D. Ng, Yu-Shu Huang, O. Teoh, A. Preutthipan, Zhifei Xu, T. Sugiyama, K. Wong, K. Kwok, Brigitte Fung, R. Lee, J. Ng, Shuk-yu Leung, D. Che, A. Li, T. Wong, I. Khosla, A. Nathan, M. Leopando, Hussein Al Kindy
With recognition of the importance of obstructive sleep apnea syndrome (OSAS) in children, practice guidelines have been developed for the management of OSAS in the USA and Europe. A panel of experts in pediatric OSAS in Asia were appointed by the Asian Paediatric Pulmonology Society (APPS) to prepare a position statement for management of childhood OSAS in Asia. The purpose of this statement is to provide a reference standard in the diagnosis and management of childhood OSAS for doctors working in Asia. The expert panel determined the scope of this statement. Focused literature search related to the key topics was conducted by panel members. The final content of this statement was agreed on by all panel members and approved by the council of APPS. The current statement covered diagnostic approach, diagnostic criteria, management algorithm, drug-induced sleep endoscopy, medical treatment including medications and positive pressure ventilation, surgical treatment including adenotonsillectomy, orthodontic treatment, and orofacial myofunctional therapy (OMT). Diagnostic criteria of childhood OSAS from 1 year to 18 years were presented that include both clinical (criteria A) and polysomnography findings (criteria B) in the diagnosis of childhood OSAS. The use of nocturnal pulse oximetry as a screening tool was suggested using the McGill oximetry score. Management of OSAS with medical treatment, tonsillectomy and adenoidectomy (TandA), positive airway pressure, orthodontic devices, nasal valves, and OMT were reviewed. Management of persistent OSAS after TandA was addressed, and the importance of weight control was emphasized. The position statement provides a guideline to the management of childhood OSAS in Asia.
{"title":"The Asian Paediatric Pulmonology Society (APPS) position statement on childhood obstructive sleep apnea syndrome","authors":"D. Ng, Yu-Shu Huang, O. Teoh, A. Preutthipan, Zhifei Xu, T. Sugiyama, K. Wong, K. Kwok, Brigitte Fung, R. Lee, J. Ng, Shuk-yu Leung, D. Che, A. Li, T. Wong, I. Khosla, A. Nathan, M. Leopando, Hussein Al Kindy","doi":"10.4103/PRCM.PRCM_13_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_13_17","url":null,"abstract":"With recognition of the importance of obstructive sleep apnea syndrome (OSAS) in children, practice guidelines have been developed for the management of OSAS in the USA and Europe. A panel of experts in pediatric OSAS in Asia were appointed by the Asian Paediatric Pulmonology Society (APPS) to prepare a position statement for management of childhood OSAS in Asia. The purpose of this statement is to provide a reference standard in the diagnosis and management of childhood OSAS for doctors working in Asia. The expert panel determined the scope of this statement. Focused literature search related to the key topics was conducted by panel members. The final content of this statement was agreed on by all panel members and approved by the council of APPS. The current statement covered diagnostic approach, diagnostic criteria, management algorithm, drug-induced sleep endoscopy, medical treatment including medications and positive pressure ventilation, surgical treatment including adenotonsillectomy, orthodontic treatment, and orofacial myofunctional therapy (OMT). Diagnostic criteria of childhood OSAS from 1 year to 18 years were presented that include both clinical (criteria A) and polysomnography findings (criteria B) in the diagnosis of childhood OSAS. The use of nocturnal pulse oximetry as a screening tool was suggested using the McGill oximetry score. Management of OSAS with medical treatment, tonsillectomy and adenoidectomy (TandA), positive airway pressure, orthodontic devices, nasal valves, and OMT were reviewed. Management of persistent OSAS after TandA was addressed, and the importance of weight control was emphasized. The position statement provides a guideline to the management of childhood OSAS in Asia.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125141513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This report reviews the historical developments leading to recognition of pediatric obstructive sleep apnea. It briefly summarized the rationale why the upper airway becomes at risk of collapsibility during sleep. It also reviews the complaints that vary with age. It emphasizes points of the examination that must be systematically look for. The report reviews the variables to monitor, to look for, and to be analyzed, and patterns not often looked at but that disturb sleep and lead to complaints and symptoms in sleep polysomnography.
