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Airway Closing Index (ACI), the ratio of % change in FVC to % change in FEV1 with bronchoprovocation, may represent changes in airflow due to airway closure, as opposed to airway narrowing. The objective of this study was to evaluate ACI during exercise bronchoprovocation (EB) in children. Children, 6 to 18 years of age, who underwent EB using a stationary bicycle ergometer over a 6-year period were reviewed. Pulmonary function, including ACI, in patients with a positive exercise challenge, defined as ≥10% decrease in FEV1 following exercise, were compared to patients with a negative challenge. A total of 1030 children with a median age of 13 (IQR 11–15) underwent EB, of which 376 (37%) had a positive exercise challenge. There was wide variability in ACI, with a median of 0.75 (0.28–1.21). Median ACI in those with a positive test was 0.68 (IQR 0.41–0.93) compared to 0.84 (IQR 0.09–1.06) for those with a negative test, p = 0.017. Median ACI was higher in older children (p < 0.001) and females (p < 0.0001). Median percent change in FEV1 following bronchodilator for children in the highest quintile for ACI was 4.5 (IQR 1.3–8.1) compared to 5.5 (IQR 2–9.2) for children in the lowest quintile, p = 0.04. There is wide variability in the ACI in children undergoing EB. ACI was lower in children with a positive challenge, the significance is unknown. Children with higher ACI may have increased airway closure with bronchoprovocation, and less response to bronchodilators. [ABSTRACT FROM AUTHOR]

Objective: To characterize a cohort of children with airflow limitation resistant to bronchodilator (BD) therapy. Methods: Pulmonary function tests performed in children 6–17 years of age at 15 centers in a clinical research consortium were screened for resistant airflow limitation, defined as a post-BD FEV1 and/or an FEV1/FVC less than the lower limits of normal. Demographic and clinical data were analyzed for associations with pulmonary function. Results: 582 children were identified. Median age was 13 years (IQR: 11, 16), 60% were males; 62% were Caucasian, 28% were African-American; 19% were obese; 32% were born prematurely and 21% exposed to second hand smoke. Pulmonary diagnoses included asthma (93%), prior significant pneumonia (28%), and bronchiectasis (5%). 65% reported allergic rhinitis, and 11% chronic sinusitis. Subjects without a history of asthma had significantly lower post-BD FEV1% predicted (p = 0.008). Subjects without allergic rhinitis had lower post-BD FEV1% predicted (p = 0.003). Children with allergic rhinitis, male sex, obesity and Black race had better pulmonary function post-BD. There was lower pulmonary function in children after age 11 years without a history of allergic rhinitis, as compared to those with a history of allergic rhinitis. Conclusions: The most prevalent diagnosis in children with BD-resistant airflow limitation is asthma. Allergic rhinitis and premature birth are common co-morbidities. Children without a history of asthma, as well as those with asthma but no allergic rhinitis, had lower pulmonary function. Children with BD-resistant airflow limitation may represent a sub-group of children with persistent obstruction and high risk for life-long airway disease. [ABSTRACT FROM AUTHOR]

The role of oxidative stress in asthma is gaining increasing scientific attention. The hallmark of asthma is airway inflammation. Oxidative stress may initiate and augment inflammation, and may also result from inflammation. Exposure to tobacco smoke, ozone, diesel exhaust, and a variety of other pollutants generates reactive oxygen species and other oxidative stressors. Some studies suggest that asthmatics have a decreased ability to respond to oxidative stress, while others find upregulated antioxidative function. Oxidative stress may alter the Th1/Th2 immune response and result in activation of NF-kβ, a powerful inducer of pro-inflammatory genes. Genetic polymorphisms may play an important role in determining susceptibility to oxidative stress. Many therapeutic strategies to decrease oxidative stress in asthma have been suggested. Dietary changes, antioxidant vitamins, other antioxidant drugs, Ayurvedic supplements, and even radon exposure in a hot bathroom have been studied. Minimizing exposure of young children to environmental tobacco smoke remains paramount. [ABSTRACT FROM AUTHOR]

