owing to C. lacerata colonization, resulting in allergic airway inflammation. Herein, we report a rare case of C. lacerata-related broncholithiasis associated with asthma exacerbation. [ABSTRACT FROM AUTHOR]

Background: Recurrent wheezing is a common clinical problem in early childhood, which is associated with significant morbidity. There is no international consensus on the management and prevention of recurrent wheezing; therefore, identifying the risk factors associated with recurrent wheezing is crucial to prevent episodes of wheezing in young children. Methods: In this retrospective study, we collected the data of 24,737 patients who were admitted to our hospital between 27th April 2012 and 11th September 2019. After screening for patients with wheezing, we identified 8572 patients with a primary diagnosis of pneumonia with wheezing. Patients' clinical data were collected from the hospital medical records. Patients were stratified for age in the groups of < 6 months, 6–12 months, and > 12 months. Results: Among the 8569 pediatric pneumonia patients with wheezing, there were 343 patients with recurrent wheezing. Most enrolled patients were under 6 months of age (45.17%) and had a normal birth weight (86.95%). Winter was the most common onset season for the first episode of wheezing, while spring was the most common season for the second episode of wheezing for those with recurrent wheezing. The univariate and multivariate logistic regression analysis for the risk factor associated with recurrent wheezing showed that male gender, past history of respiratory and cardiovascular diseases, low birth weight, development of severe pneumonia, and PICU admission were significantly associated with recurrent wheezing. Conclusion: Male gender, past history of respiratory and cardiovascular diseases, low birth weight, severe pneumonia, and PICU admission are independent risk factors of recurrent wheezing in the pediatric population. [ABSTRACT FROM AUTHOR]

Background: Anticholinergics have been used to treat death rattle (DR) in dying patients with palliative care. However, the effect of anticholinergics is still controversial. No quantitative summary of their effects is reported. Objective: This study aimed to systematically review and quantitatively synthesize the effect of anticholinergics on DR treatment and prophylaxis. Design: A systematic search was performed in the electronic databases (PubMed, Embase®, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) from inception to October 2021. Studies conducted to determine the effect of anticholinergics compared with other anticholinergics or placebo on noise reduction score in dying patients were included. A network meta-analysis was performed for DR treatment. The effect of anticholinergics at four hours was assessed. A pairwise meta-analysis was performed for DR prophylaxis. Results: A total of nine studies were included with 1103 patients. Six studies were randomized controlled trials, and three studies were cohort studies. Seven studies were conducted for DR treatment, while two studies were conducted for DR prophylaxis. For DR treatment, no statistically significant difference was observed between each anticholinergic (hyoscine hydrobromide, hyoscine butyl bromide, atropine, and glycopyrrolate) and placebo and among any anticholinergics. However, the surface under cumulative ranking curve indicated that hyoscine butyl bromide had the highest surface under the cumulative ranking curve (SUCRA) with 71.3%. For DR prophylaxis, the relative risk of DR occurrence for hyoscine butyl bromide was 0.23 (0.04, 1.18; I2 = 84.5%) compared with no treatment. Conclusion: This study showed no strong evidence of the regular use of anticholinergics for DR treatment. In addition, hyoscine butyl bromide appears to have a high potential for DR prophylaxis. [ABSTRACT FROM AUTHOR]

Objective: PHACE is a rare syndrome that can present with airway hemangiomas. Management for these patients is variable and the utilization of operative endoscopic airway evaluation has not been described. The objectives of this study were to identify the incidence of airway symptoms in patients being evaluated for PHACE syndrome and determine the utility of operative endoscopy. Methods: An IRB-approved retrospective cohort study was conducted on consecutive pediatric patients with head and neck infantile hemangioma (IH) evaluated in a multi-disciplinary vascular anomalies center between 2013 and 2019. Patients were included if they were being worked up for PHACE syndrome and had an otolaryngology evaluation. Demographics, clinical, and surgical variables were collected. Results: There were 317 patients with head and neck IH. Thirty-six patients met inclusion criteria. The majority of patients were female (31/36; 86.1%) and less than half of the patients (15/36; 41.7%) were eventually diagnosed with PHACE syndrome. Median age at presentation was 2 months (range 0-82 months). A total of 28/36 (77.8%) of patients were managed with propranolol. The majority of the patients presented without aerodigestive symptoms; however, 16/36 (44.4%) of patients presented with symptoms such as stridor, hoarseness, and dysphagia. A total of 20/36 (55.6%) of patients underwent operative endoscopy. A total of 8/20 (40.0%) of patients who underwent operative endoscopy had operative intervention. Of the entire cohort, only 2/15 (13.3%) patients diagnosed with PHACE were found to have a subglottic hemangioma. Both patients presented with stridor. Conclusion: Operative endoscopy remains useful in the workup of PHACE syndrome to identify subglottic hemangiomas, however there may be relatively low yield in asymptomatic patients. In office flexible laryngoscopy may be a less invasive means to examine the subglottic region. A multi-center prospective study would be necessary to evaluate incidence of subglottic hemangiomas in asymptomatic patients evaluated for PHACE. [ABSTRACT FROM AUTHOR]