{"title":"Pediatric obstructive sleep apnea: A short review of clinical aspects","authors":"C. Guilleminault, Yu-Shu Huang","doi":"10.4103/PRCM.PRCM_7_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_7_17","url":null,"abstract":"This report reviews the historical developments leading to recognition of pediatric obstructive sleep apnea. It briefly summarized the rationale why the upper airway becomes at risk of collapsibility during sleep. It also reviews the complaints that vary with age. It emphasizes points of the examination that must be systematically look for. The report reviews the variables to monitor, to look for, and to be analyzed, and patterns not often looked at but that disturb sleep and lead to complaints and symptoms in sleep polysomnography.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129539390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A joint effort on children with obstructive apnea by Asian pediatric pulmonologists","authors":"K. Wong","doi":"10.4103/PRCM.PRCM_14_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_14_17","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123749366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Nathan, Y. Qiao, F. Jafar, Y. Chan, K. Eg, S. Thavagnanam, S. Bakar, I. Sam, J. Debruyne
Context: Viruses are the main causes of acute lower respiratory tract infections (ALRIs) in childhood and its impact on hospital admission is largely unknown. Aims: The aim of this study is to determine (a) virus detection, (b) risk factors for admission, particularly virus detection, and (c) differential clinical responses to viral infections, in children attending pediatric emergency department (PED) with an ALRI in Malaysia. Subjects and Methods: This prospective study included children ≤2 years who presented to PED between September 1, 2010, and March 6, 2012, with features of lower respiratory tract infection. Nasopharyngeal aspirates (NPAs) were tested using a multiplex polymerase chain reaction (PCR) for 11 respiratory viruses. Results: Two hundred children were recruited in the study. Two-thirds (65.5%) of them were admitted. NPA-PCR was positive in 54% of all patients: 50.4% of those admitted and 60.9% of those discharged. The most common viruses detected were respiratory syncytial virus (RSV) (49.1%), rhinovirus (30.6%), and parainfluenza viruses (12.0%). Five patients had mixed infections. RSV detection was associated with previous history of wheeze (odds ratio, 2.05 [95% confidence interval 1.06, 4.00]). Viruses were detected in all severely ill patients and patients with apnea. Multivariate analysis showed that virus detection was not associated with the need for admission, but female sex, lack of breastfeeding and, attending nursery were associated with hospitalization. Conclusions: Half of the children who presented to the emergency room with ALRI had viruses detected in their NPA. There was no association between virus detection and hospitalization. RSV was associated with history of wheeze. Female gender, lack of breastfeeding, and nursery attendance were associated with hospitalization.
{"title":"Viruses and hospitalization for childhood lower respiratory tract infection in Malaysia: A prospective study","authors":"A. Nathan, Y. Qiao, F. Jafar, Y. Chan, K. Eg, S. Thavagnanam, S. Bakar, I. Sam, J. Debruyne","doi":"10.4103/PRCM.PRCM_2_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_2_17","url":null,"abstract":"Context: Viruses are the main causes of acute lower respiratory tract infections (ALRIs) in childhood and its impact on hospital admission is largely unknown. Aims: The aim of this study is to determine (a) virus detection, (b) risk factors for admission, particularly virus detection, and (c) differential clinical responses to viral infections, in children attending pediatric emergency department (PED) with an ALRI in Malaysia. Subjects and Methods: This prospective study included children ≤2 years who presented to PED between September 1, 2010, and March 6, 2012, with features of lower respiratory tract infection. Nasopharyngeal aspirates (NPAs) were tested using a multiplex polymerase chain reaction (PCR) for 11 respiratory viruses. Results: Two hundred children were recruited in the study. Two-thirds (65.5%) of them were admitted. NPA-PCR was positive in 54% of all patients: 50.4% of those admitted and 60.9% of those discharged. The most common viruses detected were respiratory syncytial virus (RSV) (49.1%), rhinovirus (30.6%), and parainfluenza viruses (12.0%). Five patients had mixed infections. RSV detection was associated with previous history of wheeze (odds ratio, 2.05 [95% confidence interval 1.06, 4.00]). Viruses were detected in all severely ill patients and patients with apnea. Multivariate analysis showed that virus detection was not associated with the need for admission, but female sex, lack of breastfeeding and, attending nursery were associated with hospitalization. Conclusions: Half of the children who presented to the emergency room with ALRI had viruses detected in their NPA. There was no association between virus detection and hospitalization. RSV was associated with history of wheeze. Female gender, lack of breastfeeding, and nursery attendance were associated with hospitalization.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124149207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The purpose of this article is to describe and summarize the clinical manifestations and radiographic features of focal bulging of chest walls in children using plain chest radiography and computed tomography (CT) scans. Methods: From 2008 to 2014, we identified 12 patients with forked ribs younger than 18 years of age. These patients received plain chest radiography and computed tomographic scans of the chest for focal anterior chest wall protrusion at the outpatient chest clinic of a children's facility. Results: A total of 12 patients (5 girls and 7 boys; age range, 2–12 years; median, 5 years) were enrolled in this study. Six patients had right-sided costal lesions, four had left-sided lesions, and two had anomalies on both sides. The most common rib involved was the 4th rib. Two patients with forked cartilages and one patient with forked rib were not detected in frontal radiograph but seen by CT scans only. Up to the time of this writing, the follow-up of patients revealed no progression of focal bulging. Conclusion: In otherwise healthy children with asymptomatic focal anterior chest wall bulging, forked ribs is a common cause of variation. The chest radiographs may be normal. Chest CT scans demonstrated forked ribs/cartilage as the cause of focal bulging of the chest wall unequivocally in such instances.
