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Objective: To investigate the relationship between serum chitinase 3-like protein 1 (YKL-40) and peripheral blood CD4+/CD8+ratio with inflammatory factors and concurrent wheezing in children with adenoviral pneumonia (AP). Methods: 97 children with AP who were admitted to Hubei Provincial Maternal and Child Health Hospital from October 2019 to October 2022 were selected as the AP group. They were divided into wheezing group and non-wheezing group according to whether they were or not concurrent wheezing, and 50 healthy children in the same period were selected as the control group. Clinical data of children with AP were collected. Serum YKL-40 and inflammatory factors [interleukin (IL)-6, IL-8, tumor necrosis factor-α (TNF-α)] levels were measured by enzyme-linked immunosorbent assay, and peripheral blood CD4+and CD8+ratios were measured by flow cytometry and CD4+/CD8+ratios were calculated. Spearman correlation was used to analyze the correlation between serum YKL-40, peripheral blood CD4+/CD8+ratio and inflammatory factor levels in children with AP, and multi-factor logistic regression was used to analyze the factors influencing the complications of wheezing in children with AP. Results: Compared with the control group, serum YKL-40 and peripheral blood CD8+ratio were increased and CD4+ratio and CD4+/CD8+ratio were decreased in the AP group (P＜0.05). The levels of serum IL-6, IL-8, TNF-α in the AP group were higher than the control group (P＜0.05). Spearman correlation analysis showed that serum YKL-40 was positively correlated with IL-6, IL-8 and TNF-α levels and the peripheral blood CD4+/CD8+ratio was negatively correlated with IL-6, IL-8 and TNF-αlevels in children with AP (P＜0.05). The incidence rate of wheezing in 97 cases of children with AP during hospitalization was 50.52% (49/97). Multivariate Logistic regression analysis showed that respiratory failure, small airway lesions, atopic body mass and increased serum IL-6, IL-8, TNF-α and YKL-40 were independent risk factors for concurrent wheezing in children with AP, and increased peripheral blood CD4+/CD8+ratio was an independent protective factor (P＜0.05). Conclusion: Increased serum YKL-40 levels and reduced peripheral blood CD4+/CD8+ratios in children with AP are strongly associated with increased levels of inflammatory factors and concomitant wheezing. [ABSTRACT FROM AUTHOR]

Exposure to perfluoroalkyl substances (PFAS) may be harmful to humans; however, previous studies have been inconsistent regarding the potential for PFAS-induced immunosuppresion. This study explored the relationship between PFAS exposure and risks of asthma, wheezing, and immunosuppression in 12–19 year-olds using the National Health and Nutrition Examination Survey (NHANES) data. Logistic regression models were used to reveal associations between serum PFAS levels and risks of asthma, wheezing, asthma attack, and emergency department visits. Pearson's correlation was used to determine the relationship between serum PFAS levels and leukocyte count. Data were also stratified by sex. We found that medium–low levels of serum perfluorooctane sulfonate (PFOS) (6.90–12.40 ng/mL) and serum perfluorooctanoic acid (PFOA) (2.43–3.60 ng/mL) were negatively related, respectively, to current asthma and wheezing in boys, and to wheezing in girls. Meanwhile, boys with medium–high levels (1.50–3.00 ng/mL) of serum perfluorohexanesulfonate (PFHxS) had a high risk of wheezing. Among asthmatic participants, both medium–high levels (3.75–5.07 ng/mL) of serum PFOA and high levels (> 3.92 ng/mL) of PFHxS correlated with asthma attacks in boys; likewise, medium–low levels (0.70–0.99 ng/mL) of serum PFNA correlated with asthma attacks in girls. Also, PFOA and PFNA levels were weakly positively correlated with basophil count, whereas PFOS levels were weakly negatively correlated with eosinophils in asthmatic boys, indicating that basophils may be important in the immune response to PFAS exposure among asthmatics. [ABSTRACT FROM AUTHOR]

A few studies have already investigated preschool children with asthma during the pandemic. The purpose of this research was to investigate how preschool children with asthma were affected by the precautionary measures adopted during the pandemic. Preschool children with asthma aged 18–60 months evaluated in our clinic in March–May 2019, before the Covid-19 pandemic, were included in the study. The lockdown continued during March, April, and May 2020. The questionnaires and asthma symptom control tests for preschool children with asthma in 2019 and 2020 were then evaluated. Sixty-three preschool children with asthma, 37 boys and 26 girls, aged 18–60 months (median 47) were included in the study. The median number of upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs), and the use of antibiotics were significantly lower in 2020 than 2019 (p<.01). The median numbers of the pediatric emergency department (PED) visits and hospitalizations were also lower in 2020 than in 2019 (p<.05). In 2019, 31 children with asthma were well controlled, 28 were partly controlled, and 4 were uncontrolled, compared to 58 well controlled, four partly controlled, and one uncontrolled in 2020 (p<.01). Preschool children with asthma have been positively affected in terms of PED admission, hospitalization, and asthma symptom control in association with the Covid-19 pandemic and the resulting lockdown measures. This study revealed that wheezing decreased significantly in the absence of respiratory infection in preschool children with asthma. Namely, fewer infections meant less wheezing. [ABSTRACT FROM AUTHOR]

A decade-long neglect of rhinovirus as an important agent of disease in humans was primarily due to the fact that they were seen as less virulent and capable of causing only mild respiratory infections such as common cold. However, with an advent of molecular diagnostic methods, an increasing number of reports placed them among the pathogens found in the lower respiratory tract and recognized them as important risk factors for asthma-related pathology in childhood. As the spread of rhinovirus was not severely affected by the implementation of social distancing and other measures during the coronavirus disease 2019 (COVID-19) pandemic, its putative pathogenic role has become even more evident in recent years. By concentrating on children as the most vulnerable group, in this narrative review we first present classification and main traits of rhinovirus, followed by epidemiology and clinical presentation, risk factors for severe forms of the disease, long-term complications and the pathogenesis of asthma, as well as a snapshot of treatment trials and studies. Recent evidence suggests that the rhinovirus is a significant contributor to respiratory illness in both high-risk and low-risk populations of children. [ABSTRACT FROM AUTHOR]