Background: Objective investigation of the characteristics of acute bronchiolitis in infants is important for its diagnosis and treatment. Methods: Lung sound data of 50 patients diagnosed with respiratory syncytial virus (RSV) acute bronchiolitis (m:f = 29:21, median of age 7 months), 20 patients with RSV acute respiratory tract infections without acute bronchiolitis (m:f = 10:10, 5 months) and 38 age‐matched control infants (m:f = 23:15, 8 months) were analyzed using a conventional method and compared. Furthermore, the relationships between lung sound parameters and clinical symptoms (clinical score, length of hospital stay and SpO2 level) in the bronchiolitis and the non‐bronchiolitis patients were examined. Results: Results of lung sound analysis showed that the inspiratory sound power of patients with RSV respiratory tract infections was low and the expiratory sound power was high compared with those of the controls. When the patients with RSV respiratory tract infections were divided into the bronchiolitis and non‐bronchiolitis groups, the expiratory/inspiratory ratio of the bronchiolitis patients was greater than that of the non‐bronchiolitis patients. There was no difference in the clinical symptoms, clinical score and length of hospital stay between the bronchiolitis and non‐bronchiolitis patients, except for the SpO2 level on admission. Conclusion: Lung sound analysis confirmed that patients with RSV acute bronchiolitis present with marked airway narrowing. Considering these results as a characteristic of acute bronchiolitis, it would be meaningful to reflect it in the improvement of diagnosis, treatment and subsequent management. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to propose a treatment method and the effect on the nervous system of digital therapeutics, which is a new treatment method to replace surgery and drug prescription for the treatment and prevention of diseases. Methods: The 20 subjects who participated in the experiment, including men and women, had an average age of 26 ± 2.40 years. The proposed treatment method used three types of sound stimulation and air or bone conduction sound transmission methods to induce total of 6‐time EEG electroencephalogram(EEG) changes. EEG was measured with 200 sampling rate each in the P4, Cz, F8 and T7 channel located in the parietal, central, frontal and temporal lobes, respectively, according to the 10/10 system. A total of 2 min of data were created by extracting EEG signals with less noise from the measured data and the extracted data were applied with a 1–40 Hz Butterworth filter and a 50 Hz notch filter with a quality factor of 30. After that, EEG are subdivided into delta (0.5–4 Hz), theta (4–8 Hz), alpha (8–13 Hz), beta (13–30 Hz), and gamma (30–45 Hz) bands. Finally, EEG changes in response to sound stimuli were analyzed using power spectral density and T‐test validation in the frequency band. Results: When a sound stimulus of less than 1 KHz was stimulated by air conduction, brainstem activation was induced and the reticular activation system was activated. In addition, a great potential for replacing drugs was confirmed by inducing changes in the nervous system similar to drugs used for sedation. Conclusion: These results will be able to expand the concept of digital therapeutics, and it is expected that it will be developed as a safer treatment method that can replace surgery and drugs. [ABSTRACT FROM AUTHOR]

