Search

Introduction One of the most comprehensive Canadian surveys completed to date on the state of asthma reported that 2 million Canadians, including 10%-15% of children, are currently affected by this [...], A study examining the relationship between housing conditions, respiratory health, and school absenteeism was conducted in the city of Winnipeg in Manitoba, Canada. As part of this study, a survey was completed by 3,424 parents of children in grades 3 and 4 to determine the a) relationship between self-reported visible mold in homes and tested airborne mold; b) relationships of self-reported visible mold, tested airborne mold, and asthma and/or persistent colds; c) school absenteeism rates due to asthma and/or persistent colds; and d) children's socioeconomic status (SES) and incidence of asthma and/or persistent colds. In addition, a complete inspection of a subset of 715 homes was conducted, including the collection of over 1,400 indoor and 500 outdoor air samples for mold analysis. Results indicate a significant association between self-reported visible mold and airborne mold. Additionally, a significant association was found between Cladosporium levels from air samples (the most common genus type found) and children's asthma in combination with persistent colds. Children with persistent colds in combination with asthma miss significantly more school than children who have only asthma or only persistent colds. Children from poorer families reported more persistent colds than children from high-income families. No association was found between income and asthma. Furthermore, SES was not a significant factor for number of school days missed.

Immunization against influenza is recommended for pediatric and adult patients in high-risk groups including those with lung, heart, or kidney disease, suppressed immune function, diabetes, metabolic diseases and those receiving long-term aspirin therapy. However, the rate of immunization among high-risk children is low, partly because the real risk to these children is poorly studied and unclear. The rate of illness and complications from influenza in low- and high-risk children was evaluated in a study of 99 patients. About half the children were male, and 43 were classified as high-risk. Significantly more high-risk patients were at least six months old. Both types of patients more commonly had type B than type A influenza. Most patients in the high-risk group had pulmonary diseases such as asthma. Only 4 of the 38 high-risk patients over six months old had been immunized and none had received preventive therapy for influenza. Significantly more high-risk patients were hospitalized for at least 14 days, and significantly more had hospital-acquired influenza infections. Four high-risk patients, all of whom had pulmonary disease, and two low-risk patients required intubation to assist breathing. Two of the three patients who died were from the high-risk group. The study indicates that children at high risk, particularly those with pulmonary disease, should be immunized against influenza infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