At its introduction in the management of pediatric asthma, montelukast was regarded as a potentially revolutionary drug due to its mechanism of action and easy clinical applicability. Nevertheless, its use in daily practice and evidence from clinical trials have shown that, rather than a radical change in the approach to asthmatic children, montelukast more likely represents a second-line medication that is useful when inhaled steroids alone fail in providing adequate symptom control. Furthermore, increasingly reported side effects have raised concerns regarding its safety. In the last decade, several studies have tried to better define the strengths and drawbacks of montelukast both in preschool wheezing and school-age asthma. The present review summarizes the literature published on this topic since 2010, highlighting the often-controversial results and the unanswered questions regarding the role of montelukast in pediatric asthma. Moreover, advances in the understanding of the mechanisms of action of montelukast are reported. The main finding emerging from the present analysis is that montelukast application is likely to be useful in a subset of asthmatic children rather than in large groups of patients. Future studies should focus on the identification of biomarkers able to predict which patients will benefit from montelukast to achieve a more tailored prescription. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) stimulates the production of specific immunoglobulin (Ig) E and IgG4 antibodies as a hallmark of the Th2 immune response. In this paper, we evaluated the occurrence of atopic diseases in 10-year-old children who were positive for RSV-specific IgG antibodies during infancy. Methods: The prospective follow-up of 72 children included a physical examination, an International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and the determination of RSV-specific antibodies and total and allergen-specific IgE. Results: Children with asthma had their first wheezing episode at a younger age (χ2 8.097, df = 1, p = 0.004). RSV-specific IgG4 levels at year one were positively correlated with atopic dermatitis (AD) (tau_b = 0.211, p = 0.049) and current AD (tau_b = 0.269, p = 0.012); and RSV-specific IgE levels were positively correlated with allergic rhinitis (AR) (tau_b = 0.290, p = 0.012) and current AR (tau_b = 0.260, p = 0.025). Positive RSV-specific IgE at the age of one increased the chances of asthma occurrence by 5.94 (OR = 5.94, 95% CI = 1.05–33.64; p = 0.044) and the chances of AR by more than 15 times (OR = 15.03, 95% CI = 2.08–108.72; p = 0.007). A positive family history of atopy increased the chances of asthma occurrence by 5.49 times (OR = 5.49, 95% CI = 1.01–30.07; p = 0.049), and a longer duration of exclusive breastfeeding lowered that chance (OR = 0.63, 95% CI = 0.45–0.89; p = 0.008). Prenatal smoking increased the chances of AR occurrence by 7.63 times (OR = 7.63, 95% CI = 1.59–36.53; p = 0.011). Conclusion: RSV-specific IgE and RSV-specific IgG4 antibodies could be risk markers for the development of atopic diseases in children. [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]

Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors that may contribute to recurrent wheezing in infants under the age of five. Material and Method: In the Outpatient Department of Saveetha Medical College and Hospital, Chennai, a cross-sectional investigation was conducted on children younger than 5 years old. The study group consisted of fifty infants with symptoms and signs of recurrent wheezing. All of the parents filled out the questionnaires provided. To comprehend the characteristics of the study groups, a statistical analysis of descriptive data was conducted. The risk factors were analyzed using bivariate and multivariate statistical analyses that included all significant predictors with a p

Wheezing is a critical indicator of various respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD). Current diagnosis relies on subjective lung auscultation by physicians. Enabling this capability via a low-profile, objective wearable device for remote patient monitoring (RPM) could offer pre-emptive, accurate respiratory data to patients. With this goal as our aim, we used a low-profile accelerometer-based wearable system that utilizes deep learning to objectively detect wheezing along with respiration rate using a single sensor. The miniature patch consists of a sensitive wideband MEMS accelerometer and low-noise CMOS interface electronics on a small board, which was then placed on nine conventional lung auscultation sites on the patient’s chest walls to capture the pulmonary-induced vibrations (PIVs). A deep learning model was developed and compared with a deterministic time–frequency method to objectively detect wheezing in the PIV signals using data captured from 52 diverse patients with respiratory diseases. The wearable accelerometer patch, paired with the deep learning model, demonstrated high fidelity in capturing and detecting respiratory wheezes and patterns across diverse and pertinent settings. It achieved accuracy, sensitivity, and specificity of 95%, 96%, and 93%, respectively, with an AUC of 0.99 on the test set—outperforming the deterministic time–frequency approach. Furthermore, the accelerometer patch outperforms the digital stethoscopes in sound analysis while offering immunity to ambient sounds, which not only enhances data quality and performance for computational wheeze detection by a significant margin but also provides a robust sensor solution that can quantify respiration patterns simultaneously.

Introduction and aim: A direct causal relationship between vitamin D (vit D) deficiency and recurrent wheezing has not been proven. The present study investigated the role of vit D in enhancing the risk of asthma or recurrent wheezing by modifying the intensity of the inflammatory process. Material and method: Forty children with wheezing presenting at the emergency service and sixteen healthy control subjects were included in the study. Children with wheezing were either in the first episode (20) or with recurrent wheezing (20). Children with chronic diseases, and other conditions that present with acute wheezing or that might influence the vit D level, were excluded. Blood samples were taken at presentation and 3–6 months later, to evaluate the serum levels of total IgE, vit D, IL-10 and IL-31. Statistical analysis was performed using the SPSS 25 program, with a significance level of p < 0.05. Results and conclusion. The vit D level was lower in patients with recurrent wheezing compared with those with a single episode and with the control group, and this increased with time. IL-10 was significantly higher in children with wheezing than in the control group, with the highest values in those with an acute episode of wheezing. IL-31 was higher in children with recurrent wheezing than in those with a first episode only at the initial point, while at the final time point it was lower. Low levels of vit D appear to be detected more frequently in recurrent wheezing than in simple wheezing. Immune modulation, as measured by Th2 status reflected by IL-10 and IL-31 levels, appears to depend on the wheezing phenotype and on the general health status.