Abstract. A study was designed to determine the usefulness of cold air inhalation challenge testing in children with asthma and to determine the magnitude and duration of the response. A total of 17 children with asthma, mean age 11.7 years (range 6 to 16 years) and eight nonasthmatic children, mean age 11.5 years (range 7 to 15 years) were studied. The average response to isocapneic hyperventilation with cold air in the asthmatic children was a decrease in vital capacity of 10%, a decrease in forced expiratory volume in I second (FEV[sub 1]) of 19%, a decrease in peak flow rate (PFR) of 24%, and a decrease in maximal midexpiratory flow rate (MMFR) of 36%. This was significantly different from the response to the same level of hyperventilation with warm, fully saturated air. The response to isocapneic hyperventilation with cold air in nonasthmatic children was significantly different from the asthmatic children's response with a mean decrease in vital capacity of 0.9%, a decrease in forced expiratory volume in I second of 2.5%, a decrease in peak flow rate of 7%, and a decrease in maximal midexpiratory flow rate of 10%. The response in the asthmatic children occurred four to eight minutes after challenge and resolved in eight to 12 minutes. Although the response was highly significant, none of the children developed respiratory distress. It was concluded that isocapneic hyperventilation with cold air is a safe and simple test for diagnosing asthma in children. [ABSTRACT FROM AUTHOR]

Background: Increased weight gain in children during the COVID-19 pandemic has been reported. Changes in weight in children with asthma during this period have not been well described. Methods: Retrospective review of children with asthma, 6–18 years of age, seen in 2019 and 2020. Mean monthly rates of change in body mass index (BMI) were compared between years. Demographic and asthma-related factors were examined. Results: Two hundred sixty-seven patients were enrolled. BMI increased by 0.128 ± 0.283 kg/m2/month during the pandemic year as compared with 0.084 ± 0.160 kg/m2/month during the previous year (P = 0.03). Patients with baseline overweight or obesity trended toward higher rates of BMI increase than those starting with normal weight, with the greatest BMI increase occurring in the severely obese. Conclusions: In this single-site study of children with asthma, there was a greater monthly rate of BMI gain during the early pandemic as compared with that observed in the previous year. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to the article "Are β2-adrenoceptor polymorphisms important in asthma -- an unravelling story," by A. E. Tattersfield and I.P. Hall, in the October 23, 2004 issue.

Objectives: Though parents of children with asthma smoke, they often avoid smoking in their homes or near their children, thus limiting exposure. It is not known if such low-level environmental tobacco smoke (ETS) results in measurable exposure or affects lung function. The objectives of this study were to measure urinary cotinine in preschool children with asthma, and to examine the relationship between low-level ETS exposure and pulmonary function tests (PFTs). Methods: Preschool children with asthma were enrolled. Parents completed questionnaires on ETS exposure and asthma control, urinary cotinine concentrations were measured and PFTs were compared between subjects with and without recent ETS exposure. Results: Forty one subjects were enrolled. All parents denied smoking in their home within the last 2 weeks, but 14 (34%) parents admitted to smoking outside their homes or away from their children. Fifteen (37%; 95%CI: 23-53) of the children had urinary cotinine levels ≥1 ng/ml, of which seven (17%; 95%CI: 8-32) had levels ≥5 ng/ml. FEV1 and FEV0.5 were lower in subjects with a urinary cotinine level ≥5 ng/ml as compared to those with levels <1 ng/ml or between 1 and 5 ng/ml; both at baseline and after inhalation of albuterol. Five of seven subjects with urinary cotinine levels ≥5 ng/ml had FEV0.5 less than 65% of predicted values. There were no significant differences in IOS measures. Conclusions: Despite parental denial of smoking near their children, preschool children may be exposed to ETS. Such low-level ETS exposure may affect lung function, possibly in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Abstract: Background: The relationship between sweat electrolytes and age is uncertain, as is the value of measuring sodium or the chloride:sodium ratio. Methods: 13,785 sweat tests performed over 23years at one center through the Macroduct collection in clinically obtained samples were analyzed. Results: Sweat chloride tended to decrease over the first year of life, slowly increase until the fourth decade, then either level off or slightly decrease. In children, sweat sodium overlapped between those with positive and negative sweat tests, but not in adults. If the sweat test was positive, there was a higher likelihood of having a chloride:sodium ratio >1, but most subjects with a ratio >1 did not have CF. Conclusions: Sweat chloride and sodium vary with age. Measurement of sweat sodium did not add discriminatory value. The proportion of subjects with a chloride:sodium ratio >1, with or without CF, varied greatly between age ranges. [Copyright &y& Elsevier]