{"title":"Focal chest wall protuberance due to forked ribs or cartilages: An analysis of 12 cases","authors":"K. Wong, Yen-Chun Huang, S. Lai, C. Chiu","doi":"10.4103/PRCM.PRCM_13_16","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_13_16","url":null,"abstract":"Objective: The purpose of this article is to describe and summarize the clinical manifestations and radiographic features of focal bulging of chest walls in children using plain chest radiography and computed tomography (CT) scans. Methods: From 2008 to 2014, we identified 12 patients with forked ribs younger than 18 years of age. These patients received plain chest radiography and computed tomographic scans of the chest for focal anterior chest wall protrusion at the outpatient chest clinic of a children's facility. Results: A total of 12 patients (5 girls and 7 boys; age range, 2–12 years; median, 5 years) were enrolled in this study. Six patients had right-sided costal lesions, four had left-sided lesions, and two had anomalies on both sides. The most common rib involved was the 4th rib. Two patients with forked cartilages and one patient with forked rib were not detected in frontal radiograph but seen by CT scans only. Up to the time of this writing, the follow-up of patients revealed no progression of focal bulging. Conclusion: In otherwise healthy children with asymptomatic focal anterior chest wall bulging, forked ribs is a common cause of variation. The chest radiographs may be normal. Chest CT scans demonstrated forked ribs/cartilage as the cause of focal bulging of the chest wall unequivocally in such instances.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131040406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asthma is a common condition, which is commonly, badly diagnosed and badly treated, leading to unnecessary morbidity and even death in childhood, despite which complacency about management at all levels of care persists. Asthma is an umbrella term like anaemia and arthritis and should not be used as an unqualified diagnosis. It is suggested that airway disease should be deconstructed into treatable and untreatable components, such as fixed and variable airflow obstruction and airway inflammation and infection. Every effort should be made to make an objective diagnosis, and treatment should be individualised accordingly. Objective testing for airway inflammation may include determination of atopic status, blood eosinophil count and exhaled nitric oxide; physiological testing includes peak flow measurement, comprising response to exercise and short-acting μ-2 agonists. Most school-age atopic children with recurrent wheeze respond well to low-dose inhaled corticosteroids if these are regularly and correctly administered. The provision of an asthma plan is mandatory. If response is poor, rather than uncritically escalating therapies, a review of adherence and any adverse environmental factor should be considered. Asthma attacks are a red flag sign of a bad prognosis, and should prompt a full review, and changes in the asthma plan as necessary. Also, regular reviews of progress and treatment need are mandatory, even in the well child with asthma. In all contexts, the importance of getting the basic rights cannot be overemphasised; still, asthma deaths are attributed to neglect of this principle. Other issues discussed in this review include the approach to the child who is breathless on exercise and the diagnosis of exercise-induced laryngeal obstruction; the so-called habit/honk cough; the problem of breathlessness and airway disease in the obese child, including the airway as the target of systemic inflammation; and the problem of 'asthma' complicating other airways diseases such as cystic fibrosis and extrapulmonary diseases such as sickle-cell anaemia. Overall, the main message of this review is that it should never be forgotten that asthma is a disease which kills children and should always be taken seriously.