Hodgkin's disease with an initial tracheobronchial involvement is extremely rare. The symptoms might be misleading, resulting in a diagnosis delay. We report the case of a 38-year-old woman with a one-month history of wheezing and a non-productive cough. The physical examination revealed a good general state of health, bilateral diffuse wheezing and supra-clavicular lymphadenopathy. The adenopathy biopsy's histopathology revealed Hodgkin's disease. The whole body FDG-PET scan was an important tool to assess the diagnosis as well as for the staging. The patient was treated with chemotherapy. Another unusual aspect is the tracheobronchial metastasis confirmed by a bronchial biopsy. Thus, our patient was put on a second-line chemotherapy. She died one year after the initial diagnosis. To conclude, it is a rare case of an Hodgkin lymphoma with a tracheobronchial relapse. It should be considered in the differential diagnosis of a tracheal tumor.

Foreign body aspiration (FBA) is one of the common causes of significant morbidity and mortality in a toddler child. Airway foreign bodies might be presented as a spectrum, ranging from the acute onset of choking, cyanosis, and respiratory distress to delayed onset of mild respiratory distress, wheezing, persistent cough, and fever. Here, we report a case of peanut aspiration in a toddler child, who was initially being treated as acute bronchial asthma, and the diagnosis was subsequently confirmed on computed tomography (CT) chest as a case of tracheal FBA. A foreign body was successfully retrieved by rigid bronchoscopy under general anesthesia and was a peanut by morphology. The possibility of FBA should be considered in any toddler child, who presents for the first time with acute bronchial asthma-like symptoms; wheezing, coughing, or respiratory distress. In a resource-limited setting, low-dose CT chest can be an early noninvasive diagnostic tool to detect all airway foreign bodies.

Foreign body aspiration (FBA) is one of the common causes of significant morbidity and mortality in a toddler child. Airway foreign bodies might be presented as a spectrum, ranging from the acute onset of choking, cyanosis, and respiratory distress to delayed onset of mild respiratory distress, wheezing, persistent cough, and fever. Here, we report a case of peanut aspiration in a toddler child, who was initially being treated as acute bronchial asthma, and the diagnosis was subsequently confirmed on computed tomography (CT) chest as a case of tracheal FBA. A foreign body was successfully retrieved by rigid bronchoscopy under general anesthesia and was a peanut by morphology. The possibility of FBA should be considered in any toddler child, who presents for the first time with acute bronchial asthma-like symptoms; wheezing, coughing, or respiratory distress. In a resource-limited setting, low-dose CT chest can be an early noninvasive diagnostic tool to detect all airway foreign bodies. [ABSTRACT FROM AUTHOR]

Nannan Jiang,1– 3 Wei Xu,1– 3 Huijie Huang,1– 3 Xiaoling Hou,1– 3 Li Xiang1– 3 1Department of Allergy, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, People’s Republic of China; 3China National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of ChinaCorrespondence: Li Xiang, Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing, People’s Republic of China, Tel/Fax +861059616934, Email dr_xiangli2022@126.comPurpose: Asthma and recurrent wheezing (RW) have been identified as risk factors for anaphylaxis; however, little is known about the characteristics of anaphylaxis in children with a history of asthma or RW in Chinese children.Patients and Methods: This was a retrospective, observational chart review of children who were diagnosed with anaphylaxis in a tertiary children’s hospital between 2014 and 2021. Patients’ demographics, symptoms, triggers and presence of physician-diagnosed asthma/RW history were collected from medical charts.Results: A total of 399 anaphylactic reactions in 264 patients were analyzed; 119 patients (45.1%) had a history of asthma/RW. Food was the most common cause (85.5%, 341/399). Compared with patients without a history of asthma/RW, buckwheat-induced anaphylaxis was significantly more common in the asthma/RW group (9.4% vs 0.5%, p < 0.001), patients with a history of asthma/RW had higher rates of oropharyngeal symptoms (17.3% vs 8.6%, p = 0.011) and wheezing (34.5% vs 15.9%, p < 0.001). Ninety-one reactions (22.8%, 91/399) presented as severe anaphylaxis, but no difference existed between asthma/RW and non-asthma/RW groups. Children with a history of asthma/RW were more likely to receive inhaled β agonists than children without a history of asthma/RW (11.8% vs 2.5%, p = 0.003). A larger proportion of children without asthma/RW history were treated with epinephrine (11.7%) than children with asthma/RW history (6.9%).Conclusion: Our finding revealed that different clinical profiles of anaphylaxis in children with and without a history of asthma/RW. Our study did not find that children with a history of asthma/RW have more severe anaphylactic reactions compared with children without asthma/RW. Buckwheat-induced anaphylaxis was more common in the asthma/RW group, wheezing and oropharyngeal symptoms affected a higher proportion of the asthma/RW group.Keywords: anaphylaxis, asthma, epinephrine, wheezing, children

Abstract Background Constipation has been hypothesized to be associated with the increased risk of wheezing or asthma. However, the relation remains a subject of debate. We conducted this meta-analysis to assess whether constipation influences the risk of wheezing/asthma. Methods PubMed, Embase, and Web of Science were systematically searched for studies published between 1955 and January 2022. Two reviewers independently extracted data and assessed the quality of each study. Results were pooled using fixed-effects models or random-effects models as appropriate. Results In total, 3 original articles with 178,661 participants, which met the criteria, were included in this meta-analysis. Constipation was associated with an increased risk of wheezing/asthma in later life (RR = 2.02, 95% CI = 1.24–3.29, P

