Terapia nasal de alto flujo durante la exacerbación del asma en sujetos adultos / 18 Terapia nasal de alto flujo durante la exacerbación del asma en sujetos adultos High-flow nasal therapy during asthma exacerbation in adult subjects

El asma es una enfermedad respiratoria crónica frecuente que afecta al 1-18% de la población en diferentes países y secaracteriza por síntomas variables como sibilancias, disnea, opresión torácica, tos y además presentar limitación variable alflujo aéreo espiratorio. Las exacerbaciones moderadas-graves de asma se diagnostican clínicamente por la presencia dedisnea persistente y la obstrucción de las vías respiratorias. En la actualidad, la terapia de oxigenoterapia convencional seutiliza principalmente en entornos clínicos, pero no puede garantizar un soporte respiratorio suficiente, lo que aumenta laprobabilidad de requerir ventilación mecánica no invasiva o en casos donde esté en riesgo la vida del paciente ventilaciónmecánica invasiva. La terapia nasal de alto flujo (TNAF) se introdujo en la práctica clínica y su papel está adquiriendo cadavez más importancia. Sin embargo no se ha descrito su uso en pacientes adultos con exacerbación del asma. Esta revisiónse diseñó para analizar los potenciales fisiológicos de la TNAF y su eficacia en pacientes adultos que cursan exacerbacióndel asma en entornos clínicos.(AU)

Asthma is a common chronic respiratory disease that affects 1-18% of the population in different countries and is characte-rized by variable symptoms such as wheezing, dyspnea, chest tightness, cough, and variable expiratory airflow limitation.Moderate-severe exacerbations of asthma are clinically diagnosed by the presence of persistent dyspnea and airway obs-truction. Currently, conventional oxygen-therapy is mainly used in clinical settings, but it cannot guarantee sufficient respiratorysupport, increasing the likelihood of requiring non-invasive ventilation or in cases where invasive mechanical ventilation islife-threatening. High-flow nasal therapy (HFNT) was introduced into clinical practice and its role is becoming increasinglyimportant. However, its use in adult patients with asthma exacerbation has not been reported. This review aimed to discussthe physiological potentials of HFNT and effectiveness in adult patients with asthma exacerbation in clinical settings.(AU)

Prevalencia del síndrome de apnea obstructiva del sueño infantil en una unidad de sueño de referencia / Prevalence of childhood obstructive sleep apnoea syndrome in a referral sleep unit

Introducción: El síndrome de apnea obstructiva del sueño (SAOS) afecta a entre el 1 y el 6% de la población infantil. En su diagnóstico, se incluyen: a) ronquidos y/o apneas; y b) un índice de apneas e hipopneas >3/hora obtenido en la polisomnografía (PSG). El objetivo principal de este trabajo es determinar la prevalencia del SAOS en nuestra población de estudio. Pacientes y métodos: Estudio descriptivo con una muestra de 151 niños con edades comprendidas entre 1 y 12 años, remitidos a la unidad de sueño del Hospital General Universitario Gregorio Marañón para la realización de una PSG. Se analizaron las variables demográficas sexo y edad; las variables clínicas ronquidos, apneas e hipertrofia amigdalar; y la presencia de SAOS basada en el criterio diagnóstico polisomnográfico de un índice de apneas e hipopneas >3/hora. Resultados: La edad media de la muestra fue de 5,37 años (desviación estándar: 3,05) y el 64,9% eran varones. En el 90,1% de los casos, el motivo de consulta fue sospecha de SAOS. Los ronquidos, las apneas y la hipertrofia amigdalar se observaron en el 73,5, el 48,7 y el 60% de los casos, respectivamente. Se diagnosticó SAOS en 19 (12,6%) niños; en el 13,5% de los roncadores; en el 15,1% de los niños con apneas; y en el 15,6% de los niños con hipertrofia amigdalar. Conclusiones: En nuestro estudio, la prevalencia del SAOS en niños fue del 12,6%, superior a la descrita en la mayoría de los estudios epidemiológicos, pero similar a la observada en los que incluyen la PSG para el diagnóstico del SAOS.(AU)