Listening to music while exercising can alter afferent feedback from breathing sounds; however, it is currently unknown whether auditory distraction with music mitigates exertional dyspnea in healthy individuals. Purpose: This study aimed to determine whether listening to music through headphones (a) affects the sensory (breathing intensity [BI]) and/or affective (breathing unpleasantness [BU]) components of dyspnea during exercise at different intensities and (b) affects exercise performance. Methods: Twenty-two recreationally active individuals (24 ± 3 yr, 10 women) performed two 5-min constant loads (10% below/above gas exchange threshold [GET]) and an 8-km cycling time trial with ambient laboratory noise or self-selected music in a randomized crossover design. BI, BU, and ventilation (V̇ E) were measured at each minute of the constant loads and every 2 km of the time trial. Ratios of BU/ V̇ E and BI/ V̇ E were used to examine the gain in dyspnea during the time trial. Results: In the 10% below GET trial, BU was reduced in the first (P = 0.03) and final (P = 0.04) minutes. In the 10% above GET trial, BU and BI were reduced with music (P < 0.05). During the time trial with music, BU/ V̇ E was significantly attenuated by 9%–13% (P < 0.05) despite a greater heart rate and self-selected power output (P < 0.05). Conclusions: Music through headphones mitigated the sensation of dyspnea and changed the accretion of dyspnea per unit increase in V̇ E leading to a higher self-selected workload during self-paced exercise. The dyspnea-reducing intervention of self-selected music may improve exercise tolerance and performance and promote adherence to regular aerobic exercise. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine respiratory morbidity of late preterm infants versus infants with intrauterine growth retardation (IUGR) at school-age. Patients and Methods: Late preterm appropriate for gestational age (AGA) infants (34-36, 6/7 weeks) (Group 1), IUGR infants (Group 2), extremely preterm AGA (Group 3) and term AGA infants (Group 4) born between 2004 and 2008 were included in this case-control study and assessed for respiratory morbidity at school-age. We evaluated the impact of late preterm compared with IUGR and term gestation on respiratory morbidity by using validated American Thoracic Society -- Division of Lung Diseases (ATS-DLD-78-C) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. Questionnaires on wheezing, infectious respiratory morbidity, and physician-diagnosed asthma panels were constituted and groups were compared. Results: A total of 160 patients were enrolled in the study and 97 (60.6%) of them were boys. Respiratory morbidities at school-age were found to be significantly higher in both late preterm and IUGR groups when compared to term controls. Each weekly increase in gestational age reduced the risk for wheezing episodes (OR perGW:0.82,95%CI:0.71-0.97, p:0.02). Regarding infectious respiratory morbidities, there was a significant increase when the number of people living at home increased (OR perperson:1.79,95%CI:1.12-2.87, p:0.01), and a decrease in female gender (OR:0.41,95%CI:0.17-0.99, p:0.04) and in the week of gestation (OR perGW:0.84,95%CI:0.71-1.00, p:0.04). Atopic dermatitis (OR:5.26,95%CI:1.57-17.69, p<0.01) and maternal asthma (OR:5.38,95%CI:1.17-24.60, p:0.03) history were found to be risk factors for asthma. Conclusion: Being IUGR may be an important risk factor for respiratory morbidity at school-age. Further studies are needed on this subject. [ABSTRACT FROM AUTHOR]

Introduction: We examined the relationship between current tobacco use and functionally important respiratory symptoms.Methods: Longitudinal cohort study of 16 295 US adults without COPD in Waves 2-3 (W2-3, 2014-2016) of the Population Assessment of Tobacco and Health Study. Exposure-Ten mutually exclusive categories of tobacco use including single product, multiple product, former, and never use (reference). Outcome-Seven questions assessing wheezing/cough were summed to create a respiratory symptom index; cutoffs of ≥2 and ≥3 were associated with functional limitations and poorer health. Multivariable regressions examined both cutoffs cross-sectionally and change over approximately 12 months, adjusting for confounders.Results: All tobacco use categories featuring cigarettes (>2/3's of users) were associated with higher risk (vs. never users) for functionally important respiratory symptoms at W2, for example, at symptom severity ≥ 3, risk ratio for exclusive cigarette use was 2.34 [95% CI, 1.92, 2.85] and for worsening symptoms at W3 was 2.80 [2.08, 3.76]. There was largely no increased symptom risk for exclusive use of cigars, smokeless tobacco, hookah, or e-cigarettes (adjustment for pack-years and marijuana attenuated the cross-sectional e-cigarette association from 1.53(95% CI 0.98, 2.40) to 1.05 (0.67, 1.63); RRs for these products were also significantly lower compared to exclusive use of cigarettes. The longitudinal e-cigarette-respiratory symptom association was sensitive to the respiratory index cutoff level; exclusive e-cigarette use was associated with worsening symptoms at an index cutoff ≥ 2 (RR = 1.63 [1.02, 2.59]) and with symptom improvement at an index cutoff of ≥ 3 (RR = 1.64 [1.04, 2.58]).Conclusions: Past and current cigarette smoking drove functionally important respiratory symptoms, while exclusive use of other tobacco products was largely not associated. However, the relationship between e-cigarette use and symptoms was sensitive to adjustment for pack-years and symptom severity.Implications: How noncigarette tobacco products affect respiratory symptoms is not clear; some studies implicate e-cigarettes. We examined functionally important respiratory symptoms (wheezing/nighttime cough) among US adults without COPD. The majority of adult tobacco users smoke cigarettes and have higher risk of respiratory symptoms and worsening of symptoms, regardless of other products used with them. Exclusive use of other tobacco products (e-cigarettes, cigars, smokeless, hookah) was largely not associated with functionally important respiratory symptoms and risks associated with their use was significantly lower than for cigarettes. The association for e-cigarettes was greatly attenuated by adjustment for cigarette pack-years and sensitive to how symptoms were defined. [ABSTRACT FROM AUTHOR]