Objectives. The relationship between exhaled nitric oxide (FeNO) and asthma severity or control is inconsistent. Active smoking lowers FeNO, but the relationship between passive smoking and FeNO is less clear. Children may be exposed to low-level environmental tobacco smoke (ETS) or thirdhand smoke, even if parents avoid smoking in the presence of their children. Our hypothesis was that FeNO is lower in children with asthma exposed to low-level ETS when compared with those who are not exposed. Methods. Children with stable asthma, 8-18 years of age, on low- or medium-dose inhaled corticosteroids (ICS) were enrolled. Spirometry, Asthma Control Questionnaire (ACQ), FeNO, exhaled breath condensate pH (EBC pH), and EBC ammonia were compared between children with and without ETS exposure as determined by urinary cotinine. Results. Thirty-three subjects were enrolled, of which 10 (30%) had urinary cotinine levels ≥1 ng/ml. There were no significant differences between the two groups in age, sex, BMI percentile, atopy status, FEV1, EBC pH, or EBC ammonia. Median ACQ was 0.29 (IQR: 0.22-0.57) for those with cotinine levels <1 ng/ml and 0.64 (IQR: 0.57-1.1) for those with cotinine levels of ≥1 ng/ml, p = .02. Median FeNO (ppb) was 23.9 (IQR: 15.2-34.5) for unexposed subjects and 9.6 (IQR: 5.1-15.8) for exposed subjects, p = .008. Conclusions: Children with asthma on low to medium doses of ICS and recent low-level ETS exposure have lower FeNO levels when compared with non-ETS-exposed subjects. Exposure to low-level ETS or thirdhand smoke may be an important variable to consider when interpreting FeNO as a biomarker for airway inflammation. [ABSTRACT FROM AUTHOR]

Abstract: Decreased transplacental transfer of antibodies and altered immunoresponsiveness may place preterm (PT) infants at higher risk for serious consequences from respiratory syncytial virus (RSV) bronchiolitis. We hypothesize that among infants hospitalized with RSV bronchiolitis, immune response in PT infants may be different when compared with that of term infants. Nasal-wash samples were collected from 11 PT (<37 weeks of gestation) and 13 term infants (≥37 weeks of gestation) hospitalized with RSV bronchiolitis. Severity of illness (clinical score [CS]), admission peripheral oxygen saturation, and days subjects required supplemental oxygen were compared. Nasal-wash leukocyte count as well as cytokines for interleukin (IL)-8, IL-4, and interferon-γ (IFN-γ) were assayed. No significant differences in CS, admission SaO2, and O2 days were seen between PT and term infants. Nasal-wash leukocyte counts and IL-8 levels were higher in term infants compared with PT and correlated with severity (higher CS) in term (p < 0.05) but not in PT (p > 0.05) infants. IL-4 and IFN-γ levels did not differ between the 2 groups (p > 0.05). PT infants hospitalized with RSV bronchiolitis have lower nasal-wash leukocyte counts and a less robust IL-8 response than term infants, and only in term infants did IL-8 levels correlate with clinical disease severity. [Copyright &y& Elsevier]