This article discusses the imaging feature of active pulmonary tuberculosis known as the Nodular Reverse Halo Sign (NRHS). The case study focuses on a 19-year-old female patient who presented with symptoms of cough, fever, loss of appetite, and weight loss. High-resolution computed tomography (HRCT) of the lungs revealed the NRHS, along with other findings consistent with post-primary pulmonary tuberculosis. The NRHS is associated with active granulomatous infections, particularly pulmonary tuberculosis, and can aid in the early diagnosis and effective management of the disease. [Extracted from the article]

BackgroundProtracted bacterial bronchitis (PBB) is often diagnosed clinically according to chronic wet cough, which can be resolved by appropriate antibiotics. Though rarely performed in PBB diagnosis, bacterial cultures by sputum or bronchoalveolar lavage (BAL) fluid can provide etiological features, which may be different in western countries and different areas of China. This study aimed to investigate the clinical and etiological features and outcomes in children of different ages with PBB in northeast China.MethodsWe retrospectively analyzed children diagnosed with PBB by positive BAL fluid or sputum bacterial cultures between 2017 and 2021. Children were divided into three age groups:

IntroductionThe association between sleep duration and cough, wheezing, and dyspnea was unclear. This research aimed to test this relationship.MethodsResearch data were obtained from people who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2012. We used weighted logistic regression analysis and fitted curves to explore the association between sleep and respiratory symptoms. In addition, we investigated the association between sleep duration, chronic obstructive pulmonary disease (COPD), and asthma. The stratified analysis is used to analyze inflection points and specific populations.ResultsThe 14,742 subjects are weighted to reflect the 45,678,491 population across the United States. Weighted logistic regression and fitted curves show a U-shaped relationship between sleep duration and cough and dyspnea. This U-shaped relationship remained in people without COPD and asthma. The stratified analysis confirmed that sleep duration before 7.5 h was negatively associated with cough (HR 0.80, 95% CI 0.73–0.87) and dyspnea (HR 0.82, 95% CI 0.77–0.88). In contrast, it was positively associated with cough and (HR 1.30, 95% CI 1.14–1.48) dyspnea (HR 1.12, 95% CI 1.00–1.26) when sleep duration was >7.5 h. In addition, short sleep duration is associated with wheezing, asthma, and COPD.ConclusionBoth long and short sleep duration are associated with cough and dyspnea. And short sleep duration is also an independent risk factor for wheezing, asthma, and COPD. This finding provides new insights into the management of respiratory symptoms and diseases.

Background: There is a large deal of heterogeneity in the clinical appearance, duration, and course of the disease among children who wheeze and have recurrent coughs. Objectives: To evaluate clinically, epidemiologically and laboratory the children attended to Al-Azhar Assuit University Hospital by coughing and wheezing. Subjects and Methods: This study is a retrospective study between 1st March 2020 and the 28th February 2021 and prospective study between 1st March 2021 and 30th November 2021 and was carried out in outpatient and inpatient Pediatric Chest Unit in Al-Azhar Assuit University Hospital. Result: Among the studied cases (Total n=324), there were 106 (32.8%) suffered from bronchial asthma, 81 (25%) suffered from pneumonia, 63 (19.4%) suffered from bronchiolitis, 27 (8.3%) suffered from COVID-19 and 47 (14.5%) suffered from other cases such as bronchitis, GERD, lung abscess and F.B. Conclusion: Cough in pediatric is due to multiple underlying causes, the most common are bronchial asthma, pneumonia, bronchiolitis, COVID-19, foreign body aspiration, and gastroesophageal reflux. Bronchial asthma was more prevalent among age (6-12) years but pneumonia was among age (1-6) years, bronchiolitis was among age (1-2) years and COVID-19 was among age (12-18) years. Bronchial asthma and infections as pneumonia and bronchiolitis had declined among breast feeding cases. [ABSTRACT FROM AUTHOR]

Chronic cough is a common symptom with a diversity of underlying respiratory causes. The COVID-19 pandemic has added complexity to the identification of the etiology of chronic cough, as persistent cough has been frequently reported among COVID-19 survivors. We present a case of a 21-year-old woman, with prolonged cough and wheezing following a mild COVID-19 infection. Despite multiple attempts to recognize the cause and manage her cough, her symptoms did not improve. A careful examination revealed monophonic wheezing and purulent sputum, raising suspicion for Endobronchial Tuberculosis (EBTB). Chest computed tomography scan showed a tree-in-bud pattern and narrowed the bronchial lumen. Acid-fast bacillus smear and genXpert MTB/RIF test further confirmed the presence of Mycobacterium tuberculosis. This case highlights the importance of considering EBTB as a potential diagnosis for chronic cough, particularly in COVID-19 survivors in tuberculosis-endemic areas. [ABSTRACT FROM AUTHOR]

