Paediatric Respiratory Reviews最新文献

Viral bronchiolitis is the most common pediatric acute respiratory infection leading to hospitalization, and it causes a significant healthcare burden worldwide. Current guidelines recommend supportive management after many clinical trials on specific therapies failed to demonstrate benefits. However, several studies in the past decade have revealed that bronchiolitis may not be a homogeneous disease, but instead may constitute an umbrella comprised of different "endotypes" and "phenotypes" based on patient characteristics, etiology, pathophysiological mechanisms, and clinical presentation. In this extensive review, we summarize the current evidence that several different types of bronchiolitis ("bronchiolitides") coexist, with different short- and long-term consequences on respiratory health and the risk of asthma development. Disease pathobiology, immune response, and clinical characteristics may differ between the two most prevalent viral agents, respiratory syncytial virus and rhinovirus. Recent randomized trials have shown that some subgroups of children may benefit from the use of systemic corticosteroids and/or bronchodilators. These findings also suggest that some children may benefit from individualized therapeutical approaches for viral bronchiolitis rather than following broad recommendations for treating all patients uniformly using only supportive management.

Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are essential in asthma management, but the guidelines for treatment in preschool children remain heterogeneous worldwide. This systematic review evaluates the efficacy and safety of LABA + ICS therapy in asthmatic children under six years. We searched four databases, identifying six eligible studies (n = 1415 preschoolers), and in all the LABA used was salmeterol. Due to high heterogeneity, quantitative analysis was not feasible. Three before-and-after studies demonstrated significant reductions in unscheduled visits and hospitalizations due to asthma exacerbations with LABA + ICS. One RCT showed fewer exacerbations in the LABA + ICS group compared to ICS alone. Night-time awakenings decreased significantly in two studies but not in one RCT. Improvements in lung function using impulse oscillometry and FeNO levels were noted with LABA+ICS in one RCT. No significant adverse effects were reported. Despite positive findings, high-quality trials are needed to confirm these results, particularly using formoterol as LABA, aligning with the recommendations. Further research is imperative to optimize asthma management in preschool children.

Climate change may have devastating effects on the pathogenesis of non-cystic fibrosis bronchiectasis in children since it affects the biological cycle of the respiratory pathogens and alters the human respiratory defense mechanisms. Bronchiectasis in children has been identified as an emerging global epidemic that has attracted the attention of the medical community over recent years. Pediatric pulmonologists should be aware of the consequences of climate change on children with bronchiectasis and plan strategies to ameliorate these effects.

Community acquired pneumonia is among the most common causes of hospitalisation in children, despite most cases being successfully managed in ambulatory care. Empyema is the most common complication of hospitalised pneumonia, and although associated with considerable morbidity, death is rare, even in severe disease. Beyond the acute infection, there is a recognised association of paediatric lower respiratory tract infection and impaired lung function over the whole life span. Longitudinal birth cohorts highlight the deleterious effect of paediatric pneumonia on lung function and the development of chronic obstructive pulmonary disease and a near doubling of respiratory associated mortality in adults. Less clear is how to reconcile this worrisome data with most children only having mild abnormalities on spirometry in paediatric follow up. Recurrent or severe pneumonia is infrequently associated with irreversible lung injury such as bronchiectasis or bronchiolitis obliterans.

The chest and spine deformity in neuromuscular disease (NMDz) can impact respiratory mechanics and pulmonary function by changing the orientation of the muscles and joints of the respiratory system and placing them in a mechanically unfavorable position. This increases mechanical load on weak respiratory muscles and eventually can cause respiratory failure. Therefore, chest and spine deformity in NMDz will both lead to increased respiratory "load" and decreased respiratory muscle "pump", an exceptionally bad combination. While the current pharmacotherapies used for progressive neuromuscular disease focus on slowing progression, a similar approach has been used for decades in managing chest and spine deformity in patients with NMDz. There are, however, variable approaches to doing so and a recognition that not all "neuromuscular scoliosis" is the same and that each patient type (i.e. hypotonic vs. hypertonic) requires a different approach. Figuring out what approach to use requires both an understanding of the underlying pathophysiology of a particular neuromuscular condition and considering available options for and timing of surgical interventions. The remaining discussion will focus on hypotonic neuromuscular scoliosis.