• Cystic fibrosis (CF) is characterized by chronic inflammation, destruction of lung tissue. • Treatment should reduce airway inflammation without causing immunosuppression. • In animals, lenabasum resolved innate immune responses without immunosuppression. • Results from this Phase 2 study support further testing of lenabasum in CF. Background. Few therapies specifically address the chronic airway inflammation in cystic fibrosis (CF) that contributes to progressive destruction of lung tissue and loss of lung function. Lenabasum is a cannabinoid type 2 receptor (CB2) agonist that resolves inflammation in a number of in vitro and in vivo models. Methods. A Phase 2 double-blind, randomized, placebo-controlled study assessed the safety and tolerability of lenabasum in adults with CF. Subjects with FEV 1 % (ppFEV 1) ≥40% predicted were randomized to lenabasum 1 or 5 mg or placebo once daily (QD) (Weeks 1–4), then 20 mg QD, 20 mg twice daily (BID) or placebo (Weeks 5–12), with follow-up at Week 16. Pulmonary exacerbations (PEx) were recorded and biomarkers of blood and lung inflammation were measured. Results. Of 89 subjects randomized, 51 lenabasum and 23 placebo-only subjects completed the study. No deaths or serious or severe adverse events (AE) were considered related to lenabasum. Most AEs were mild/moderate, and the most common were PEx, hemoptysis, dry mouth, and upper respiratory infection. Three lenabasum and one placebo-only subjects discontinued the study for a treatment related AE. New PEx were treated with intravenous antibiotics in 4.0% of lenabasum-treated vs. 11.4% of placebo-treated subjects, during Weeks 1–4 and 5.2% compared to 13.0% during Weeks 5–12 (p <0.2). No significant differences in ppFEV1 were observed between treatment groups. Sputum neutrophils, eosinophils, and neutrophil elastase were numerically reduced, and significant (p <0.05) reductions in IL-8 and immunoglobulin G levels occurred with lenabasum. Conclusions. The safety findings of lenabasum, coupled with biomarker data, support further testing in a larger study with a longer duration. [ABSTRACT FROM AUTHOR]

Background: The 2013 Cystic Fibrosis Foundation's Infection Prevention and Control Guideline (CFF IP&C) was developed to reduce the risk of acquisition and transmission of respiratory pathogens in patients with cystic fibrosis (CF). Objective: We hypothesised that the incidence of common CF respiratory pathogens would decrease at our centre after implementation of the guideline. Methods: All patients with CF seen at our centre from August 2012 through August 2017 who had respiratory cultures were included. Patients were excluded from incidence analysis if they did not have at least one culture per year. Quarterly data were collected for one year before and three years after implementation of the guidelines to determine the incidence and prevalence of seven organisms commonly found in respiratory cultures of patients with CF. Results: Quarterly and annual incidence and prevalence rates of common organisms did not change during the study period. Discussion: There were no significant differences in the incidence or prevalence of common respiratory organisms in the first three years after implementation of the CF IP&C guideline. Long-term follow-up is needed to determine if changes occur over time. [ABSTRACT FROM AUTHOR]

Background: Patients with low health literacy may not have an adequate understanding of basic health information, and were more likely to skip necessary tests and treatments, or wrongly administer medications. There are limited studies on rapid assessment of health literacy in parents and its impact on asthma control in their children. Materials and Methods: This study involves prospective assessment of health literacy in parents and asthma control in their children, age ≥2 years. Primary caregivers completed the Short Assessment of Health Literacy (SAHL) and the Newest Vital Signs (NVSs) questionnaires. Scores of ≤14 on the SAHL or ≤3 on the NVS were considered indicative of low health literacy and/or numeracy. Asthma control was assessed with the Asthma Control Test (ACT), Child ACT (cACT), or the Test for Respiratory and Asthma Control in Kids (TRACK). Scores of ≤19 on the ACT or cACT, and <80 on the TRACK were considered indicative of not well-controlled asthma. Results: Two hundred sixty-four children were enrolled, with mean age of 8.9 + 4.4 years. Sixty-three percent were male. Seventy-seven percent of parents identified themselves as White, 18% Black/African American, and 7% Asian. Twenty-five percent had state-supported health insurance. Seventy-eight parents (30%) were assigned to the low health literacy group. There were no differences between the 2 groups in age, race, or sex. Those with low health literacy were more likely to have state-supported health insurance, P < 0.0001. Fifty-four percent of the children whose parents had low health literacy had asthma not well controlled as compared with 30% of those with health literacy scores in the normal range, odds ratio: 2.66 (95% confidence interval: 1.55–4.56). This relationship persisted on multivariate analysis after accounting for health insurance and age. Conclusion: Low health literacy in primary caregivers is associated with not well-controlled asthma in children in a diverse, suburban population. [ABSTRACT FROM AUTHOR]

The article discusses the infants and young children are primarily prescribed metered dose inhalers (MDIs) to be used with a spacing device. Topics include valved holding chambers (VHCs), are thought to markedly improve airway deposition in children and therefore asthma control; and with the development of masked VHCs, pediatricians have moved dramatically away from prescribing nebulized forms of medications to MDIs, even for infants and young children.