Introduction: Obstructive sleep apnoea syndrome (OSAS) affects between 1% and 6% of children. Its diagnosis includes: a) snoring and/or apnoea; and b) an apnoea and hypopnoea index >3/hour obtained by polysomnography (PSG). The main aim of this work is to determine the prevalence of OSAS in our study population. Patients and methods: We conducted a descriptive study with a sample of 151 children aged between 1 and 12 years, who had been referred to the sleep unit of the Hospital General Universitario Gregorio Marañón for a PSG. We analysed the demographic variables sex and age; the clinical variables snoring, apnoeas and tonsillar hypertrophy; and the presence of OSAS based on the polysomnographic diagnostic criterion of an apnoea and hypopnoea index >3/hour. Results: The mean age of the sample was 5.37 years (standard deviation: 3.05) and 64.9% were males. In 90.1% of cases, the reason for the visit was suspected OSAS. Snoring, apnoeas and tonsillar hypertrophy were observed in 73.5, 48.7 and 60% of cases, respectively. OSAS was diagnosed en 19 children (12.6%); in 13.5% of snorers; in 15.1% of those with apnoeas; and in 15.6% of the children with tonsillar hypertrophy. Conclusions: In our study, the prevalence of OSAS in children was 12.6%, which is higher than that reported in most epidemiological studies that include PSG for the diagnosis of OSAS.(AU)

Hendidura laríngea tipo 2 asociada a síndrome de Opitz G/BBB / Type 2 laryngeal cleft associated with OpitzG/BBB syndrome

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The Preschool Asthma Risk Factors Scale: A predictive tool for asthma and respiratory symptoms among preschool children in Lebanon

Background: The Preschool Asthma Risk Factor Scale (PS-ARFS) is a tool that enables clinicians to assess environmental exposure of preschool children, history of parental asthma, and dietary habits. The objective of this study was to evaluate the PS-ARFS ability to predict asthma diagnosis and respiratory symptoms 1 year after baseline assessment and improve the scale if necessary. Methods: A prospective cohort study conducted between November 2018 and March 2019 in three Lebanese schools (from three different Lebanese Governorates) enrolled 515 preschool children aged 3–5 years. Parents completed a detailed questionnaire sent with their children (Phase 1; T0). All parents who participated in Phase 1 were invited to take the same survey by telephone (Phase 2; T1), 1 year later. The interview was conducted by one study-independent person. Of the total sample, 141 (27.4%) children were lost to follow-up. Results: Higher odds of asthma diagnosis at 1 year were significantly associated with playing outside (adjusted odds ratio [aOR] = 3.958) and having a heating system in the bedroom (aOR = 6.986) at baseline, but inversely associated with the female gender (aOR = 0.365). Based on those results, the improved PS-ARFS-I was generated. A higher PS-ARFS-I at T0 was significantly associated with higher odds of asthma at T1 (aOR = 1.08; p < 0.001; 95% confidence interval [CI] 1.05–1.10); similar results were obtained with the longer PS-ARFS (aOR = 1.079; p < 0.001; 95% CI 1.050–1.109). Moreover, among non-asthmatic children at baseline, the PS-ARFS score predicted wheezing and cough at T1 but not bronchial secretions; the PS-ARFS-I score at baseline did not predict symptoms at T1. Conclusion: This study shows that the PS-ARFS-I and PS-ARFS could predict diagnosed asthma at 1-year follow-up (AU)

Consumo de productos ultraprocesados y enfermedades respiratorias sibilantes en niños. Proyecto SENDO / Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project

Introducción: El consumo de productos ultraprocesados (UP) se relaciona con múltiples enfermedades en el adulto, como hipertensión arterial, diabetes o asma.Objetivo: estudiar si el consumo de UP en niños se asocia con enfermedades respiratorias sibilantes (asma o bronquitis/sibilancias de repetición).Material y métodos: Estudio transversal dentro del proyecto SEguimiento del Niño para un Desarrollo Óptimo (SENDO), una cohorte abierta, multidisciplinar y multipropósito de niños españoles. El consumo de UP se calculó mediante cuestionarios semicuantitativos de frecuencia de consumo de alimentos. Los alimentos se agruparon según la clasificación NOVA y se estimó el consumo diario y el porcentaje de kilocalorías procedentes de UP. Dividimos la exposición en «alto» y «bajo» a partir de la mediana de consumo. Se calcularon las odds ratio y los intervalos de confianza al 95% para las enfermedades respiratorias sibilantes asociadas al consumo alto de UP, usando como referencia el bajo consumo. Se calcularon estimadores brutos y multiajustados y se utilizaron modelos de regresión mixtos para tener en cuenta la correlación entre hermanos.Resultados: En los 513 niños estudiados (51,8% varones, edad media de 5,2 años), el consumo medio de UP fue de 446,76g/día, representando un 39,9% de la ingesta calórica total. Un alto consumo de UP se asoció a un incremento del 87% de la prevalencia de enfermedades respiratorias sibilantes (OR 1,87; IC 95% 1,01-3,45). Encontramos que un mayor consumo de UP multiplica por 2,12 (IC 95% 1,10-4,05) la prevalencia de bronquitis/sibilancias de repetición.Conclusiones: Nuestros resultados muestran una asociación directa entre el consumo de UP y la prevalencia de enfermedades sibilantes en niños. (AU)

