Search

INTRODUCTION Exercise-induced bronchospasm (EIB) is common in young asthmatics and obesity is becoming an epidemic in this population. Both conditions can give rise to or worsen respiratory symptoms upon exercise and may interfere with recreational and sports activities. OBJECTIVE To investigate the association between obesity and the risk and severity of EIB in asthmatic children and adolescents. METHODS This study included data from asthmatic patients aged between 7 and 19 years undergoing treadmill running tests to evaluate EIB, defined as a reduction greater than or equal to 10% in forced expiratory volume in the first second (FEV1 ) compared to baseline. Eutrophic, obese, and overweight individuals were categorized according to body mass index z-score (eutrophic, -0.5

In contrast to spirometry, which requires active participation of the individual and is challenging for the preschool age group, the impulse oscillometry system comprises a test that minimizes the degree of coordination required. The study aimed to compare the results of Impulse Oscillometry System (IOS) in children with and without respiratory symptoms.A cross-sectional study was conducted in children aged between 3 and 6 years. A short version of the ATS-DLD-78-C questionnaire validated for Brazilian children was applied to identify two groups: children with and without respiratory symptoms. The IOS analysis was carried out measuring the following parameters in triplicate: resistance at 5 Hz (R5Hz) and 20 Hz (R20Hz), respiratory reactance at 5 Hz (X5Hz), and R5-R20Hz before and after bronchodilator application.A total of 76 preschoolers were selected, 55 (72.4%) of whom had respiratory complaints. The coefficient of variability of R5Hz was ≤17% in 70/76 (92.1%) of the children. Resistances at R5Hz and R5-R20Hz in the children with respiratory complaints reached values higher than those of children without symptoms before bronchodilation.The results obtained for resistance using IOS in children with respiratory symptoms were higher in the pre-bronchodilator examination for R5Hz and R5-R20Hz compared to those of children without respiratory symptoms.Prospective investigations suggest that irreversible changes in lung function begin in infancy, before reaching school age. Pulmonary function follow-up in children with recurrent wheezing or asthma is important for confirmation of diagnosis and evaluation of the disease severity. The Impulse Oscillometry System (IOS) can be useful in assessing children's pulmonary function since it requires minimal patient cooperation and can be successfully applied to preschool children being an alternative to individuals who have difficulty performing spirometry.

RESUMO Objetivo: Avaliar a prevalência e a gravidade da sibilância em lactentes no primeiro ano de vida, utilizando o protocolo padronizado do Estudio Internacional de Sibilancias en Lactantes- fase 3, e comparar os valores obtidos com os observados no Estudio Internacional de Sibilancias en Lactantes- fase 1, realizado no mesmo centro. Métodos: Entre 2009 e 2010, pais e responsáveis de lactentes responderam ao questionário escrito do Estudio Internacional de Sibilancias en Lactantes- fase 3, e os resultados obtidos foram comparados aos do Estudio Internacional de Sibilancias en Lactantes- fase 1, realizado entre 2005 e 2006. Oslactentes foram separados em sibilantes e “não sibilantes”. Osprimeiros foram divididos de acordo com a frequência dos episódios: sibilância ocasional, quando apresentaram menos de três, e sibilância recorrente, quando manifestaram três ou mais. Resultados: A prevalência de sibilantes foi similar nas duas fases (44,6 versus46%). Segundo a frequência, houve aumento na prevalência de sibilância ocasional (19,4 versus 23%; p=0,03) e redução na de sibilância recorrente (26,7 versus 21,6%; p=0,005). Observou-se, ainda, aumento expressivo no diagnóstico de asma (7,5 versus 21,8%) e no uso de corticosteroides inalatórios (11,7 versus 35%), como também na hospitalização por sibilância na fase 3 (19,7 versus 32,6%), período da pandemia Influenza A (H1N1), o que pode ter contribuído para este desfecho. Conclusões: A prevalência da sibilância no primeiro ano de vida permanece elevada. Apesar de a avaliação temporal mostrar queda na prevalência da sibilância recorrente, aumento significante de sua morbidade foi identificado pelo maior número de hospitalizações. Além disso, houve indícios de melhora no manejo da sibilância dos lactentes, refletido pelo aumento do diagnóstico de asma e maior indicação de tratamentos preventivos.

The objective of this study was to identify risk factors for wheezing disorders in the first year of life in infants living in São Paulo (SP), Brazil, applying the standardized protocol of the Estudio Internacional de sibilancia en lactentes-Phase 1. A total of 1014 parents or caregivers of infants, who attended for routine evaluation and immunization in public health centers were interviewed in Southern SP city. Risk factors significantly associated with recurrent wheezing were: history of previous pneumonia, daycare attendance, consumption of processed food, presence of a cat at home, more than five upper respiratory infection (URI) episodes and the first URI before the age of sixth month. Most of these risk factors for wheezing can be avoided or controlled. Prospective studies on wheezing, especially in children with a severe presentation, are needed to analyze the impact of these risk factors and the effect of preventive actions.