IMPORTANCE Soy isoflavone supplements are used to treat several chronic diseases, although the data supporting their use are limited. Some data suggest that supplementation with soy isoflavone may be an effective treatment for patients with poor asthma control. objective To determine whether a soy isoflavone supplement improves asthma control in adolescent and adult patients with poorly controlled disease. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind, placebo-controlled trial conducted between May 2010 and August 2012 at 19 adult and pediatric pulmonary and allergy centers in the American Lung Association Asthma Clinical Research Centers network. Three hundred eighty-six adults and children aged 12 years or older with symptomatic asthma while taking a controller medicine and low dietary soy intake were randomized, and 345 (89%) completed spirometry at week 24. INTERVENTIONS Participants were randomly assigned to receive soy isoflavone supplement containing 100 mg of total isoflavones (n=193) or matching placebo (n=193) in 2 divided doses administered daily for 24 weeks. MAIN OUTCOMES AND MEASURES The primary outcome measure was change in forced expiratory volume in the first second (FEV,) at 24 weeks. Secondary outcome measures were symptoms, episodes of poor asthma control, Asthma Control Test score (range, 5-25; higher scores indicate better control), and systemic and airway biomarkers of inflammation. RESULTS Mean changes in prebronchodilator FEV, over 24 weeks were 0.03 L (95% Cl, -0.01 to 0.08 L) in the placebo group and 0.01 L (95% Cl, -0.07 to 0.07 L) in the soy isoflavone group, which were not significantly different (P = .36). Mean changes in symptom scores on the Asthma Control Test (placebo, 1.98 [95% Cl, 1.42-2.54] vs soy isoflavones, 2.20 [95% Cl, 1.53-2.87]; positive values indicate a reduction in symptoms), number of episodes of poor asthma control (placebo, 3.3 [95% Cl, 2.7-4.1] vs soy isoflavones, 3.0 [95% Cl, 2.4-3.7]), and changes in exhaled nitric oxide (placebo, -3.48 ppb [95% Cl, -5.99 to -0.97 ppb] vs soy isoflavones, 1.39 ppb [95% Cl, -1.73 to 4.51 ppb]) did not significantly improve more with the soy isoflavone supplement than with placebo. Mean plasma genistein level increased from 4.87 ng/mL to 37.67 ng/mL (P < .001) in participants receiving the supplement. CONCLUSIONS AND RELEVANCE Among adults and children aged 12 years or older with poorly controlled asthma while taking a controller medication, use of a soy isoflavone supplement, compared with placebo, did not result in improved lung function or clinical outcomes. These findings suggest that this supplement should not be used for patients with poorly controlled asthma. [ABSTRACT FROM AUTHOR]

Context: Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. Untreated GER has been postulated to be a cause of inadequate asthma control in children despite inhaled corticosteroid treatment, but it is not known whether treatment with proton pump inhibitors improves asthma control.Objective: To determine whether lansoprazole is effective in reducing asthma symptoms in children without overt GER.Design, Setting, and Participants: The Study of Acid Reflux in Children With Asthma, a randomized, masked, placebo-controlled, parallel clinical trial that compared lansoprazole with placebo in children with poor asthma control who were receiving inhaled corticosteroid treatment. Three hundred six participants enrolled from April 2007 to September 2010 at 19 US academic clinical centers were followed up for 24 weeks. A subgroup had an esophageal pH study before randomization.Intervention: Participating children were randomly assigned to receive either lansoprazole, 15 mg/d if weighing less than 30 kg or 30 mg/d if weighing 30 kg or more (n = 149), or placebo (n = 157).Main Outcome Measures: The primary outcome measure was change in Asthma Control Questionnaire (ACQ) score (range, 0-6; a 0.5-unit change is considered clinically meaningful). Secondary outcome measures included lung function measures, asthma-related quality of life, and episodes of poor asthma control.Results: The mean age was 11 years (SD, 3 years). The mean difference in change (lansoprazole minus placebo) in the ACQ score was 0.2 units (95% CI, 0.0-0.3 units). There were no statistically significant differences in the mean difference in change for the secondary outcomes of forced expiratory volume in the first second (0.0 L; 95% CI, -0.1 to 0.1 L), asthma-related quality of life (-0.1; 95% CI, -0.3 to 0.1), or rate of episodes of poor asthma control (relative risk, 1.2; 95% CI, 0.9-1.5). Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, no treatment effect for lansoprazole vs placebo was observed for any asthma outcome. Children treated with lansoprazole reported more respiratory infections (relative risk, 1.3 [95% CI, 1.1-1.6]).Conclusion: In this trial of children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, compared with placebo, improved neither symptoms nor lung function but was associated with increased adverse events.Trial Registration: clinicaltrials.gov Identifier: NCT00442013. [ABSTRACT FROM AUTHOR]