Introduction: The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma.Objective: To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing).Material and methods: A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development ?SENDO? project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according the NOVA classification, and the daily consumption was estimated along with the percentage of kilocalories from the UP. The exposure was grouped into “high” and “low” from the median consumption. Odds ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings.Results: In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR 1.87; 95% CI 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI 1.10-4.05) the prevalence of bronchitis/recurrent wheezing.Conclusions: The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children. (AU)

Polysomnographic Characteristics of Snoring Children: A Familial Study of Obstructive Sleep Apnea Syndrome / Características polisomnográficas de los niños que roncan: un estudio familiar del síndrome de apnea obstructiva del sueño

Background and objectives: Available evidence suggests a familial basis for OSA. The aim of the present study was to assess the potential influences of parental OSA in predicting the diagnosis and severity of OSA in snoring children.Methods: Observational study, we prospectively enrolled 84 children and their parents. A complete nocturnal polysomnography was performed. Children were categorized into 3 severity groups according to the apnea–hypopnea index (AHI<1h−1, AHI≥1h−1 to AHI<5h−1, and AHI≥5h−1). Adults were grouped according two criteria (AHI≥5h−1 and ≥10h−1).Results: There were no significant differences in age, gender, BMI and BMI z-score among groups. Among the children, 54.7% had an AHI≥1h−1 and 21.4% had an AHI≥5h−1. Overall, we observed that 60.7% of fathers and 23.8% of mothers of our population had OSA (AHI≥5h−1). The prevalence of fathers with OSA increases with the children's severity (83% in the group of children with moderate-severe OSA, p=0.035). The odds of having moderate-severe pediatric OSA (AHI≥5h−1) were more than 4 times higher among children with a father with AHI≥5h−1 (OR: 4.92, 95% CI: 1.27–19.06; p=0.021). There was no evidence of any maternal influence on OSA severity among the children studied.Conclusions: Our findings suggest a high prevalence of OSA among the family members studied with an increased association of childhood OSA with paternal OSA. Prediction of OSA risk among children can be significantly improved by adding data on paternal OSA status. (AU)

Contexto y objetivos: La evidencia disponible sugiere una base familiar para la AOS. El objetivo del presente estudio fue evaluar las posibles influencias de la AOS de los padres para predecir el diagnóstico y la gravedad de la AOS en los niños que roncan.Métodos: Estudio observacional en el que incluimos prospectivamente a 84 niños y sus padres. Se realizó una polisomnografía nocturna completa. Los niños se clasificaron en 3 grupos de gravedad según el índice de apnea-hipopnea (IAH <1h−1, IAH ≥1h−1 a IAH <5h−1y IAH ≥5h−1). Los adultos se agruparon según dos criterios (IAH ≥5 h-1 y ≥10 h-1).Resultados: No había diferencias significativas en la edad, el sexo, el IMC y la puntuación z del IMC entre los grupos. Entre los niños, el 54,7% tenía un IAH ≥1h−1 y el 21,4% tenía un IAH ≥5h−1. En general, observamos que el 60,7% de los padres y el 23,8% de las madres de nuestra población tenían AOS (IAH ≥5h−1). La prevalencia de padres con AOS aumenta con la gravedad de la AOS en los niños (83% en el grupo de niños con AOS moderada-grave, p=0,035). La probabilidad de tener AOS pediátrica moderada-grave (IAH ≥5h−1) fue más de 4 veces mayor en los niños con un padre con IAH≥5h−1 (OR: 4,92, IC 95%: 1,27-19,06; p=0,021). No hubo evidencia de que hubiera alguna influencia materna en la gravedad de la AOS en los niños estudiados.Conclusiones: Nuestros hallazgos sugieren una alta prevalencia de AOS entre los miembros de la familia estudiados con una mayor asociación de la AOS infantil con la AOS paterna. La predicción del riesgo de AOS entre los niños puede mejorarse significativamente al incluir información sobre el estado de la AOS paterna. (AU)

Childhood wheezing phenotypes and their association to perinatal factors: a longitudinal study

