Search

The article discusses the long-term impact of childhood disadvantage on lung function and respiratory health in adulthood. It highlights that many respiratory diseases in adults have their origins in early life, and various preconception, antenatal, and early life exposures can affect healthy lung development. Factors such as preterm birth, respiratory tract infections, familial atopy and asthma, maternal ill-health, social disadvantage, poor nutrition, and exposure to tobacco smoke and unclean air can contribute to impaired lung growth and lifelong disadvantage. The article suggests the use of lung health charts and a lung function tracker app to monitor lung development and intervene early. It emphasizes the importance of prioritizing children in low-income settings, where access to spirometry is lacking, and calls for global efforts to improve access to diagnostic tools for all children. The article also raises the question of whether preschool screening should be considered for high-risk children. Overall, the article emphasizes the need to prioritize children's well-being in decision-making and planning for the future. [Extracted from the article]

A recent study commissioned by the World Health Organization (WHO) has highlighted the lack of access to basic treatments for asthma and chronic obstructive pulmonary disease (COPD) in low- and middle-income countries (LMICs). The research found that the majority of LMICs do not have widespread availability of essential medications for these conditions, and where limited availability exists, the costs are often prohibitive. This lack of access to treatment poses a significant barrier to improving the health outcomes of individuals with asthma and COPD. The study emphasizes the need for global advocacy and collaborative efforts to ensure that everyone, regardless of their location, has access to timely diagnosis and appropriate treatments. It also calls for a more inclusive and representative approach to scientific research and knowledge creation, challenging inequitable systems and advocating for ethical practices. [Extracted from the article]

Background Despite increased access to highly active antiretroviral therapy (HAART), lung disease remains common in human immunodeficiency virus (HIV)–infected (HIV+) adolescents. There is limited information on changes in lung function over time in perinatally HIV+ adolescents on HAART. The objective was to investigate the progression of spirometry findings over 2 years in HIV+ adolescents on HAART in a prospective cohort, the Cape Town Adolescent Antiretroviral Cohort (CTAAC). Methods HIV+ adolescents aged 9–14 years, with at least 6 months of HAART, and a comparator group of healthy HIV-uninfected (HIV–), age-matched controls were enrolled in CTAAC. Spirometry and bronchodilator testing were done at baseline, 12 months, and 24 months. Mixed-effect models were used to compute longitudinal changes in lung function. Results Five hundred fifteen HIV+ adolescents, mean age 12 (standard deviation [SD], 1.6) years, 50.4% male, and 110 HIV– adolescents, mean age 11.8 (SD, 1.8) years, 45.6% male, were tested at baseline; 477 (93%) HIV+ and 102 (93%) HIV– adolescents at 12 months; and 473 (92%) HIV+ and 97 (88%) HIV– adolescents at 24 months. Only 5.4% of the HIV+ adolescents had HIV viral load >10 000 copies/mL at baseline. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were lower in the HIV+ compared to the HIV– adolescents and tracked with no deterioration or catch-up over 2 years. Previous pulmonary tuberculosis (PTB) or lower respiratory tract infection (LRTI) was significantly associated with reduced FEV1 and FVC (P <.05 for both). Conclusions HIV+ adolescents had lower lung function over 2 years than HIV– adolescents. This study highlights the need for lung function surveillance and prevention of LRTIs and PTB in HIV+ adolescents. [ABSTRACT FROM AUTHOR]