It has been established that infants and children who are regularly exposed to tobacco smoke have more frequent and more serious respiratory illnesses than children not exposed to smoke. Children who are 'passive smokers' have usually been identified by obtaining information from the mother about the number of cigarettes smoked in the home, but it is now possible to measure environmental smoke exposure by testing the infant's urine for cotinine, a by-product of nicotine metabolism. These two techniques, interviewing the mother and testing for urine cotinine levels, were used and compared with each other in a study of 518 infants. The babies were six to eight weeks old and were having their first well-child visit with the doctor. Using a urine cotinine level of 10 micrograms per liter as a cut-off, the percentage of infants with a high level was calculated. Only 8 percent of the 305 infants from homes where no one smoked had high levels, whereas 96 percent from the 74 homes where the mother and one other family member smoked had high levels. If just the mother smoked, 91 percent of infants had high cotinine levels; if one family member smoked other than the mother, 44 percent of babies had high cotinine. Infants who were breast-fed by mothers who smoked had especially high urine cotinine, presumably because the breast milk of smokers contains large amounts of cotinine. The mother's estimate of how many cigarettes were smoked in the home correlated well with the urine cotinine level in the infant, suggesting that mothers are reliable sources for this information. Therefore, simply asking about family smoking habits can accurately identify infants at increased risk for respiratory diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lung infections are often the cause of illness and death in patients with AIDS. Because these infections may be caused by several different organisms, it is important to determine the causative agent. Sixteen pediatric patients with AIDS who had breathing difficulties were tested for lung infection with the use of a flexible bronchoscope to remove cells and fluid from the lungs (lavage). Bronchoscopy is the visual examination of the lungs, using a bronchoscope or curved flexible tube with a fiberoptic light system. The bronchoscope can also be used to obtain specimens for laboratory examination. Bronchoalveolar lavage involves irrigating (washing out) the bronchi (large airways) and alveoli (tiny gas-exchanging sacs in the lungs); during lavage cells are often obtained for examination. This technique has previously been used in adults and shown to an effective and safe method for diagnosing the causes of lung (pulmonary) disease. Flexible bronchoscopy and bronchoalveolar lavage were used in 16 children with AIDS who developed symptoms of lung disease, including difficult and rapid breathing. Their ages ranged between 3 and 36 months. No problems with the procedure were encountered with the pediatric patients, even in patients who had abnormal breathing rates and low levels of oxygen in the body. In 62 percent of the children the bacteria Pneumocystis carinii was found. One patient was infected with Pseudomonas aeruginosa as well as Pneumocystis carinii. Flexible bronchoscopy and bronchoalveolar lavage should be used in the examination of pediatric patients with AIDS so that microorganisms can be correctly identified and proper treatment can be administered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gastroesophageal reflux (GER), the backflow of stomach contents into the esophagus, is responsible for many respiratory diseases in children, including pneumonia, breathing stoppage (apnea), asthma, and bronchitis (swelling in the bronchial tree). Although the mechanism is not well understood, it is thought that breathed-in stomach contents stimulate the receptors in the esophagus to cause spasms in the bronchial tree. Bronchopulmonary dysplasia (BPD) is a disease in infants characterized by abnormal tissue growth in the breathing structures, sometimes necessitating mechanical breathing devices. Children with bronchopulmonary dysplasia show improvement with treatment given for gastroesophageal reflux, even when GER has not been confirmed. GER tends to aggravate existing lung disease. To determine the frequency of gastroesophageal reflux in children with BPD, 14 children with the condition and 13 infants without BPD were studied. The acid content in the esophagus was measured with a probe to diagnose GER. Children with BPD had fewer episodes of GER, which lasted a shorter amount of time. Therefore a true diagnosis of GER cannot be made in children with BPD. Although it is difficult to draw conclusions from this small study, GER is either insignificant in some children with BPD or else periodic episodes contribute to existing lung disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bronchitis, swelling in the bronchial tree of the breathing structures, can produce mucus. Cast bronchitis is characterized by the production of material that takes on the shape of breathing structures, much like a mold. These fibrous or mucus-like materials, called casts, differ from plugs of mucus by their shape and consistency. Although this type of bronchitis has been reported in adults, few cases have been found among children. It is suspected that many children with asthma-like bronchitis have bronchial casts. The clinical and X-ray findings of 72 children, three months to 5.5 years of age, with asthma-like or spastic bronchitis lasting more than two weeks and bronchial casts, are reported. Bronchial casts were found either in the stomach contents (from swallowing) or spontaneously coughed up. In 65 patients, the bronchitis lasted 10 to 24 months. An allergic response is not a likely cause, since laboratory indications of allergy were not found in the eight patients evaluated. Only one patient had a hypersensitive reaction, indicating an allergic condition. The casts were usually soft, hollow, white and had a branch-like appearance measuring 0.2 to 0.8 inches. They were composed of abnormal epithelial cells (the cells covering internal organs), inflammatory cells (which cause swelling) and some noncellular material. Viruses were not found in any of the 11 cast specimens studied. It is not known how the casts are formed. The strength of the casts depended on the ability of the epithelial cells to become attached. The more clumped the cells, the harder the cast. The epithelial cell transformation found in patients with cast formation is different from that caused by irritants (smoke for example) and allergens. Cystic fibrosis, a genetic condition causing excess mucus production, was later confirmed in one patient. It is concluded that cast formation may be a common event in infants and children with obstructive bronchitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stark PC, Burge HA, Ryan LM, et al, Am J Respir Crit Care Med. 2003;168:232-237 Purpose of the Study. Previous studies found a relationship between home dampness and lower respiratory [...]