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: To date, there is no data on forced oscillation technique (FOT) as a tool to evaluate elexacaftor/tezacaftor/ivacaftor (ETI) modulator in young patients with cystic fibrosis (pwCF).

Objective: Our study aimed to assess the effect of a 6-month ETI treatment on FOT parameters and compare it to the effect on spirometry and nitrogen multiple-breath washout (N₂MBW) parameters.

Method: Forty-nine pwCF (median age 12.39 years, 59.2% male) were assessed with spirometry, N₂MBW, and FOT before and 3 and 6 months after receiving ETI. The trends in changes of spirometric and FOT parameters were compared among pwCF of different disease severity and in the three patient groups according to their mutation group, that is, F/F, F/non-F, and non-F/non-F. Panel regression was applied to define the predictors of LCI.

Results: A significant change was observed 6 months after receiving ETI in height, weight, BMI, Rs5z-score, Xs5z-score, AXz-score, FEV₁z-score, FVCz-score, FEF_25-75z-score, LCI and sGrs (p < 0.01). FOT followed a similar trend in parameters' change with spirometry and N₂MBW three and 6 months after ETI among different severity groups based on LCI (p < 0.05). Genotype group was found to have a minor role in ETI efficacy; a significant improvement was found in the non-F/non-F group in all pulmonary tests (p < 0.01).

Conclusions: Our preliminary data suggest that oscillometry parameters showed a significant improvement after ETI treatment among all genotype groups. More data are required to assess whether and which FOT parameters could be used as surrogates of LCI or spirometry for the long-term follow-up of pwCF.

Introduction: Bronchiectasis in children is a neglected chronic suppurative lung disease that imposes a substantial burden on children and adolescents and their families, adversely affecting quality of life (QoL). Incorporating health-related quality of life (HRQoL) tools into routine care can improve outcomes by highlighting disease burden and guiding tailored interventions. This scoping review aimed to identify self-reported questionnaires assessing QoL in pediatric bronchiectasis (PB).

Methods: Following the PRISMA extension for scoping reviews, we searched Embase, CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and PubMed for articles published in English since 2000. Pre-specified keywords (QoL, children, adolescents, bronchiectasis, lung disease, patient reported outcome measures (PROM), primary ciliary dyskinesia, cystic fibrosis) and related index terms were used. Studies employing questionnaires or items assessing QoL in children and adolescents with bronchiectasis were included without geographical restrictions. Two authors independently screened and appraised eligible manuscripts.

Results: The search yielded 731 articles, of which 373 were relevant to respiratory diseases. Thirty-three met inclusion criteria, identifying 15 unique HRQoL tools used in bronchiectasis or related conditions. Only five (33%) of these tools were developed for adults with bronchiectasis and no pediatric-specific bronchiectasis HRQoL questionnaires were identified.

Conclusion: This scoping review highlights the absence of any validated, pediatric-specific HRQoL tools for bronchiectasis. Developing such a questionnaire, informed by existing instruments and our review findings, is an urgent priority. A validated tool will enhance understanding of disease impact on children, adolescents and their families, supporting tailored clinical care and research interventions.

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: Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity, contributing to long term adverse respiratory outcomes that persist across the life course. However, it remains unclear how childhood opportunity impacts the underlying risk for developing BPD and post-discharge respiratory health, both of which may impact long term outcomes.

Methods: Observational cohort of 845 children born very preterm (≤32 weeks), followed for post-prematurity respiratory disease. We derived childhood opportunity index (COI) from the census tract corresponding to each subject's address. Linear regression was used to identify the impact of COI on neonatal and childhood respiratory outcomes. In a secondary analysis, we examined differences in outcomes between races (White, non-White), across quartiles of COI.

Results: Children residing in neighborhoods with lower COI were born at a significantly smaller birth weight, earlier gestation, and spent longer duration on mechanical ventilation (MV) in the NICU. No direct association was observed between COI and longer-term respiratory outcomes. Racial disparities in birth outcomes within COI quartiles became more pronounced at higher levels of opportunity. Longer duration of MV in the NICU was significantly associated with longer-term outcomes including increased hospital readmissions in early life and lower FEV₁ and FVC % predicted in childhood.

Conclusion: Low COI is associated with longer duration of MV in the NICU, which itself is associated with increased healthcare utilization and reduced functional respiratory outcomes. Racial disparities in birth outcomes within similar neighborhood contexts demonstrate the need for targeted interventions to advance health equity in this population of vulnerable infants.