{"title":"Asthma: What's new, and what should be old but is not!","authors":"A. Bush","doi":"10.4103/PRCM.PRCM_11_16","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_11_16","url":null,"abstract":"Asthma is a common condition, which is commonly, badly diagnosed and badly treated, leading to unnecessary morbidity and even death in childhood, despite which complacency about management at all levels of care persists. Asthma is an umbrella term like anaemia and arthritis and should not be used as an unqualified diagnosis. It is suggested that airway disease should be deconstructed into treatable and untreatable components, such as fixed and variable airflow obstruction and airway inflammation and infection. Every effort should be made to make an objective diagnosis, and treatment should be individualised accordingly. Objective testing for airway inflammation may include determination of atopic status, blood eosinophil count and exhaled nitric oxide; physiological testing includes peak flow measurement, comprising response to exercise and short-acting μ-2 agonists. Most school-age atopic children with recurrent wheeze respond well to low-dose inhaled corticosteroids if these are regularly and correctly administered. The provision of an asthma plan is mandatory. If response is poor, rather than uncritically escalating therapies, a review of adherence and any adverse environmental factor should be considered. Asthma attacks are a red flag sign of a bad prognosis, and should prompt a full review, and changes in the asthma plan as necessary. Also, regular reviews of progress and treatment need are mandatory, even in the well child with asthma. In all contexts, the importance of getting the basic rights cannot be overemphasised; still, asthma deaths are attributed to neglect of this principle. Other issues discussed in this review include the approach to the child who is breathless on exercise and the diagnosis of exercise-induced laryngeal obstruction; the so-called habit/honk cough; the problem of breathlessness and airway disease in the obese child, including the airway as the target of systemic inflammation; and the problem of 'asthma' complicating other airways diseases such as cystic fibrosis and extrapulmonary diseases such as sickle-cell anaemia. Overall, the main message of this review is that it should never be forgotten that asthma is a disease which kills children and should always be taken seriously.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"27 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116215131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu-Ting Yu, S. Shyur, S. Chu, Yu-Hsuan Kao, H. Lung, Wei‐Te Lei, Li-Ching Fang, Chien-Hui Yang
Background: Allergic rhinitis (AR) is characterized by eosinophilic infiltration and immunoglobulin E (IgE)-mediated reaction after exposure to an allergen. Its severity may be correlated to fractional exhaled nitric oxide (FeNO). This study aimed to evaluate the correlation of FeNO and various parameters with severity of AR in Taiwanese children with moderate persistent asthma. Materials and Methods: The study enrolled 103 children aged 5–18 years with AR and moderate persistent asthma from the Outpatient Department, Mackay Memorial Hospital, Taipei. Based on Total Nasal Symptom Score (TNSS), the patients were divided into high-score group (TNSS ≥5) and low-score group (TNSS <5). Both groups were assessed and compared by FeNO, blood eosinophil percentage, serum total IgE level, specific IgE levels to 8 allergens, and pulmonary function tests. Results: The low-score group showed significantly lower FeNO (18.57 ± 14.47 vs. 26.83 ± 17.84 ppb; P < 0.05), lower blood eosinophil percentage (3.08 ± 3.43 vs. 4.53 ± 3.37%; P < 0.05), lower level of serum total IgE (232.64 ± 438.88 vs. 510.63 ± 732.64 IU/mL; P < 0.05), and lower specific IgE to Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), and dog (1.80 ± 2.35 vs. 3.66 ± 2.23, P < 0.05; 1.78 ± 2.36 vs. 3.56 ± 2.31, P < 0.05; and 0.00 ± 0.00 vs. 0.29 ± 0.81, P < 0.05). There are no significant differences between two groups about forced expiratory volume in 1 s (FEV1) (96.95 ± 13.39 vs. 97.85 ± 14.98% predicted; P = 0.75), FEV1/forced vital capacity percentage (89.00 ± 9.78 vs. 90.20 ± 5.85%; P = 0.47), and forced expiratory flow 25%–75% (55.16 ± 18.48 vs. 56.75 ± 20.15% predicted; P = 0.68). Conclusions: Taiwanese children with moderate persistent asthma with more severe symptoms of AR are significantly associated with higher levels of FeNO, total IgE, specific IgE to Der p, Der f, and dog, and higher blood eosinophil percentage.