The article discusses a study on the effectiveness of the proton pump inhibitor (PPI) lansoprazole in asthmatic children without symptoms of gastroesophageal reflux (GER). The Study of Acid Reflux in Children With Asthma was a randomized placebo-controlled clinical trial in the U.S. that treated children with poor asthma control with either lansoprazole or placebo. More respiratory infections or adverse events were observed in children who received lansoprazole under the study. Children with poorly controlled asthma without GER symptoms and using inhaled corticosteriod showed no improvements in symptoms and lung function.

Sickle cell disease (SCD) is a hemoglobinopathy and vasculopathy resulting in vaso-occlusive crises, chronic end-organ damage, and shortened life span. The only curative therapy is allogeneic stem cell transplant (AlloSCT) (Talano/Cairo, EJH, 2015). Unfortunately, only approximately 16% of the sickle cell population has an HLA matched unaffected sibling (Bhatia/Cairo, BMT, 2014). We have demonstrated the safety and efficacy of familial haploidentical transplants (FHI) in this population with 100% engraftment (Cairo et al, JAMA Peds, 2019). However, the incidence of sinusoidal obstructive syndrome (SOS) in SCD AlloSCT recipients is approximately 32% (McPherson, BMT, 2011). Defibrotide primarily targets endothelium and can reduce endothelial cell injury (Falanga et al, Leukemia, 2003 and Scallia et al, Clin Pharm, 1996). Corbaciolgu et al (Lancet 2012) demonstrated the safety and efficacy of prophylactic defibrotide in high-risk pediatric AlloSCT recipients to significantly reduce the incidence of SOS. To determine the safety and efficacy of defibrotide prophylaxis for SOS in children, adolescents and young adults (CAYA) with high-risk SCD following MAC and FHI AlloSCT, utilizing CD34+ selection with CD3 addback. Patients with SCD aged 2 to 35 years with high-risk SCD (stroke, ≥2 acute chest syndrome in past 2 years, ≥3 pain crises in last 2 years, abnormal TCD study, ≥1 silent infarct lesion on MRI) were enrolled after being consented (NCT02675959). Patients were in two cohorts (2 to 17.99 years and 18 to 34.99 years of age) for age-based analysis and treatment (Table 1 and 2). All patients received a MAC regimen prior to receipt of an FHI with CD34+ selection and CD3 addback peripheral blood stem cell transplantation (PBSCT), as we have already demonstrated (Cairo et al, ASH, 2018). Defibrotide was given day -10 during conditioning through day +21 following transplant. Baseline studies of organ function and biomarkers were obtained prior to transplantation. We have enrolled eight patients, five in cohort 1 (median age 9.9 years) and three in cohort 2 (median age of 24 years) with a gender ratio (M/F) of 4/4. Patients had hemoglobin SS (n=7) or hemoglobin SC (n=1). Patients had either a maternal (n=7) or sibling (n=1) donor. Patients had early neutrophil engraftment (median day +11 (day +7 to day +14)). All tolerated 109 ± 11doses of defibrotide. There were no severe adverse or bleeding events probably or directly related to defibrotide. No patient developed SOS. The preliminary data suggests defibrotide is safe and well tolerated in CAYA patients with high-risk SCD following MAC and FHI AlloSCT, utilizing CD34+ selection with CD3 addback. A larger cohort and/or follow-up will be required to confirm these preliminary findings. Supported by FDA R01FD004090 and Jazz Pharmaceuticals. [ABSTRACT FROM AUTHOR]