Highly effective modulator therapy (HEMT), particularly the triple combination elexacaftor-tezacaftor-ivacaftor (ETI), significantly improved clinical outcomes and quality of life in people with Cystic Fibrosis (pwCF). This review analyzes current knowledge on the impact of HEMTs on gastrointestinal (GI) symptoms and features in pwCF. A descriptive review of English literature until February 29, 2024, was conducted using medical databases. Observational studies and clinical trials addressing GI reflux disease (GERD), lower GI symptoms and pancreatic disease were considered. Studies report positive effects of HEMTs on pH levels and bicarbonate secretion as well as improvement on intestinal inflammation. HEMTs also demonstrated positive effects on GERD and lower GI symptoms or conditions CF related such as dysbiosis. Taking ETI during pregnancy could also allow resolution of meconium ileus in fetuses with CF. The best benefits were observed in pancreatic function, potentially delaying CF-related diabetes and recovering pancreatic function in some children on ETI. Larger trials, particularly in pediatric populations, need to confirm these findings and explore long-term effects.

Introduction: Pseudohypoaldosteronism type 1b (PHA1B) is a rare autosomal recessive disease caused by dysfunction of amiloride-sensitive epithelial sodium channels (ENaC), that might present with a wide variety of pulmonary symptoms.

Methods: We provide a systematic review of published cases with PHA1B and respiratory symptoms, adding a relevant case from our clinic.

Results: Thirty-seven publications presenting 61 cases were identified apart from our case. Parental consanguinity was reported in 24/62 patients. In 39 patients the onset of pulmonary manifestations was early in infancy. Lower respiratory tract infections caused by Pseudomonas aeruginosa and Staphylococcus aureus were reported in 3 cases each, while 2 patients developed bronchiectasis. Pathological sweat test results were recorded in all 34 patients with available data. In 36/47 patients the underlying pathogenic variant was identified in SCNN1A gene.

Conclusion: High clinical suspicion is required when treating patients with PHA1B for the potential need for early treatment of respiratory symptoms to avert any permanent pulmonary damage.

Mask mandates for children were implemented at schools and childcare centers during the COVID-19 pandemic, and the US continues to recommend masking down to the age of two in certain settings. Medical interventions should be informed by high-quality evidence and consider the possibility of harm (i.e., include harm-benefit analyses). In this review, we weigh the existing evidence for the effectiveness of mask mandates to protect against COVID-19 and other viral respiratory infections and the harms associated with face mask wearing in children. There is a lack of robust evidence of benefit from masking children to reduce transmission of SARS-CoV-2 or other respiratory viruses. The highest quality evidence available for masking children for COVID-19 or other viral respiratory infections has failed to find a beneficial impact against transmission. Mechanistic studies showing reduced viral transmission from use of face masks and respirators have not translated to real world effectiveness. Identified harms of masking include negative effects on communication and components of speech and language, ability to learn and comprehend, emotional and trust development, physical discomfort, and reduction in time and intensity of exercise. Effectiveness of child masking has not been demonstrated, while documented harms of masking in children are diverse and non-negligible and should prompt careful reflection. Recommendations for masking children fail basic harm-benefit analyses.

Objectives: To investigate the epidemiology, aetiology, diagnostics and management of childhood pneumonia in low and middle income countries (LMICs).

Design: Review of published english literature from 2019 to February 2024.

Results: Lower respiratory tract infections (LRTIs) still result in significant mortality in children under 5 years of age in LMICs. Important studies have reported a change in the pathogenesis of LRTIs over the last 5 years with respiratory syncytial virus (RSV) resulting in a large burden of disease. SARS-CoV-2 had a significant direct and indirect impact in children in LMICs. Mycobacterium tuberculosis (MTB) remains a priority pathogen in all children. Nucleic acid amplification and rapid antigen tests have improved diagnostic accuracy for MTB and other bacterial pathogens. Point of care diagnostics may overcome some limitations, but there is a need for better cost-effective diagnostics. Access to shorter courses of TB treatment are now recommended for some children, but child friendly formulations are lacking. The role of chest X-ray in TB has been recognized and included in guidelines, and lung ultrasound to diagnose LRTI is showing promise as a lower cost and accessible option.

Conclusion: Advances in diagnostics and large multi-centre studies have provided increased understanding of the causative pathogens of LRTIs in LMICs. Increased access to preventive strategies such as vaccines, treatment modalities including antivirals, and addressing upstream factors such as poverty are essential if further declines in LRTIs in LMICs are to be realised.