Pediatric Pulmonology最新文献

Introduction: Because Americans spend approximately 87% of their time indoors, indoor air quality is a critical determinant of childhood asthma outcomes. Indoor environmental pollutants are heterogenous and dynamic, reflecting variations in household behaviors, building characteristics, and outdoor air quality and environmental exposures that penetrate the home envelope. The purpose of this state-of-the-art review is to provide an overview of current knowledge on common indoorpollutants.

Methods: PubMed was queried for studies published on indoor air pollutants between 2020 and 2025. Key pollutants identified are mold, particulate matter ≤ 2.5 µm (PM_2.5), nitrogen dioxide (NO₂), volatile organic compounds (VOCs), and radon.

Results: These studies highlight significant associations between pollutants and asthma prevalence, increased asthma symptoms, and reduced lung function. Some associations exist despite exposures levels below thresholds set by the U.S. Environmental Protection Agency (EPA) and the World Health Organization (WHO).

Conclusion: Further research is needed to expand our understanding of mixture effects and develop evidence-based practices for decreasing exposure to improve asthma outcomes.

Objective: To assess parents of children requiring invasive mechanical ventilation's (IMV) perceptions of their children's developmental delays and disabilities.

Methods: Parents of children <3 years of age who required IMV after neonatal disease were interviewed as a consecutive series from a state-wide agency (n = 20) and a ventilator clinic (n = 15). Interview topics included parents': (1) perception of their child's current developmental functioning, (2) understanding of their child's disability risks, and (3) prior conversations with providers about developmental milestones and disability risks. Interviews were coded using a modified template approach and discussed to consensus. Main and sub-themes were determined iteratively with all investigators.

Results: Thirty-five parents were interviewed. Themes were categorized under two topics: (1) Parents' recall of conversations with providers; (2) Parents' perspectives on developmental delays. Topic 1 themes: (1) Despite wanting information on developmental outcomes, parents report unclear expectations for delay and disability based on limited conversations; (2) Parents reported a lack of access to neurodevelopmental expertise, most often directing questions to therapists or other parents. Topic 2 themes: (1) Parents can identify specific developmental milestones and delays; (2) Parents have an idea of overall disability, sometimes attributed to specific diagnoses or medical complexity; (3) Parents are hopeful for their child's future development.

Conclusion: Parents of children requiring IMV value honesty about disability and recall few prior conversations. Most parents can identify developmental delays yet expect catch-up. Ultimately, improving communication between providers and parents about disability risk is critical to support children requiring IMV.

Background: Little is known about the mechanisms underlying the link between violence-related distress and asthma, particularly for asthma endotypes.

Methods: Cross-sectional analysis of violence-related distress in the previous 6 months (assessed using the Checklist of Children's Distress Symptoms [CCDS] scale) and nasal epithelial gene expression in 3 studies of youth with asthma aged 8-20 years: Stress and Treatment Response in Puerto Rican and African American Children with Asthma (STAR, n = 128), Epigenetic Variation and Childhood Asthma in Puerto Ricans (EVA-PR, n = 228), and Vitamin D Kids Asthma (VDKA, n = 47). We then tested for the association between expression of CCDS-related genes and nasal epithelial transcriptomic profiles corresponding to T2-high and T17-high asthma endotypes.

Results: In a meta-analysis of the CCDS score in the three cohorts, we identified 12 differentially expressed genes (DEGs) with false discovery rate-adjusted p value (FDR-P) < 0.05 and the same direction of association as in the discovery cohort (EVA-PR) in at least one replication cohort. Of these 12 DEGs, 9 (S100A7A, CCL2, CCL8, CXCL9-11, COL15A1, CD300E, and LILRB1) were upregulated and significantly associated with T17-high asthma in a meta-analysis of the three cohorts. Two genes belong to the CC Motif Chemokine Ligand family (CCL2, CCL8) and 3 belong to the CXC Motif Chemokine Ligand family (CXCL9, CXCL10, and CXCL11).

Conclusion: Nine novel genes were associated with violence-related distress and T17-high asthma in three cohorts of predominantly minoritized youth with asthma. Our findings may help uncover biologic processes underlying the violence-asthma link and could represent novel therapeutic targets for T17-high asthma.

Background: Air pollution is a significant modifiable risk factor that exacerbates asthma and compromises overall pulmonary health. American Indian/Alaska Native (AI/AN) populations may experience inequitable exposure to air pollution due to centuries of discrimination and forced relocation.

Aims: This review summarizes studies examining air pollution and its effects on pulmonary health in AI/AN children.

Materials and methods: A narrative review was undertaken by searching the largest medical literature databases. The search yielded ~100 articles, of which 12 are included in the review.