{"title":"The correlation of exhaled nitric oxide, atopy, and severity of allergic rhinitis in taiwanese children with moderate persistent asthma","authors":"Yu-Ting Yu, S. Shyur, S. Chu, Yu-Hsuan Kao, H. Lung, Wei‐Te Lei, Li-Ching Fang, Chien-Hui Yang","doi":"10.4103/PRCM.PRCM_12_16","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_12_16","url":null,"abstract":"Background: Allergic rhinitis (AR) is characterized by eosinophilic infiltration and immunoglobulin E (IgE)-mediated reaction after exposure to an allergen. Its severity may be correlated to fractional exhaled nitric oxide (FeNO). This study aimed to evaluate the correlation of FeNO and various parameters with severity of AR in Taiwanese children with moderate persistent asthma. Materials and Methods: The study enrolled 103 children aged 5–18 years with AR and moderate persistent asthma from the Outpatient Department, Mackay Memorial Hospital, Taipei. Based on Total Nasal Symptom Score (TNSS), the patients were divided into high-score group (TNSS ≥5) and low-score group (TNSS <5). Both groups were assessed and compared by FeNO, blood eosinophil percentage, serum total IgE level, specific IgE levels to 8 allergens, and pulmonary function tests. Results: The low-score group showed significantly lower FeNO (18.57 ± 14.47 vs. 26.83 ± 17.84 ppb; P < 0.05), lower blood eosinophil percentage (3.08 ± 3.43 vs. 4.53 ± 3.37%; P < 0.05), lower level of serum total IgE (232.64 ± 438.88 vs. 510.63 ± 732.64 IU/mL; P < 0.05), and lower specific IgE to Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), and dog (1.80 ± 2.35 vs. 3.66 ± 2.23, P < 0.05; 1.78 ± 2.36 vs. 3.56 ± 2.31, P < 0.05; and 0.00 ± 0.00 vs. 0.29 ± 0.81, P < 0.05). There are no significant differences between two groups about forced expiratory volume in 1 s (FEV1) (96.95 ± 13.39 vs. 97.85 ± 14.98% predicted; P = 0.75), FEV1/forced vital capacity percentage (89.00 ± 9.78 vs. 90.20 ± 5.85%; P = 0.47), and forced expiratory flow 25%–75% (55.16 ± 18.48 vs. 56.75 ± 20.15% predicted; P = 0.68). Conclusions: Taiwanese children with moderate persistent asthma with more severe symptoms of AR are significantly associated with higher levels of FeNO, total IgE, specific IgE to Der p, Der f, and dog, and higher blood eosinophil percentage.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121646851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Yu, J. Chan, F. Poon, R. Lee, Shuk-yu Leung, J. Ng, Kaganov SIu, Ada Yip, K. Kwok, E. Chan, J. Wong, D. Ng
Background: Preschool children with wheeze may develop asthma later at school age. Positive skin prick test (SPT) to common aeroallergens in preschool wheezers may be associated with a higher chance of developing asthma at school age. Methods: All patients with SPT performed for the indication of preschool wheeze, i.e., before the age of 6 years, were included in the study from 1999 to 2011. Outcome measures including asthmatic attack requiring emergency hospitalization and the need for asthma controller prescription after the age of 6 years were retrieved from the hospital database. Potential risk factors including gender, family history of asthma, blood eosinophilia, environmental tobacco exposure, personal eczema, and allergic rhinitis were also retrieved for analysis. Multiple logistic regression was performed to identify independent risk factors. Results: Altogether, 463 children were included for analysis with mean age at SPT of 3.1 ± 1.36 years and 64.6% were male. Positive SPT results were obtained in 60.5% of patients. For preschool children with wheeze, female gender (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.04–3.46, P = 0.036), positive SPT (OR = 2.96, 95% CI: 1.40–6.24, P = 0.004), and late-onset preschool wheeze hospitalization (OR = 2.82, 95% CI: 1.42–5.61, P = 0.003) were associated with a higher chance of asthmatic hospitalization after the age of 6 years. Allergic rhinitis (OR = 4.58, 95% CI: 2.16–9.71, P < 0.001) and family history of asthma (OR = 1.82, 95% CI: 1.09–3.02, P = 0.022) were associated with higher chance for asthma controller prescription. Conclusion: For preschool wheeze, female gender, positive SPT, and late-onset preschool wheeze index are associated with a higher chance of asthmatic hospitalization after the age of 6 years while allergic rhinitis and family history of asthma are associated with a higher chance for asthma controller prescription after the age of 6 years.