Rationale: Lung disease is a common cause of mortality and morbidity in HIV-infected adolescents, but there is limited information on the spectrum of lung function impairment in adolescents on antiretroviral therapy.Objectives: To investigate lung function in HIV-infected adolescents on antiretroviral therapy in the Cape Town Adolescent Antiretroviral Cohort (Cape Town, South Africa).Methods: A total of 515 South African adolescents, aged 9-14 years, stable on antiretroviral therapy for at least 6 months, underwent baseline lung function testing. Measures included spirometry, nitrogen multiple-breath washout, forced oscillation technique, 6-minute walk test, single-breath carbon monoxide diffusion testing, and bronchodilator response testing. A comparator group of 110 age- and ethnicity-matched HIV-uninfected adolescents was also tested.Results: For the HIV-infected adolescents (mean [SD] age 12 [1.6] years, 52% male), the median (interquartile range) duration of antiretroviral therapy was 7.6 (4.6-9.2) years. The median (interquartile range) nadir CD4 was 510.5 (274-903) cells/mm3. HIV-infected adolescents had significantly lower FEV1, FVC, FEV1/FVC, diffusing capacity of carbon monoxide, respiratory system compliance, and functional residual capacity than HIV-uninfected adolescents (P < 0.05 for all associations). HIV-infected adolescents had higher airway resistance and lung clearance index than HIV-uninfected adolescents (P < 0.05 for all associations). Although generally small in magnitude, these differences remained significant after adjusting for age, sex, and height. In addition, age, sex, height, and history of past lower respiratory tract infection or pulmonary tuberculosis were associated with reduced lung function.Conclusions: Perinatally infected South African HIV-infected adolescents on antiretroviral therapy have lower lung function than uninfected adolescents. Prior lower respiratory tract infection or pulmonary tuberculosis is associated with lower lung function. [ABSTRACT FROM AUTHOR]

Lower respiratory tract illness (LRTI) is a leading cause of mortality and morbidity in children. Sensitive and noninvasive infant lung function techniques are needed to measure risk for and impact of LRTI on lung health. The objective of this study was to investigate whether lung function derived from the intra-breath forced oscillation technique (FOT) was able to identify healthy infants at risk of LRTI in the first year of life.Lung function was measured with the novel intra-breath FOT, in 6-week-old infants in a South African birth cohort (Drakenstein Child Health Study). LRTI during the first year was confirmed by study staff. The association between baseline lung function and LRTI was assessed with logistic regression and odds ratios determined using optimal cut-off values.Of the 627 healthy infants with successful lung function testing, 161 (24%) had 238 LRTI episodes subsequently during the first year. Volume dependence of respiratory resistance (Δ R ) and reactance (Δ X ) was associated with LRTI. The predictive value was stronger if LRTI was recurrent (n=50 (31%): OR 2.5, Δ X ), required hospitalisation (n=38 (16%): OR 5.4, Δ R ) or was associated with wheeze (n=87 (37%): OR 3.9, Δ X ).Intra-breath FOT can identify healthy infants at risk of developing LRTI, wheezing or severe illness in the first year of life., Competing Interests: Conflict of interest: D.M. Gray has nothing to disclose. Conflict of interest: D. Czovek has nothing to disclose. Conflict of interest: L. McMillan has nothing to disclose. Conflict of interest: L. Turkovic has nothing to disclose. Conflict of interest: J.A.M. Stadler has nothing to disclose. Conflict of interest: A. Vanker reports grants from Bill and Melinda Gates Foundation (OPP1017641), Discovery Foundation, South African Thoracic Society AstraZeneca Respiratory Fellowship, National Research Fund, South Africa, CIDRI Clinical Fellowship, and MRC, South Africa, during the conduct of the study. Conflict of interest: B.L. Radics has nothing to disclose. Conflict of interest: Z. Gingl has nothing to disclose. Conflict of interest: G.L. Hall has nothing to disclose. Conflict of interest: P.D. Sly is a named inventor on a patent owned by the Telethon Kids Institute that covers this technology. The patent is licensed to Thorasys, Inc. (Canada); P.D. Sly receives no financial gain from this patent. Conflict of interest: H.J. Zar reports grants from Gates Foundation, National Research Foundation South Africa, SA Medical Research Council, Wellcome Trust and National Institutes of Health, H3 Africa, during the conduct of the study. Conflict of interest: Z. Hantos has a patent 2005903034 (A Method of Diagnosing a Respiratory Disease or Disorder or Monitoring Treatment of Same and a Devise for Use Therein) licensed to Thorasys P/L; Z. Hantos is named as an inventor on this patent owned by the Telethon Kids Institute, Perth, Australia, but receives no royalties or other payment from the patent or licensee., (Copyright ©ERS 2019.)