Results: A narrative review was undertaken by searching the largest medical literature databases. The search yielded ~100 articles, of which 12 are included in the review.

Discussion: AI/AN children are at risk of suboptimal pulmonary health outcomes due to inequitable exposures dictated by historical and current policies outside of their own control.

Conclusion: To address this inequity, specific advocacy actions must be taken to improve health outcomes related to air pollution among AI/AN youth, while also exploring additional strategies to expand access to pediatric pulmonary care.

Background: Bronchopulmonary dysplasia is one of the most common complications of preterm birth and has lifelong repercussions in respiratory health.

Objective: To examine lung function and exercise capacity and assess potential differences in exertional respiratory pattern and ventilatory and gas exchange responses in school-aged children with a history of prematurity and/or BPD.

Methods: Prospective observational study including children and adolescents born preterm, with and without BPD, and healthy term-born controls without a known history of asthma. Participants performed spirometry and cardiopulmonary exercise testing.

Results: Eighty-two children aged 6-18 years (mean: 11.9 years, SD: 3.1) were enrolled and examined in three groups: preterm-born with BPD (gestational age < 32 weeks), preterm-born without BPD (GA < 37 weeks), and term-born controls (GA ≥ 37 weeks). FVC, FEV₁, FEF_{25% -75%}, and FEV₁/FVC were normal and comparable among the three groups. V̇O₂peak% was reduced in the BPD group and was significantly lower than the control group (mean difference: -14.4, CI: -28 to -0.7, adjusted p = 0.04), but the difference was not significant when adjusting for height. The BPD group had the highest mean VE/VCO₂ adjusted for height (32.7), followed by the preterm (30.3) and the control group (29.5), and the difference between the BPD and control group was statistically significant (p = 0.015). Moreover, BPD status was significantly associated with increased VE/VCO₂ (β = +3.2, CI: 1-5.4, p = 0.005). The rest of the CPET parameters were within normal limits and comparable among groups.

Conclusions: Children with BPD have normal lung function but reduced exercise capacity and decreased ventilatory efficiency during exercise.

Background: Our prior work revealed multilevel barriers to smoking cessation interventions among cystic fibrosis (CF) families and clinical providers. Here, we assess qualitatively the implementation of CEASE-CF, a multicomponent smoking cessation intervention tailored to the needs of CF caregivers and delivered by a tobacco treatment specialist (TTS) integrated into the CF care team (NCT04777344).

Methods: We conducted interviews with CF caregivers in the CEASE-CF intervention arm and with CF clinical care providers. Interviews were recorded and transcribed. Data analysis was completed by two independent coders using NVivo. Themes were generated using a content analysis approach with a constant comparative method.

Results: In 22 interviews with caregivers (n = 12) and providers (n = 10), four overarching themes emerged: (1) Increased caregiver awareness about the sources and harms of smoke exposure; (2) Increased caregiver self-efficacy for quitting; (3) Caregiver endorsement of the effectiveness of counseling by TTS; and (4) Provider endorsement of the integration of TTS in the CF care team.

Conclusion: CEASE-CF positively impacted caregivers by increasing their awareness of the sources and harms of smoke exposure, equipping them with tools to change habits, and enhancing their self-reported confidence and self-efficacy for quitting. Consistent and multifaceted cessation support provided by a trained TTS is practice-changing and can be successfully integrated in CF care delivery.

Introduction: Bronchiolitis is the leading cause of infant hospitalizations worldwide, primarily driven by respiratory syncytial virus (RSV).

Methods: This multicenter retrospective comparative study assessed the impact of immunoprophylaxis with nirsevimab against RSV on bronchiolitis-related hospitalizations in Italy during the 2024-2025 winter season.

Results: Data from nine Italian hospitals showed a substantial 48% decrease in bronchiolitis admissions compared to the previous season (438 vs. 832 admissions). Among hospitalized infants, only 23% had received immunoprophylaxis. RSV positivity dropped significantly among immunized patients (48%) versus non-immunized (73%, p < 0.0001), with fewer RSV-related coinfections.

Discussion: While indicators of illness severity-such as ICU admission, respiratory support needs, and complications-were generally lower, no statistically significant differences in disease course were observed between immunized and non-immunized hospitalized infants. A shift in viral epidemiology was noted, with a reduction in RSV dominance and increased detection of rhinovirus and enterovirus, suggesting a pathogen replacement effect. The 2024-2025 season also saw a lower intubation rate (< 0.5%), pointing to an overall milder disease course.

Conclusions: This study supports the effectiveness of nirsevimab in reducing RSV-associated hospitalizations and reshaping the virological landscape of bronchiolitis in Italy. Early and widespread implementation of immunoprophylaxis is recommended to maximize public health benefits.