背景:学龄前喘息儿童可能在学龄后期发展为哮喘。学龄前儿童皮肤点刺试验(SPT)对常见的空气过敏原呈阳性可能与学龄期发生哮喘的较高机会有关。方法:选取1999 - 2011年所有以学龄前喘息为指征，即6岁前接受SPT治疗的患儿。从医院数据库中检索结果测量指标，包括6岁后需要紧急住院治疗的哮喘发作和哮喘控制处方的需求。潜在的危险因素包括性别、哮喘家族史、血嗜酸性粒细胞增加、环境烟草暴露、个人湿疹和过敏性鼻炎。采用多元逻辑回归来确定独立的危险因素。结果:共有463名儿童纳入分析，平均年龄为3.1±1.36岁，64.6%为男性。60.5%的患者获得SPT阳性结果。对于学龄前喘息儿童，女性(优势比[OR] = 1.90, 95%可信区间[CI]: 1.04-3.46, P = 0.036)、SPT阳性(OR = 2.96, 95% CI: 1.40-6.24, P = 0.004)、晚发性学龄前喘息住院(OR = 2.82, 95% CI: 1.42-5.61, P = 0.003)与6岁后哮喘住院的较高几率相关。变应性鼻炎(OR = 4.58, 95% CI: 2.16-9.71, P < 0.001)和哮喘家族史(OR = 1.82, 95% CI: 1.09-3.02, P = 0.022)与服用哮喘控制药物的几率较高相关。结论:对于学龄前喘息，女性、SPT阳性、晚发性学龄前喘息指数与6岁后哮喘住院的几率较高相关，过敏性鼻炎和哮喘家族史与6岁后哮喘控制处方的几率较高相关。
{"title":"The predictive factors in preschool wheezers for subsequent asthma hospitalization after the age of 6 years","authors":"P. Yu, J. Chan, F. Poon, R. Lee, Shuk-yu Leung, J. Ng, Kaganov SIu, Ada Yip, K. Kwok, E. Chan, J. Wong, D. Ng","doi":"10.4103/PRCM.PRCM_15_16","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_15_16","url":null,"abstract":"Background: Preschool children with wheeze may develop asthma later at school age. Positive skin prick test (SPT) to common aeroallergens in preschool wheezers may be associated with a higher chance of developing asthma at school age. Methods: All patients with SPT performed for the indication of preschool wheeze, i.e., before the age of 6 years, were included in the study from 1999 to 2011. Outcome measures including asthmatic attack requiring emergency hospitalization and the need for asthma controller prescription after the age of 6 years were retrieved from the hospital database. Potential risk factors including gender, family history of asthma, blood eosinophilia, environmental tobacco exposure, personal eczema, and allergic rhinitis were also retrieved for analysis. Multiple logistic regression was performed to identify independent risk factors. Results: Altogether, 463 children were included for analysis with mean age at SPT of 3.1 ± 1.36 years and 64.6% were male. Positive SPT results were obtained in 60.5% of patients. For preschool children with wheeze, female gender (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.04–3.46, P = 0.036), positive SPT (OR = 2.96, 95% CI: 1.40–6.24, P = 0.004), and late-onset preschool wheeze hospitalization (OR = 2.82, 95% CI: 1.42–5.61, P = 0.003) were associated with a higher chance of asthmatic hospitalization after the age of 6 years. Allergic rhinitis (OR = 4.58, 95% CI: 2.16–9.71, P < 0.001) and family history of asthma (OR = 1.82, 95% CI: 1.09–3.02, P = 0.022) were associated with higher chance for asthma controller prescription. Conclusion: For preschool wheeze, female gender, positive SPT, and late-onset preschool wheeze index are associated with a higher chance of asthmatic hospitalization after the age of 6 years while allergic rhinitis and family history of asthma are associated with a higher chance for asthma controller prescription after the age of 6 years.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133724873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A new global journal for our specialty","authors":"G. Wong","doi":"10.4103/PRCM.PRCM_8_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_8_17","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132874995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatments of congenital diaphragmatic hernia: The paradigm shift, controversies, and the Hong Kong experience","authors":"K.‐A. ME Lin","doi":"10.4103/prcm.prcm_19_22","DOIUrl":"https://doi.org/10.4103/prcm.prcm_19_22","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121246816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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