Introduction: Multiple gestational and early life factors have been described as the variables that increase the risk for each phenotype of infantile wheezing. Our objective was to study the evolution of wheezing in a cohort of children followed up to 9–10 years of age and its relationship with different perinatal risk factors. Methods: A longitudinal study was made on the evolution of wheezing, over time, in 1164 children from Salamanca (Spain) included in the International Study of Wheezing in Infants, when the children were 12 months old. They were classified into three phenotypes: transient early wheezing (last episode before 3 years of age), early persistent wheezing (start before 3 years age and persisting thereafter), and late-onset wheezing (first episode after 3 years of age). Univariate and multivariable analyses were performed to establish associations between the different phenotypes and perinatal factors. Results: Data were obtained corresponding to a total of 531 children. Of these, 169 (31.8%) had experienced transient early wheezing, 100 (18.8%) early persistent wheezing, 28 (5.3%) late-onset wheezing, and 234 (44.1%) had never experienced wheezing. Cesarean delivery, early exposure to infections, the presence of atopic eczema, and a smoking father were associated with transient early wheezing. Early persistent wheezing was associated with a family history of allergy, smoking, and obstetric diseases. Exclusive breastfeeding was identified as a protective factor in both transient and persistent early wheezing. Late-onset wheezing was associated with the male gender and with maternal history of rhinitis and eczema (AU)

El uso frecuente de productos de limpieza en los primeros meses de vida incrementa el riesgo de sibilancias recurrentes a los tres años / Frequent use of household cleaning products in the first months of life increases the risk of recurrent wheezing at three years

Conclusiones de los autores del estudio: el uso frecuente de productos de limpieza en los hogares de lactantes está asociado con un riesgo aumentado de sibilantes y asma, pero no con atopia, a los tres años, indicando un posible efecto inflamatorio en las vías respiratorias, no una respuesta alérgica adquirida. Comentario de los autores de la revisión: los datos de este estudio sugieren que la limpieza con productos domésticos se asocia con una mayor incidencia de sibilancias recurrentes y asma en uno de cada tres niños de tres años. Pero la calidad media del estudio deja abierta la incógnita para la ulterior investigación sobre si los productos domésticos comunes puedan preparar las vías respiratorias para una futura enfermedad pulmonar alérgica

Authors' conclusions: frequent use of household cleaning products in the home in early infancy is associated to an increased risk of wheezing and asthma in children, but not of atopy, at three years, showing a possible inflammatory effect in the respiratory tract, not an allergic acquired response. Reviewers' conclusions: the study results suggest that the use of cleaning products is associated with a higher incidence of recurrent wheezing and asthma in one in three children at the age of three years. But the medium level of quality of the study leaves the question open for further research, to try to clarify if common cleaning products could be preparing respiratory tract for future allergies

Prevalence of recurrent wheezing in infants and toddlers in Barbados: findings from a prospective study of a cohort of babies born during 2015-2017

OBJECTIVES: The main objective was to determine the prevalence of recurrent wheezing (RW) among infants and toddlers as well as the prevalence of asthma predictive risk factors among those with RW. MATERIALS AND METHODS: A prospective study of a cohort of babies recruited after their birth during July 2015-June 2017. Mothers were contacted using the WhatsApp messaging system for digital follow-up on their baby's condition at 3-monthly intervals until they were 18 months old. Information on wheezing and its correlates were collected by digital follow-up and corroborated at an in-person interview and examination of their baby at 18 months of age. Recurrent wheezing was defined as more than three episodes of wheezing or its correlates during the follow-up period. RESULTS: There were 338 males (41.5%) and 476 (58.5%) females. Overall, 31.1% (95% CI = 27.9%, 34.4%) had RW by 18 months and the same number had RW during their first year of life. Of the infants with RW, 121 (47.8%; 95% CI = 41.6, 54.2) had at least one or both of the major criteria and/or at least two minor criteria of the stringent Asthma Predictive Index (API). Of those with RW, 32.0% received antihistamine and 20% had received antibiotics on their last visit to a physician for wheezing or symptoms of cough, cold, and/or breathing difficulty. CONCLUSIONS: Nearly a third of infants and toddlers had RW and nearly half of the infants with RW had risk factors fulfilling the criteria of the stringent API

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The association between seropositivity to human toxocariasis and childhood asthma in northern Iran: a case-control study