Background: We examined the associations between factors evident at the routine 3‐month well‐child visit (WCV) and the risk of developing 36‐month parent‐reported physician‐diagnosed bronchial asthma (BA). Methods: This longitudinal study was conducted in Nagoya City, Japan, and included 40,242 children who qualified for the 3‐month WCVs in the city between April 1, 2016 and March 31, 2018. In total, 22,052 (54.8%) questionnaires linked to their 36‐month WCVs were analyzed. Results: The prevalence of BA was 4.5%. The multivariable Poisson regression model identified male sex (adjusted risk ratio [aRR], 1.59; 95% confidence interval [CI]: 1.40–1.81), born in autumn (aRR, 1.30; 95% CI: 1.09–1.55), having at least one sibling (aRR, 1.31; 95% CI: 1.15–1.49), wheeze history before 3‐month WCVs, with clinic/hospital visit: aRR, 1.99; 95% CI: 1.53–2.56; hospitalization: aRR, 2.99; 95% CI: 2.09–4.12, eczema with itch (aRR, 1.51; 95% CI: 1.27–1.80), paternal history of BA (aRR, 1.98; 95% CI: 1.66–2.34), maternal history of BA (aRR, 2.11; 95% CI: 1.77–2.49), and rearing pets with fur (aRR, 1.35; 95% CI: 1.15–1.58) were independent risk factors for BA at 36 months of age. The combination of severe wheeze history (with clinic/hospital visit or hospitalization) and maternal and paternal BA could identify high‐risk infants whose prevalence of BA was 20%. Conclusions: The combined assessment of important clinical factors enabled us to identify high‐risk infants set to derive optimal benefit from health guidance provided to the parent or caregiver of the child or infant at WCVs. [ABSTRACT FROM AUTHOR]

Medical records of 16 Japanese Black calves with respiratory signs associated with perinatal rib fracture were analyzed, retrospectively, to speculate criteria of surgical intervention for the disease. For this analysis, the severity of respiratory condition was classified into three grades: Grade 1, with no wheezing, Grade 2, with wheezing after excitement but not at rest and Grade 3, with wheezing at rest. Grade 1 (n=3) received only conservative management. Seven of Grade 2 (n=8) and all of Grade 3 (n=5) had surgical management. Clinical outcome was good in all of Grade 1, and the surgical success rate was 83% in other groups. Our result suggests that surgical intervention should be considered for cases with more the severity of Grade 2. [ABSTRACT FROM AUTHOR]

Background: This study aimed to see association of exposure to solid fuel for cooking and second-hand smoking (SHS) with asthma and recurrent wheezing in children. Carboxyhaemoglobin (COHb) levels were also estimated levels in these children and their relation to exposure to solid fuels and SHS was assessed. Methods: The study enrolled 124 children in two groups; 72(58.1%) in Group 1 with asthma/recurrent wheezing and 52(41.9%) in Group 2 as controls. Exposure to SHS and solid fuel were assessed using a simple questionnaire in both the groups. COHb levels were estimated non-invasively and it's relation to demographic variables, occurrence of asthma, exposure to SHS and solid fuel was estimated. Conclusion: The study reported significant association of SHS and use of solid fuel among children with asthma and recurrent wheezing seen in 26(36.2%) and 26(36.2%) respectively. The study showed that COHb levels were greatly elevated among children with asthma and wheezing conditions (5.45%) as compared to controls (2.95%). The study showed association of COHb levels with use of SHS and solid fuel exposure which were found to be (5.31%, 5.98%) respectively, thus emphasizing the need for interventions to reduce these potential sources of carbon monoxide exposure. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of respiratory syncytial virus (RSV) among hospitalized children with acute lower respiratory tract infections (ALRI) and associated risk factors. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2019 to Aug 2020. Methodology: After approval from the Ethical Review Board, 126 children were included in the study. Nasopharyngeal aspirates were collected from children. The direct immunofluorescence method was utilized to detect intracellular viral antigens of the respiratory syncytial virus. In addition, the presence of symptoms and history for identification of the presence or absence of risk factors was recorded. Results: 57(45.2%) patients were found to be respiratory syncytial virus positive, and 69(54.8%) were respiratory syncytial virus negative. Significant differences were found in symptoms between RSV-positive and negative children (p=0.001). Conclusion: Respiratory syncytial virus was among the leading causes of children hospitalized with acute lower respiratory tract infections, with fever and recurrent wheezing as the most common symptoms. [ABSTRACT FROM AUTHOR]

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Rhinovirus (RV)‐specific surveillance studies in the Middle East are limited. Therefore, we aimed to study the clinical characteristics, outcomes, and seasonality of RV‐associated acute respiratory infection among hospitalized young children in Jordan. We conducted a prospective viral surveillance study and enrolled children <2 years old admitted to a large public hospital in Amman, Jordan (2010–2013). Demographic and clinical data were collected by structured interviews and chart abstractions. Nasal and/or throat swabs were collected and tested for a panel of respiratory viruses, and RV genotyping and speciation was performed. At least one virus was detected in 2641/3168 children (83.4%). RV was the second most common virus detected (n = 1238; 46.9%) and was codetected with another respiratory virus in 730 cases (59.0%). Children with RV codetection were more likely than those with RV‐only detection to have respiratory distress but had similar outcomes. RV‐A accounted for about half of RV‐positive cases (54.7%), while children with RV‐C had a higher frequency of wheezing and reactive airway disease. RV was detected year‐round and peaked during winter. In conclusion, though children with RV codetection had worse clinical findings, neither codetection nor species affected most clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Wheezing may lead to asthma and reduced pulmonary function in later life. The study aims to identify wheezing trajectories and investigate their relation with pulmonary function and asthma-related outcomes at 22 years of age. Methods: Individuals from a population-based cohort in Brazil (1993 Pelotas Birth Cohort) with post-bronchodilator pulmonary function data at 22 years (3350) were included in the study. From parentally reported (4 and 11 years) and self-reported (15, 18 and 22 years) history of wheezing in the last 12 months, we used a group-based trajectory modelling approach to derive wheezing trajectories. Results: Four trajectories were identified: never/infrequent, transient-early, late-onset and persistent wheeze. After adjustments, wheezing trajectories remained associated with lower post-bronchodilator values of pulmonary function. Individuals in the persistent wheeze trajectory had a markedly poorer pulmonary function and also showed greater odds of asthma-related outcomes compared to other trajectories groups. Those following this trajectory had on average −109 ml (95% CI: −188; −35), −1.80 percentage points (95% CI: −2.73; −0.87) and −316 ml/s (95% CI: −482; −150) lower FEV1, FEV1/FVC ratio and FEF25–75% respectively; higher odds of self-reported medical diagnosis of allergy (OR 6.18; 95% CI: 3.59; 10.61) and asthma (OR 12.88; 95% CI: 8.91; 18.61) and asthma medication use (OR 9.42; 95% CI: 5.27; 16.87) compared to the never/infrequent group. Conclusions: Wheezing trajectories, especially the persistent wheeze trajectory, were related to lower pulmonary function values and increased risk of asthma and allergy diagnosis in early adulthood.