Objetivo: Avaliar a prevalencia e a gravidade da sibilância, bem como sua relacao com o diagnostico medico de asma, em lactentes no primeiro ano de vida, utilizando o protocolo padronizado do “Estudio Internacional de Sibilancias en Lactantes” (EISL, Estudo Internacional de Sibilâncias em Lactentes). Metodos: Entre marco de 2005 e agosto de 2006, os pais ou responsaveis de lactentes que procuraram unidades basicas de saude na regiao centro-sul de Sao Paulo (SP) para procedimentos de rotina e imunizacao responderam ao questionario escrito do EISL. Resultados: A amostra foi constituida por 1.014 lactentes (media de idade = 5,0 ± 3,0 meses), 467 (46,0%) dos quais apresentaram sibilância no primeiro ano de vida, sendo que 270 (26,6%) tiveram tres ou mais episodios. Entre esses ultimos, o uso de β 2 -agonista inalatorio, corticosteroide inalatorio e antileucotrieno, assim como a presenca de sintomas noturnos, dificuldade para respirar, pneumonia, idas ao pronto socorro e internacao por sibilância grave, foram significantemente mais frequentes (p < 0,05). Os pais de 35 (7,5%) dos 467 lactentes relataram o diagnostico medico de asma, o qual foi associado ao uso de corticosteroide inalatorio, percepcao de falta de ar durante as crises e seis ou mais episodios de sibilância no primeiro ano de vida. Entretanto, menos de 40% desses lactentes recebiam corticosteroide inalatorio ou antileucotrieno como tratamento. Conclusoes: A prevalencia da sibilância no primeiro ano de vida de lactentes no estudo foi alta e teve inicio precoce. A proporcao de lactentes diagnosticados e tratados como asmaticos foi baixa. Descritores: Asma/diagnostico; Asma/epidemiologia; Sons respiratorios.

BACKGROUND: Prolonged slow expiration (PSE) is a physiotherapy technique often applied in infants to reduce pulmonary obstruction and clear secretions, but there have been few studies of PSE's effects on the respiratory system. OBJECTIVE: To describe PSE's effects on respiratory mechanics in infants. METHODS: We conducted a cross-sectional study with 18 infants who had histories of recurrent wheezing. the infants were sedated for lung-function testing, which was followed by PSE. the PSE consisted of 3 sequences of prolonged manual thoraco-abdominal compressions during the expiratory phase. We measured peak expiratory flow (PEF), tidal volume (V(T)), and the frequency of sighs during and immediately after PSE. We described the exhaled volume during PSE as a fraction of expiratory reserve volume (%ERV). We quantified ERV with the raised-volume rapid-thoracic-compression technique. RESULTS: the cohort's mean age was 32.2 weeks, and they had an average of 4.8 previous wheezing episodes. During PSE there was significant V(T) reduction (80 +/- 17 mL vs 49 +/- 11 mL, P < .001), no significant change in PEF (149 +/- 32 mL/s vs 150 +/- 32 mL/s, P = .54), and more frequent sighs (40% vs 5%, P = .03), compared to immediately after PSE. the exhaled volume increased in each PSE sequence (32 +/- 18% of ERV, 41 +/- 24% of ERV, and 53 +/- 20% of ERV, P = .03). CONCLUSIONS: It was possible to confirm and quantify that PSE deflates the lung to ERV. PSE caused no changes in PEF, induced sigh breaths, and decreased V(T), which is probably the main mechanical feature for mucus clearance. Universidade Federal de São Paulo, Dept Pediat, BR-04022001 São Paulo, Brazil Grand Hop Charleroi, Serv Med Interne & Pediat, Charleroi, Belgium Universidade Federal de São Paulo, Dept Pediat, BR-04022001 São Paulo, Brazil Web of Science

Background We aimed to identify factors associated with recurrent wheezing (RW) in infants in the first year of life living in the Southern region of Sao Paulo city and participating in the “ Estudio Internacional de Sibilancias en Lactantes (EISL)” – phase 3 (P3). Methods 1335 parents of infants who were attended in primary care health units in the Southern region of Sao Paulo city from 2009 to 2010 answered the EISL-P3 written questionnaire. The wheezing group was stratified in accordance to the frequency of wheezing episodes as occasional wheezing (OW, less than three episodes), or RW (three or more episodes). Wheezing-associated factors were evaluated using multivariate analysis and were expressed as odds ratio (OR) and 95% confidence interval (95%CI). Results The most relevant factors related to OW were pneumonia (OR = 3.10, 95%CI = 1.68–5.73), hospitalisation due to pneumonia (OR = 2.88, 95%CI = 1.26–6.56) and recurrent upper respiratory infection (URI, OR = 1.87, 95%CI = 1.25–2.81). Regarding RW, recurrent URI (OR = 5.34, 95%CI = 3.83–7.45), pneumonia (OR = 4.06, 95%CI = 2.87–5.74) and asthmatic siblings (OR = 3.02, 95%CI = 1.67–5.45) were the most significantly associated factors. Conclusions In the present study, we found that recurrent URI, positive history of pneumonia and familiar history of asthma were the most relevant factors associated with RW. The precocious knowledge of these factors can enable the identification of the probable asthmatic infants and can improve both prevention strategies and treatment of these patients.

12,582 valid questionnaires were considered, and 11,411 (90.7%) infants were born with NW and 1,171 (9.3%) with LW. For the RWh, was 2,488 (21.9%) infants in the NW group and 331 (28.3%) in LW group (p < 0.001). Presented SRWh, 1,491 infants (13.1%) of the NW group and 248 (21.2%) of LW (p < 0.001) group.