The article focuses on a case study of a 34-day-old infant with hypoxic respiratory insufficiency and biphasic stridor, who was later diagnosed with PHACES syndrome based on the presence of segmental facial hemangiomas and abnormalities affecting the midline chest and abdominal wall. It also discusses the neurovascular abnormalities observed in the infant, including the absence of the right A1 segment of the internal carotid artery and the non-visualization of the left posterior.

Objective. By conducting a systematic review of the efficacy of acupoint application on children with asthma. Methods. We searched Chinese databases (CNKI, VIP, and Wanfang) and English databases (PubMed, Embase, and Cochrane Library) for studies from the establishment of the database to October 2021. The included literature studies were randomized control studies investigating the treatment of asthma in children by acupoint application. The primary outcomes included the cure rate, the resolution time of cough, and the resolution time of wheezing. The secondary outcomes included pulmonary function and interleukins. Stata 15 and RevMan 5.4 were used to analyze the extracted data. Results. A total of 24 related studies were included containing 2716 cases. The meta-analysis showed that TCM group was superior to control group in terms of cure rate, pulmonary function (FEV1), and resolution time of wheezing in children with asthma [RR = 1.26,95% (1.21,1.31), P < 0.05 ; SMD = 0.81, 95%CI (0.05,1.56), P < 0.05 ; WMD = −1.40, 95%CI (−1.75, −1.05), P < 0.05 ]. Conclusions. The present study shows that acupoint application is an effective treatment for children with asthma in China, especially in alleviating wheezing and improving quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Options to treat and prevent episodic wheezing in children are scarce. Our objective was to assess the efficacy of intermittent tiotropium bromide treatment in early childhood episodic wheezing. METHODS: This 48-week, randomized, open-label, controlled, parallel-group trial was conducted at 4 hospitals in Finland. Children aged 6 to 35 months with 2 to 4 physician-confirmed episodes of wheeze and/or shortness of breath were considered eligible. Study participants were randomly allocated to receive 1 of 3 treatments: once-daily tiotropium bromide 5 µg for 7 to 14 days during respiratory tract infections and as-needed albuterol sulfate 0.2 mg (n = 27), twice-daily fluticasone propionate 125 µg for 7 to 14 days during respiratory tract infections and as-needed albuterol sulfate 0.2 mg (n = 25), or as-needed albuterol sulfate 0.2 mg alone (n = 28). The primary outcome was efficacy, assessed as intention-to-treat by comparing the proportion of episode-free days (the days lacking symptoms or treatments) between the treatment groups. RESULTS: The proportion of episode-free days was higher in those receiving intermittent tiotropium bromide (median 97% [interquartile range, 93% to 99%]) than in those receiving intermittent fluticasone propionate (87% [78% to 93%], P = .002), or with as-needed albuterol sulfate alone (88% [79% to 95%], P = .003). Adjustment with allergic sensitization, the baseline number of physician-confirmed episodes of wheeze and/or shortness of breath, or short-course glucocorticoid treatment in the 2 weeks before the enrollment, did not affect the result. Intervention-related adverse events were not seen. CONCLUSIONS: Intermittent tiotropium bromide treatment may be an effective alternative to current therapies for episodic wheezing. Before implementation of use, further research on safety and efficacy is indicated. [ABSTRACT FROM AUTHOR]