Abstract Background Human rhinovirus (HRV) is the predominant etiological agent of the common cold in children and adults. A recent study showed that the inhibitory effect of face masks on viral shedding of HRV was less prominent than that on other respiratory viruses. Considering that most Chinese people have worn face masks in public area since the outbreak of coronavirus disease 2019, we aimed to find out whether HRV prevailed among children in 2020 and demonstrate the details of the epidemiological features of HRV under such a special circumstance. Methods We summarized the incidences of various respiratory virus infections in patients who visited the Children’s Hospital of Fudan University during 2018–2020, and genotyped HRV positive nasopharyngeal specimens collected from 316 inpatients and 72 outpatients that visited the hospital in 2020. Results There was a major prevalence of HRV among children in the latter half of 2020, with a clear seasonality that HRV-As prevailed in summer while HRV-Cs in autumn. HRV-As were more prone to cause severe lower respiratory tract infections (LRTI), while HRV-Cs were closely associated with childhood wheezing. The predominant genotypes were A11, A28, A47, A82, A101, C40 and C43. Notably, A21, A82 and A101 took up larger proportions in severe cases than in non-severe cases. Conclusions Our findings described a major prevalence of HRVs among children in 2020, which highlight the unique transmitting pattern of HRV and help to narrow the targets for antiviral strategies.

BackgroundDifferences in bronchial microbiota composition have been found to be associated with asthma; however, it is still unclear whether these findings can be applied to recurrent wheezing in infants especially with aeroallergen sensitization.ObjectivesTo determine the pathogenesis of atopic wheezing in infants and to identify diagnostic biomarkers, we analyzed the bronchial bacterial microbiota of infants with recurrent wheezing and with or without atopic diseases using a systems biology approach.MethodsBacterial communities in bronchoalveolar lavage samples from 15 atopic wheezing infants, 15 non-atopic wheezing infants, and 18 foreign body aspiration control infants were characterized using 16S rRNA gene sequencing. The bacterial composition and community-level functions inferred from between-group differences from sequence profiles were analyzed.ResultsBoth α- and β-diversity differed significantly between the groups. Compared to non-atopic wheezing infants, atopic wheezing infants showed a significantly higher abundance in two phyla (Deinococcota and unidentified bacteria) and one genus (Haemophilus) and a significantly lower abundance in one phylum (Actinobacteria). The random forest predictive model of 10 genera based on OTU-based features suggested that airway microbiota has diagnostic value for distinguishing atopic wheezing infants from non-atopic wheezing infants. PICRUSt2 based on KEGG hierarchy (level 3) revealed that atopic wheezing-associated differences in predicted bacterial functions included cytoskeleton proteins, glutamatergic synapses, and porphyrin and chlorophyll metabolism pathways.ConclusionThe differential candidate biomarkers identified by microbiome analysis in our work may have reference value for the diagnosis of wheezing in infants with atopy. To confirm that, airway microbiome combined with metabolomics analysis should be further investigated in the future.

BackgroundThere is limited information available on fast and safe bedside tools that could help clinicians establish whether the pathological process underlying cases of wheezing is due to asthmatic exacerbation, asthmatic bronchitis, or pneumonia. The study's aim was to characterize Lung Ultrasound (LUS) in school-aged children with wheezing and evaluate its use for their follow-up treatment.Materials and methodsWe carried out a cross-sectional study involving 68 consecutive outpatients (mean age 9.9 years) with wheezing and suggestive signs of an acute respiratory infection. An expert sonographer, blinded to all subject characteristics, clinical course, and the study pediatrician's diagnosis, performed an LUS after spirometry and before BDT. The severity of acute respiratory symptoms was determined using the Pediatric Respiratory Assessment Measure (PRAM) score.ResultsThe LUS was positive in 38.2% (26/68) of patients [12 (46.1%) with multiple B-lines, 24 (92.3%) with consolidation, and 22 (84.6%) with pleural abnormalities]. In patients with pneumonia, asthmatic bronchitis, and asthma, the percentages of those patients with a positive LUS were 100%, 57.7%, and 0%, respectively. Of note, patients with a positive LUS were associated with an increased need for hospital admission (30.8% vs. 2.4%, p = 0.001), administration of oxygen therapy (14.6% vs. 0%, p = 0.009), oral corticosteroids (84.6% vs. 19.0%, p

