17 research outputs found
Alpha-1 antitrypsin deficiency
No full textα-1 antitrypsin is synthesised in the liver and protects lung alveolar tissues from destruction by neutrophil elastase. α-1 antitrypsin deficiency is a common autosomal recessive condition (1:1600 to 1:1800) in which liver disease results from retention of abnormal polymerised α-1 antitrypsin in the endoplasmic reticulum of hepatocytes, and emphysema results from alveolar wall damage. The clinical consequences of α-1 antitrypsin deficiency in childhood are haemorrhagic disease in infancy, cholestasis in infancy, or chronic liver disease. Lung disease attributable to α-1 antitrypsin deficiency does not occur in childhood, but is closely linked to smoking in adults. Membranoproliferative glomerulonephritis, panniculitis, and necrotising vasculitis are associations with α-1 antitrypsin deficiency in adult life
Methacholine challenge in pre-school children—Which outcome measure?
No full textSummaryThe aim of our study was to evaluate the utility of interrupter resistance (Rint), transcutaneous oximetry and auscultation as outcome measures for a recently suggested tripling-dose methacholine (Mch) challenge in pre-school children.We studied 57 children aged 3–6 years. Rint was measured at baseline and after each Mch dose. Oxygen saturation (SaO2) and transcutaneous oxygen pressure (tcpO2) were monitored during the challenge. Mch concentrations of 0.22, 0.66, 2.0, 6.0 and 18.0mg/ml were nebulised during tidal breathing. The challenge was terminated if there was wheeze, SaO2 below 91% or persistent cough; this final Mch dose was considered as PCW.Nine healthy children, 17 with cough and 25 with wheeze performed the study up to the point of PCW or all five Mch inhalations. If a change of 20% of predicted Rint or termination by wheeze, desaturation or cough is taken as a completed test, then 39 out of 51 children (78%) had adequate Rint measurements on each occasions from start to completion. The success rate for tcpO2 measurements was similar: 38 out of 51 (76%) had complete tcpO2 data until a 15% fall of tcpO2 or clinical endpoint was reached. Using the above-mentioned cut-off levels significant change in Rint or tcpO2 preceded PCW in most of the cases.Both Rint and tcpO2 measurements may allow detection of bronchial hyper-responsiveness at lower Mch doses and also provide a less subjective measure, but will not be feasible in all children
Home oxygen for children: who, how and when?
No full textA review of the specific requirements of home oxygen therapy in children which attempts to offer guidance to clinicians and service providers
Randomised double blind placebo controlled trial of inhaled fluticasone propionate in infants with chronic lung disease
No full textIn a double blind randomised controlled trial, 30 infants with chronic lung disease received fluticasone propionate or placebo for one year. There were no significant differences between treatment groups in the incidence of any day or night time symptoms or any other outcome measure
Risk of low Apgar score and socioeconomic position: a study of Swedish male births.
No full textAIM: The aim of this study was to investigate the association between maternal socioeconomic position and a persistent low Apgar score (a score of < 7 at 1 and 5 min following birth). METHODS: The research is based on a population cohort study of 183,637 males born in Sweden between 1973 and 1976. Data from the Medical Birth Register were linked to Population and Housing Censuses. RESULTS: There was evidence that mothers working in non-manual (Odds ratio (OR) 0.83 (0.72-0.97)) and self-employed (OR 0.64 (0.44-0.93)) occupations were less likely to have an infant with a low Apgar score, compared to manual workers. There was evidence that the risk of a low Apgar score decreased as the mother's level of education increased, if the infant was born by instrumental (OR 0.86 (0.74-0.99)) or caesarean section (OR 0.80 (0.68-0.93)) delivery, but not by unassisted vaginal delivery (OR 1.01 (0.92-1.10)). CONCLUSION: There was a lower risk of poor birth condition in male infants born to more educated and non-manual/self-employed mothers. These differences may contribute to our understanding of socioeconomic differences in infant health and development although the results may not be applicable due to changes over the last 30 years
Diagnostic and treatment behaviour in children with chronic respiratory symptoms: relationship with socioeconomic factors
No full textBackground: The prevalence and severity of asthma is believed to increase with increasing socioeconomic
deprivation. The relationship between asthma diagnosis, symptoms, diagnostic accuracy, and
socioeconomic deprivation as determined by Townsend scores was determined in Sheffield schoolchildren.
Methods: All 6021 schoolchildren aged 8–9 years in one school year in Sheffield were given a parent
respondent survey based on International Survey of Asthma and Allergies in Childhood (ISAAC)
questions.
Results: 5011/6021 (83.2%) questionnaires were returned. Postcode data were available in 4131
replies (82.4%) and were used to assign a composite deprivation score (Townsend score). Scores were
divided into five quintiles, with group 1 being least and group 5 being most deprived. A positive trend
was observed from group 1 to group 5 for the prevalence of wheeze in the previous 12 months,
wheeze attacks >4/year, nocturnal wheeze and cough (all p<0.001), cough and/or wheeze “most
times” with exertion (p<0.03), current asthma (p<0.001), and significant asthma symptoms (p<0.001).
No significant trend was observed for lifetime wheeze or attacks of speech limiting wheeze. There were
no significant trends in the prevalence of current asthmatic children without significant symptoms (overdiagnosis)
or children with significant asthma symptoms but no current asthma diagnosis (underdiagnosis)
across the social groups. There was a significant negative trend in the ratio of asthma medication
to asthma diagnosis from least to most deprived groups (p<0.001).
Conclusions: Asthma morbidity and severity increase according to the level of socioeconomic deprivation.
This may be due to differences in environment, asthma management, and/or symptom reporting.
Diagnostic accuracy does not vary significantly across deprivation groups but children living in
areas of least deprivation and taking asthma medication are less likely to be labelled as having
asthma, suggesting diagnostic labelling bias
Survey of respiratory sounds in infants
No full textBackground: Over the last decade there
has been an apparent increase in childhood
wheeze. We speculated that much of
the reported increase may be attributed to
the term wheeze being adopted by parents
to describe a variety of other forms of
noisy breathing.
Aims: To investigate terminology used by
parents to describe their children’s breath
sounds.
Methods: An interview was carried out
with the parents of 92 infants with noisy
breathing, beginning with an open question
and then directed towards a more
detailed description. Finally, the parents
were asked to choose from a wheeze,
ruttle, and stridor on imitation by the
investigator and video clips of children.
Results: Wheeze was the most commonly
chosen word on initial questioning (59%).
Only 36% were still using this term at the
end of the interview, representing a decrease
of one third, whereas the use of the
word ruttles doubled.
Conclusions: Our results reflect the degree
of inaccuracy involved in the use of
the term wheeze in clinical practice,
which may be leading to over diagnosis.
Imprecise use of this term has potentially
important implications for therapy and
clinical trials