This study is a part of the Global Asthma Network (GAN) phase I project to assess asthma symptoms in children, adolescents, and their parents in Karaj, Iran. The present cross-sectional study was conducted in 2019-2020 in Karaj, Iran, in alignment with the goals of the GAN study, including assessing asthma prevalence, severity, and risk factors. In this study, 1500 students were selected using a multistage stratified cluster sampling method from 40 public and private schools in Karaj. The entire population of children aged 6-7 years or adolescents aged 13-14 years in a given school and their parents was considered the sample unit. The GAN core questionnaires were completed for students and parents. The results showed that the response rate was 89.6%. A total of 1326 children and adolescents, 572 children aged 6-7 years, and 754 aged 13-14 years and their parents were enrolled in the study. The prevalence of ever- and current wheezing was 24% and 13.8% among 6-7-year-olds, and 18.8% and 12.3% among 13-14-year-olds, respectively. In children aged 6-7 years, parental wheezing significantly increased the chances of children wheezing (odds ratio: 3.27; 95% confidence interval: 1.70, 6.310). The current study's findings showed that the prevalence of asthma symptoms among children and adolescents and their parents in Karaj, Iran, was mainly higher than the findings of studies conducted in other cities in Iran. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in infants and young children worldwide. Here we evaluated host demographic and viral factors associated with RSV disease severity in 325 RSV-infected infants under 1 year of age from 3 European countries during 2017-2020. Younger infants had a higher clinical severity (ReSViNET) score and were more likely to require hospitalization, intensive care, respiratory support, and/or mechanical ventilation than older infants (<3 months vs 3 to <6 months and 3 to <6 months vs ≥6 months). Older age (≥6 months vs <3 months), higher viral load, and RSV-A were associated with a greater probability of fever. RSV-A and RSV-B caused similar disease severity and had similar viral dynamics. Infants with a more severe RSV infection, demonstrated by having a higher ReSViNET score, fever, and requiring hospitalization and intensive care, were more likely to have developed subsequent wheezing at 1 year of age.Clinical Trials Registration: NCT03756766. [ABSTRACT FROM AUTHOR]

Background: Infant respiratory syncytial virus infection (RSV) has been associated with asthma later in life. We explored the risk of recurrent wheeze or asthma in children with infant RSV-associated hospitalization compared to other respiratory infections.Methods: We performed a retrospective cohort study using Danish national hospital discharge registers. Infants younger than 6 months, born between January 1995 and October 2018, and with a RSV hospital admission were compared to infants hospitalized for injuries, non-RSV acute upper respiratory tract infection (AURTI), pneumonia and other respiratory pathogens, nonpathogen-coded lower respiratory tract infections (LRTI), pertussis, or nonspecific respiratory infections. Infants were followed until recurrent wheeze or asthma diagnosis, death, migration, age 10 years, or study end. We estimated cumulative incidence rate ratios (CIRR) and hazard ratios (HR) adjusted for sex, age at inclusion, hospital length of stay (LOS), maternal smoking, 5-minute APGAR score (APGAR5), prematurity, and congenital risk factors (CRF).Results: We included 68 130 infants, of whom 20 920 (30.7%) had RSV hospitalization. The cumulative incidence rate of recurrent wheeze or asthma was 16.6 per 1000 person-years after RSV hospitalization, higher than after injury (CIRR, 2.69; 95% confidence interval [CI], 2.48-2.92), AURTI (CIRR, 1.48; 95% CI, 1.34-1.58), or pertussis (CIRR, 2.32; 95% CI, 1.85-2.91), similar to pneumonia and other respiratory pathogens (CIRR, 1.15; 95% CI, .99-1.34) and LRTI (CIRR, 0.79; 95% CI, .60-1.04), but lower than nonspecific respiratory infections (CIRR, 0.79; 95% CI, .73-.87). Adjusted HRs for recurrent wheeze or asthma after RSV hospitalization compared to injuries decreased from 2.37 (95% CI, 2.08-2.70) for 0 to <1 year to 1.23 (95% CI, .88-1.73) for 6 to <10 years for term-born children, and from 1.48 (95% CI, 1.09-2.00) to 0.60 (95% CI, .25-1.43) for preterm-born children. Sex, maternal smoking, LOS, CRF, and APGAR5 were independent risk factors.Conclusions: Infant RSV hospitalization is associated with recurrent wheeze and asthma hospitalization, predominantly at preschool age. If causal, RSV prophylaxis, including vaccines, may significantly reduce disease burden of wheeze and asthma. [ABSTRACT FROM AUTHOR]