RationaleThe relationship between respiratory function at hospital discharge and the severity of later respiratory disease in extremely low gestational age neonates is not well defined.ObjectivesTo test the hypothesis that tidal breathing measurements near the time of hospital discharge differ between extremely premature infants with bronchopulmonary dysplasia (BPD) or respiratory disease in the first year of life and those without these conditions.MethodsStudy subjects were part of the PROP (Prematurity and Respiratory Outcomes Program) study, a longitudinal cohort study of infants born at less than 29 gestational weeks followed from birth to 1 year of age. Respiratory inductance plethysmography was used for tidal breathing measurements before and after inhaled albuterol 1 week before anticipated hospital discharge. Infants were breathing spontaneously and were receiving less than or equal to 1 L/min nasal cannula flow at 21% to 100% fraction of inspired oxygen. A survey of respiratory morbidity was administered to caregivers at 3, 6, 9, and 12 months corrected age to assess for respiratory disease. We compared tidal breathing measurements in infants with and without BPD (oxygen requirement at 36 wk) and with and without respiratory disease in the first year of life. Measurements were also performed in a comparison cohort of term infants.ResultsA total of 765 infants survived to 36 weeks postmenstrual age, with research-quality tidal breathing data in 452 out of 564 tested (80.1%). Among these 452 infants, the rate of postdischarge respiratory disease was 65.7%. Compared with a group of 18 term infants, PROP infants had abnormal tidal breathing patterns. However, there were no clinically significant differences in tidal breathing measurements in PROP infants who had BPD or who had respiratory disease in the first year of life compared with those without these diagnoses. Bronchodilator response was not significantly associated with respiratory disease in the first year of life.ConclusionsExtremely premature infants receiving less than 1 L/min nasal cannula support at 21% to 100% fraction of inspired oxygen have tidal breathing measurements that differ from term infants, but these measurements do not differentiate those preterm infants who have BPD or will have respiratory disease in the first year of life from those who do not. Clinical trial registered with www.clinicaltrials.gov (NCT01435187).

Objective: To determine the frequency of respiratory syncytial virus (RSV) among hospitalized children with acute lower respiratory tract infections (ALRI) and associated risk factors. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2019 to Aug 2020. Methodology: After approval from the Ethical Review Board, 126 children were included in the study. Nasopharyngeal aspirates were collected from children. The direct immunofluorescence method was utilized to detect intracellular viral antigens of the respiratory syncytial virus. In addition, the presence of symptoms and history for identification of the presence or absence of risk factors was recorded. Results: 57(45.2%) patients were found to be respiratory syncytial virus positive, and 69(54.8%) were respiratory syncytial virus negative. Significant differences were found in symptoms between RSV-positive and negative children (p=0.001). Conclusion: Respiratory syncytial virus was among the leading causes of children hospitalized with acute lower respiratory tract infections, with fever and recurrent wheezing as the most common symptoms.

Wheezing at preschool age (i.e., before the age of six) is common, occurring in about 30% of children before the age of three. In terms of health care burden, preschool children with wheeze show double the rate of access to the emergency department and five times the rate of hospital admissions compared with school-age asthmatics. The consensus document aims to analyse the underlying mechanisms involved in the pathogenesis of preschool wheezing and define the risk factors (i.e., allergy, atopy, infection, bronchiolitis, genetics, indoor and outdoor pollution, tobacco smoke exposure, obesity, prematurity) and the protective factors (i.e., probiotics, breastfeeding, vitamin D, influenza vaccination, non-specific immunomodulators) associated with the development of the disease in the young child. A multidisciplinary panel of experts from the Emilia-Romagna Region, Italy, addressed twelve key questions regarding managing preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes). Systematic reviews have been conducted on PubMed to answer these specific questions and formulate recommendations. The GRADE approach has been used for each selected paper to assess the quality of the evidence and the degree of recommendations. Based on a panel of experts and extensive updated literature, this consensus document provides insight into the pathogenesis, risk and protective factors associated with the development and persistence of preschool wheezing. Undoubtedly, more research is needed to improve our understanding of the disease and confirm the associations between certain factors and the risk of wheezing in early life. In addition, preventive strategies must be promoted to avoid children's exposure to risk factors that may permanently affect respiratory health. [ABSTRACT FROM AUTHOR]

Objective: To analyze the bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in a cohort in southern Brazil. Methods: This prospective longitudinal study used data from the 1993 birth cohort in Pelotas, Brazil. The following outcome variables were measured at 22 years of age: self-reported wheezing during the last 12 months and obesity (BMI ≥ 30 kg/m2). The following exposure variables were measured at ages 11, 15, and 18: self-reported wheezing (no wheezing or symptom presentation in 1, 2, or 3 follow-ups) and obesity (non-obese or obese in 1, 2, or 3 follow-ups). Crude and adjusted logistical regression stratified by sex were used in the analyses. The reference category was defined as participants who presented no wheezing or obesity. Results: A total of 3,461 participants had data on wheezing and 3,383 on BMI. At 22 years of age, the prevalence of wheezing was 10.1% (95%CI: 9.1; 11.2), and obesity, 16.2% (95%CI: 15.0; 17.6). In females, the presence of wheezing in two follow-ups revealed a 2.22-fold (95%CI: 1.36; 3.61) greater chance of developing obesity at 22 years of age. Meanwhile, the presence of obesity in two follow-ups resulted in a 2.03-fold (95%IC: 1.05; 3.92) greater chance of wheezing at 22 years of age. No associations were found between wheezing and obesity in males. Conclusions: The obtained data suggest a possible positive bidirectional association between wheezing and obesity, with greater odds ratios in the wheezing to obesity direction in females and in the category of occurrence of exposure in two follow-ups. [ABSTRACT FROM AUTHOR]