Lung lesions in children with Crohn's disease are often difficult to diagnose and treat. We report here 3 children (aged 13, 14, and 17 years) on immunosuppressive therapy for previously diagnosed Crohn's disease who presented with nonresolving pneumonias. All 3 had unfavorable response to empiric antibiotics and had progression of lesions. Cultures of sputum and blood did not yield any organisms. Subsequent lung biopsies revealed noncaseating granulomas with giant cells in 2 subjects and bronchiolitis obliterans with organizing pneumonia in the third. All patients were treated with infliximab, a novel anti-tumor necrosis factor monoclonal antibody, and showed rapid clinical and radiologic response. We emphasize that a high index of suspicion for noninfectious etiologies needs to be maintained in patients with Crohn's disease who present with lung lesions to ensure timely intervention. Infliximab therapy seems to be effective and well tolerated in such patients. [ABSTRACT FROM AUTHOR]

To determine if micronutrient intake is associated with asthma severity, we administered the Block food frequency questionnaire to participants in a randomized clinical trial of the safety of influenza vaccine for asthmatics. The nutrition substudy included 1033 participants, aged 12–75. Intake of antioxidant vitamins, soy isoflavones, total fruits and vegetables, fats, and fiber was compared with asthma severity at baseline[forced expiratory volume in 1 second(FEV1), peak expiratory flow rate(PEF), asthma symptoms] and the rate of asthma exacerbations during the 2 weeks following influenza vaccination. The only nutrient that had a consistent association with asthma severity was genistein, a soy isoflavone. None of the nutrients evaluated were related to asthma exacerbation rate when adjusted for known confounders. The FEV1 in genistein consumers of at least 250µg/1000 Kcal/day was 82.1% predicted, 79.9% predicted for those who consumed between 1 and 249µg/1000 kcal, and 76.2% predicted in genistein nonconsumers(p = 0.006); the PEF was 82.7% predicted, 80.8% predicted, and 78.3% predicted, respectively(p = 0.009). There were no differences in the Asthma Symptom Utility Index(ASUI). We could not account for these results based on differences in demographics, body mass index, or consumption of other nutrients. Thus, increasing consumption of genistein is associated with better lung function in patients with asthma. Further studies are needed to determine whether dietary supplementation with genistein can reduce asthma severity. [ABSTRACT FROM AUTHOR]

Asthma and obesity in children are major public health concerns. Asthma makes obesity worse and obesity makes asthma worse. We report a pilot program integrating nutrition video counseling with routine office visits. To determine if routine office visits plus nutrition video counseling improve body mass index (BMI), asthma, and obesity quality of life scores. Obese children ages 7-18 years old with persistent asthma were enrolled into a 6-month program that included 3 visits with a pediatric pulmonologist and a registered dietitian and 4 additional monthly free nutrition video visits using FaceTime, WhatsApp, or Skype. Motivational interviewing guided discussions about why and how to change behaviors such as skipping meals, binge eating, excessive screen time and physical inactivity. Identifying whole foods, nutrition label reading, mindfulness and goal setting skills were taught. At each office visit, subjects underwent evaluation of anthropometric measures, respiratory and nutritional status, and validated quality-of-life measures for asthma (PAQOL) and obesity (Sizing Me Up [SMU] for 7 to 13 years; IWQOL-Kids for 14 to 18 years). Participants were assessed for BMI, asthma control, and quality of life measures pre-, mid-, and post-intervention. Twenty-one subjects were enrolled; 14 (67%) completed all visits and procedures. Twelve of the 14 (86%) reported improvement in obesity quality of life scores. Median SMU score improved from 61 (IQR 56, 76) to 76 (IQR 72, 77), P =.03. Median IWQOL-Kids score was 95 at baseline, 97 at completion, P =.20. Seven of the 14 (50%) had a decrease in BMI; mean BMI decreased from 33.0 to 31.3, which was not significant. There were no significant changes in pulmonary function or PAQOL. In this small pilot study, the addition of video nutrition counseling to enhance office visits showed promising results and allows for deep discussions on the complexities of behavior change. However, future studies should be longer, combined with other multidisciplinary approaches, and have larger sample sizes. [ABSTRACT FROM AUTHOR]