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This chapter addresses the breathing disorders associated with Early onset scoliosis (EOS), the ways to evaluate them, and the role of medical providers in managing children with EOS in resource-limited settings (RLS). EOS is often classified by aetiology, but diagnosis and strategies for care depend on the age at presentation. Several pathophysiologic processes coexist in children with EOS. Spine and chest wall deformities lead to malalignment of the vertebral body, ribs, and sternum. On physical exam, a posterior rib hump is present with or without changes in the anterior chest. One shoulder is often higher than the other. Inspection will also reveal that children use their abdominal muscles to exhale more forcefully at rest; however, this is not a prolonged exhalation but a short push with every breath. The physical examination in young children who are able to run should include an examination after running to hear breath sounds with deeper breathing and to count the respiratory rate.

Investigations in associations between subjective health-related quality of life (HRQoL) measures and objective clinical assessments in patients with early-onset scoliosis (EOS) are limited. The purpose of this study is to investigate the association between pulmonary function rated by parents and pulmonary function testing (PFT) in patients with EOS.In this cross-sectional study, patients with EOS at any stage of treatment from 2011 to 2018 were identified in 2 registries including 33 centers. Parents' perception of pulmonary function was evaluated using pulmonary function (PF) domain in the Early-Onset Scoliosis 24 item Questionnaire (EOSQ-24). PFT measures included FVC% predicted, FEV1/FVC, and TLC% predicted. All PFT predicted values utilized arm span. PFT and EOSQ-24 questionnaire were completed within 180 days of each other with an average day difference of 26 days.176 patients (mean age: 10.4 years old, female: 56%) were identified. 33% of patients were of congenital/structural etiology, 27% neuromuscular, 26% syndromic, and 14% idiopathic. Wide variance and lower scores of PF domain were reported by parents at lower FVC% predicted values ( 50%). As FVC% predicted values increased, PFD scores increased with simultaneous decreases in variance with few exceptions.More variability and frequent lower pulmonary function values are reported by parents when percent forced vital capacity (FVC%) is 50%. This likely reflects the degree to which children adapt to restrictive lung disease and the limits on adaptation that occur increasingly as lung function falls below 50% predicted. As a direct linear association with high correlation was expected, more research into the character of what the PF domain is measuring is necessary.IV.

Etiology of early onset scoliosis as described by C-EOS does not predict pulmonary function. Further study is required to provide granularity with regard to specific C-EOS classifications.

Polysomnograms (PSGs) are not used in most spine centers for children with EOS. There are no standards for PSG referrals, and the yield from PSGs is unknown. We describe referrals for PSGs in 96 children5 years old with EOS, their lung functions, types of EOS, and frequency of abnormal PSGs.

The 6 minute walk (6MW) correlates with age and inversely with the Cobb angle for patients with congenital scoliosis prior to spine surgical intervention. All had low 6MW values compared to age-matched norms. 6MW is useful as a serial measure of functional status for each patient over time.

Indigenous children in developed countries are at increased risk of chronic suppurative lung disease (CSLD), including bronchiectasis. We evaluated sociodemographic and medical factors in indigenous children with CSLD/bronchiectasis from Australia, United States (US), and New Zealand (NZ).Indigenous children aged 0.5-8 years with CSLD/bronchiectasis were enrolled from specialist clinics in Australia (n = 97), Alaska (n = 41), and NZ (n = 42) during 2004-2009, and followed for 1-5 years. Research staff administered standardized parent interviews, reviewed medical histories and performed physical examinations at enrollment.Study children in all three countries had poor housing and sociodemographic circumstances at enrollment. Except for increased household crowding, most poverty indices in study participants were similar to those reported for their respective local indigenous populations. However, compared to their local indigenous populations, study children were more often born prematurely and had both an increased frequency and earlier onset of acute lower respiratory infections (ALRIs). Most (95%) study participants had prior ALRI hospitalizations and 77% reported a chronic cough in the past year. Significant differences (wheeze, ear disease and plumbed water) between countries were present.Indigenous children with CSLD/bronchiectasis from three developed countries experience significant disparities in poverty indices in common with their respective indigenous population; however, household crowding, prematurity and early ALRIs were more common in study children than their local indigenous population. Addressing equity, especially by preventing prematurity and ALRIs, should reduce risk of CSLD/bronchiectasis in indigenous children.

Bronchiectasis among children living in developing regions is associated with respiratory infections during early childhood, but specific risk factors that precede childhood bronchiectasis are not fully characterized. We hypothesized that severe respiratory syncytial viral (RSV) infection in infancy would increase the risk of bronchiectasis among Alaska Native children in rural Alaska. This was a follow-up cohort study of a 1993-1996 case-control study of RSV-hospitalized case patients and their controls. For each 5-8-year-old former case-patient and control subject, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed all historical chest radiographs. Ten (11%) RSV cases and 10 (9%) controls had radiographic evidence of bronchiectasis. The mean age at radiographic diagnosis of bronchiectasis was 3.3 years (range, 1.2-6.1 years). Children were more likely to develop bronchiectasis if their chest radiographs, when they were2 years of age, showed lung parenchymal densities (RR = 3.9, P0.013), persistent parenchymal densities6 months' duration (RR = 3.0, P = 0.02), or infiltrates on multiple episodes (test for trend, P = 0.003). Radiographic features of hyperinflation and atelectasis among children2 years old were not associated with eventual bronchiectasis. A single severe infection with RSV alone did not predispose Alaska Native infants to bronchiectasis. Childhood bronchiectasis was associated with lung and hence airway injury, manifested on radiographs by parenchymal densities or "pneumonia" rather than by hyperinflation or atelectasis.

Childhood asthma and atopy prevalence patterns in the developing world are only beginning to be defined. No such information exists for Vietnam. Estimates would assist in anticipating health service needs as well as add to the growing database on global patterns of atopy. To estimate the prevalence of atopic symptoms in school children in Ha Noi, Vietnam, a cross-sectional survey was conducted of children aged 5- to 11-years-old in two schools using the parent self-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The response rate was 66.4% (969 responses). The overall prevalence of selected symptoms were: 'ever wheezed' 24.9%, 'wheezed in past 12 months' 14.9%, 'ever had asthma' 12.1%, 'doctor-diagnosed asthma' 13.9%, 'ever experienced allergic rhinitis (AR) symptoms' 34.9%, 'AR-conjunctivitis symptoms in past 12 months' 10.7%, 'ever had hay fever' 7.8%, 'doctor-diagnosed hay fever' 11.2%, 'ever had eczema' 3.3% and 'doctor-diagnosed eczema' 3.2%. Kappa statistics demonstrated high within symptom category consistency for 'ever had asthma/doctor-diagnosed asthma' (0.728) and 'ever had eczema/doctor-diagnosed eczema' (0.906). Age and gender adjusted odds ratios (OR) were also consistently significant across wheeze and allergic rhinitis symptom categories [highest OR = 10.10 (95% CI 6.23-16.35) between allergic rhinoconjunctivitis and wheeze in past 12 months]. There is a high prevalence of ISAAC-based symptoms in school children in Ha Noi, Vietnam, often above global averages. The high level of association between atopic symptoms suggests some degree of reliability and validity. Childhood atopy symptom prevalence in Vietnam is more similar to that in developed countries rather than developing countries.