Objective·To investigate the potential risk factors of recurrent wheezing in preschool children. Methods·A casecontrol study was conducted in 370 children with wheezing admitted to the Department of Respiratory Medicine in a specialized hospital for children in Shanghai from December 2019 to December 2020. The children were preschool children aged 3-6 years. According to the frequency of wheezing, pediatric patients were divided into occasional wheezing group (1-2 attacks per year) and recurrent wheezing group (≥3 attacks per year). The face-to-face questionnaire was performed to the parents responding for basic information and recurrent wheezing risk factors including the children age, gender, gestational age, birth weight, history of eczema, history of allergic rhinitis, history of food allergy, history of inhalational pollen allergy, history of bronchiolitis, maternal age, production mode, feeding pattern, history of parental asthma, resident area (city/village), passive smoking, history of pet contact, seasonal factors, etc. Univariate analysis was used to compare risk factors of recurrent wheezing between the two groups. Logistic regression analysis was used to analyze the independent risk factors associated with recurrent wheezing. Results·Three hundred and seventy cases were enrolled, including 204 cases (55.14%) in the occasional wheezing group and 166 cases (44.86%) in the recurrent wheezing group. A total of 10 risk factors were determined for recurrent wheezing, which included children's age (χ²= 36.608, P=0.000), gender (χ²=4.290, P=0.038), eczema (χ²=6.250, P=0.012), allergic rhinitis (χ²=10.787, P=0.001), inhaling pollen (χ²=8.868, P=0.003), history of bronchiolitis (χ²=27.898, P=0.000), gestational age (χ²=5.141, P=0.023), feeding pattern (χ²=4.316, P=0.038), parental asthma history (χ²=5.050, P=0.025) and resident area (χ²=31.013, P=0.000). The Logistic regression showed that allergic rhinitis (OR=4.759, 95%CI 1.665-13.603), bronchiolitis (OR=12.113, 95%CI 5.686-25.802), premature birth (OR=3.092, 95%CI 1.120-8.539) and living in city (OR=2.395, 95%CI 1.326-4.324) were the independent risk factors of recurrent wheezing. Conclusion·The independent risk factors for recurrent wheezing in preschoolers include allergic rhinitis, bronchiolitis, premature birth and living in city. [ABSTRACT FROM AUTHOR]

Background: Resolution rates of IgE-mediated cow's milk allergy (IgE-CMA) by age 5 years, and risk factors for its persistence were previously described., Objective: To extend follow-up until the end of adolescence., Methods: An extension study of 23 of 54 patients diagnosed with IgE-CMA from a population-based study of 13,019 newborns, who remained allergic at age 5 years. Patients were examined at age 17 and their history reviewed. Resolution was determined by regular milk consumption without adverse reactions, or a negative oral food challenge (OFC). Allergy was defined by a recent objective reaction to milk and a positive skin prick test (SPT), or by sensitization ≥95% PPV to milk. Risk factors for persistence at age 17 were examined in the entire cohort., Results: Of the 23 patients followed, 8/23 (35%) had spontaneous resolution, and 15 had persistent IgE-CMA. Overall, 39 (72.2%) of the 54 patients initially diagnosed with IgE-CMA had spontaneous resolution by age 17. Risk factors for IgE-CMA persistence at age 17 years included SPT >6 mm at time of diagnosis (p=0.03), no cow's milk formula feeding in the nursery (p=0.008), and wheezing on diagnostic OFC/initial reaction to milk (p=0.04). Seven patients experienced objective reactions after age 5 years. These patients had more wheezing (p=0.045) or anaphylaxis (p=0.02) on diagnostic OFC/initial reaction and more current asthma (p=0.007)., Conclusion: Significant rate of spontaneous resolution of IgE-CMA still occurs beyond age 5 and few patients with IgE-CMA, mostly asthmatics, experience objective reactions by early adulthood. This should be considered in the treatment approach of IgE-CMA patients., (Copyright © 2024. Published by Elsevier Inc.)

Simple clinical indices, complex composite phenotyping/endotyping and telehome monitoring now allow us to evaluate the risk of preschool wheezing on a population or individual level. We herein discuss the usefulness of clinical markers which involve underlying issues such as in utero smoke exposure, the pathophysiology of viral-immunological-allergic interactions, and changes in airway epithelium, mesenchyme and smooth muscle cells. The most important unmet need in this age group remains disease-modifying interventions., (Pediatric Pulmonology© 2024 The Author(s). Pediatric Pulmonology published by Wiley Periodicals LLC.)

A 7-year-old girl with hematuria and clinical suspicion of Alport syndrome (AS) presented with dyspnea and nocturnal cough, initially diagnosed and treated as asthma. Despite inhaled corticosteroid therapy, her symptoms persisted, and spirometry indicated obstructive lung function without bronchodilator response. Chest CT revealed diffuse thickening of the esophageal wall, tracheal compression, with involvement of the gastric cardia, suggestive of diffuse leiomyomatosis. Subsequent genetic reanalysis confirmed the presence of a contiguous deletion of COL4A5 and COL4A6 genes, solidifying the diagnosis of AS. Diffuse leiomyomatosis, a rare benign neoplasm associated with AS, typically manifests as dysphagia, but in this case, it presented initially with asthma-like symptoms. This case emphasizes the importance of imaging when asthma treatment fails, particularly in patients with coexisting conditions of another system., (© 2024 Wiley Periodicals LLC.)

Background: Limited investigations have focused on the association between the Mediterranean dietary (MeD) and asthma among children and adolescents. We aimed to study the associations between a modified Mediterranean dietary pattern and asthma symptoms in children living in Iran., Method: This cross-sectional study was conducted among 7667 children and adolescence. Data on dietary intakes, asthma symptoms and other possible confounders, were collected using a questionnaire completed by parents. The relationship between Mediterranean diet (MeD) and asthma was assessed using logistic regression., Results: We found that participants in the highest quartile of MeD score had 32% lower odds of wheezing in the past 12 months in the whole population when compared with those in the lowest quartile (OR: 0.68; 95% CI: 0.51-0.90; P trend  < 0.001). Regarding the wheezing, a linear reducing trend was observed in girls (OR: 0.88; 95% CI: 0.62-1.25; P trend  = 0.04); and a significant protective association was seen among boys (OR: 0.45; 95% CI: 0.28-0.73; P trend  < 0.001). Analyses by gender showed, girls and boys in the highest quartile had 68% and 51% lower odds of current asthma in comparison with the first quartile., Conclusion: Mediterranean-style diet emphasizing high in fruits, vegetables, and cereals and low in fast foods is associated with reduced wheezing as an asthma-related symptom. On the other hand, meat intake has adverse correlation with asthma prevalence. No association was found between this dietary pattern and asthma. Further prospective investigations should be conducted to confirm these findings., (© 2024 The Authors.)