Background: Early-life severe respiratory syncytial virus (RSV) infection has been associated with subsequent risk of asthma and recurrent wheeze. However, changes in the association over time and the interaction effect of the age at first RSV infection are less well understood. We aimed to assess the time-varying association between RSV and subsequent asthma and wheeze admission and explore how the association was affected by the age at RSV infection.Methods: We retrospectively followed up a cohort of 23 365 children for a median of 6.9 years using Scottish health databases. Children who were born between 2001 and 2013 and had RSV-associated respiratory tract infection (RTI) admissions under 2 years were in the exposed group; those with unintentional accident admissions under 2 years comprised the control group. The Cox proportional-hazards model was used to report adjusted hazard ratios (HRs) of RSV admissions on subsequent asthma and wheeze admissions. We did subgroup analyses by follow-up years. We also explored how this association was affected by the age at first RSV admission.Results: The association was strongest in the first 2 years of follow-up and decreased over time. The association persisted for 6 years in children whose first RSV-RTI admission occurred at 6-23 months of age, with an adjusted HR of 3.9 (95% confidence interval [CI], 3.1-4.9) for the first 2 years, 2.3 (95% CI, 1.6-3.2) for 2 to <4 years, and 1.9 (95% CI, 1.2-2.9) for 4 to <6 years of follow-up. In contrast, the association was only significant for the first 2 years after first RSV-RTI admissions occurring at 0-5 months.Conclusions: We found a more persistent association for subsequent asthma and wheeze in children whose first severe RSV infection occurred at 6-23 months compared to those whose first severe RSV infection occurred at 0-6 months. This provides new evidence for further assessment of the association and RSV intervention programs. [ABSTRACT FROM AUTHOR]

Background: Swimming-induced pulmonary edema (SIPE) occasionally occurs during swimming in cold open water. Although optimal treatment for SIPE is unknown, non-invasive positive pressure ventilation (NPPV) is an option for prehospital treatment.Research Question: Is NPPV a feasible and safe prehospital treatment for SIPE, and which outcome measures reflect recovery after treatment?Study Design and Methods: A prospective observational study was conducted at Vansbrosimningen, Sweden's largest open water swimming event, from 2017 through 2019. Swimmers with a diagnosis of SIPE and with peripheral oxygen saturation (Spo2) of ≤ 95%, persistent respiratory symptoms, or both were eligible for the study. NPPV was administered on site as CPAP by facial mask or as positive expiratory pressure (PEP) by a PEP device. Discharge criteria were Spo2 of > 95% and clinical recovery. Four outcome measures were evaluated: Spo2, crackles on pulmonary auscultation, pulmonary edema on lung ultrasound (LUS), and patient-reported respiratory symptoms.Results: Of 119 treated individuals, 94 received CPAP, 24 received treatment with a PEP device, and one required tracheal intubation. In total, 108 individuals (91%) were discharged after NPPV for a median of 10 to 20 min and 11 individuals (9%) required hospital transfer. NPPV resulted in increased Spo2 from a median of 91% to 97% (P < .0001) together with improvement of six patient-reported respiratory symptoms (median numerical rating scales, 1-7 to 0-1; P < .0001). No significant decrease in auscultation of crackles (93% vs 87%; P = .508) or pulmonary edema on LUS (100% vs 97%; P = .500) was seen during NPPV treatment.Interpretation: NPPV administered as CPAP or via a PEP device proved feasible and safe as prehospital treatment for SIPE with a vast majority of patients discharged on site. Spo2 and patient-reported respiratory symptoms reflected recovery after treatment, whereas pulmonary auscultation or LUS findings did not. [ABSTRACT FROM AUTHOR]