BACKGROUND: Besides the well-known risk factors, Toxocara infection is thought to play a signif­icant etiological role in the development of childhood asthma. To further explore this associa­tion, the prevalence of Toxocara infection in sera of asthmatic children and healthy controls in northern Iran was investigated. METHODS: In this case-control study, cases were 145 physician-confirmed asthmatic children diag­nosed according to the Global Initiative for Asthma (GINA) guidelines. Controls were 115 age- sex-residence-matched children who did not have physician-diagnosed asthma. The presence of anti-Toxocara immunoglobulin G (IgG) was tested using enzyme-linked immunosorbent assay. Univariate and multivariate logistic regression methods were used for case-control comparisons. RESULTS: Seropositivity rate was 4.1% (95% CI, 3.4-4.7%) in asthmatic children and 0.86% (95% CI, 0.71-1.0%) in controls, suggesting a strong association (P-value < 0.02). Moreover, Toxocara infection was not significantly more prevalent (P-value = 0.12) in children with moderate sus­tainable asthma (9.3%, 3/32) than in children with mild sustainable asthma (2.3%, 3/113). Mean total immunoglobulin E (IgE) level was significantly higher in Toxocara-infected children (222.3 ± 367.1) than in non-infected children (143.19 ± 218.05) in the case group (P-value < 0.05). CONCLUSIONS: Our findings indicated that Toxocara infection can play an important role in child­hood asthma. Further experimental and epidemiological studies are needed to clarify this hypothesis

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Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon

OBJECTIVES: The Asthma Risk Factor Scale (ARFS) is used to screen for asthma in Lebanese pre-school children (aged 3-16 years). The study objective was to describe factors associated with asthma, confirm ARFS score validity among Lebanese preschool children, and develop a risk score for asthma diagnosis in this age group (Pre-School Asthma Risk Factor Scale [PS-ARFS]).METHODS: A cross-sectional study enrolled 515 preschool children (November 2018 and March 2019). The ARFS is a 15-item tool that assesses children's environmental exposure, parental history of asthma, and dietary habits. RESULTS: The percentage of asthmatic children was 8.2%. Higher odds of asthma in children were associated with living near a prairie sprayed with pesticides (odds ratio [OR] = 2.33), playing out-doors (OR = 2.89), having a heater in the bedroom (OR = 10.73), attending a nursery (OR = 2.91), having a mother who smokes cigarettes (OR = 3.35) or water pipe (OR = 2.46), a sister with a history of seasonal allergy (OR = 6.81), and a parental history (mother and father) of asthma (OR = 6.15 a n d OR = 9.83, respectively). Higher ARFS scores (OR = 1.144) were associated with higher odds of asthma. Accordingly, the PS-ARFS was created according to the following formula: ARFS score + (playing out-door × 2.4) + (heating system in the bedroom × 12.9) + (having attended a nursery × 2.5) (area under the curve = 0.908 [0.860-0.957]; P< 0.001); at value: 14.20, Se = 84.3% and Sp = 90.9%.CONCLUSION: PS-ARFS is suggested for screening of asthma in preschool children in an epidemio-logical setting and in the absence of spirometry

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Efectos de una sesión de fisioterapia respiratoria en la obstrucción de la vía aérea en niños/as menores de 3 años / Effects of a single chest physical therapy session on bronchial obstruction in children younger than 3 years old

ANTECEDENTES Y OBJETIVO: La fisioterapia respiratoria (FR) es ampliamente utilizada para el manejo de disfunciones respiratorias infantiles, sin embargo, estudios dirigidos a objetivar este efecto son escasos. Por tanto, el objetivo de este estudio fue evaluar el efecto de una sesión de FR sobre la obstrucción bronquial en niños/as menores de 3 años. MATERIALES Y MÉTODOS: Estudio exploratorio. Fueron incluidos un total de 39 menores de 3 años (26 niños y 13 niñas) con diagnóstico de síndrome bronquial obstructivo (SBO). El nivel de obstrucción bronquial fue valorado mediante el score de Tal modificado antes y después de una sesión de FR. Mediante la prueba de Wilcoxon se compararon los niveles de obstrucción bronquial pre y postintervención en todo el grupo, según género y edad. RESULTADOS: Se observó una reducción significativa del grado de obstrucción bronquial en todo el grupo, varones, mujeres, menores y mayores de 9 meses (p < 0,05) posterior a una sesión de FR. CONCLUSIÓN: Una sesión de FR fue efectiva en disminuir el grado de obstrucción bronquial en niños/as con diagnóstico de SBO menores de 3 años

BACKGROUND AND OBJECTIVE: Chest physical therapy (CPT) is widely used for the management of childhood respiratory disorders, however, studies that quantify this effect are scarce. Therefore, the aim of this study was to assess the effect of a single chest physical therapy (CPT) session on the bronchial obstruction of children younger than three years old. MATERIAL AND METHODS: This is an exploratory study. Thirty nine children younger than three years old (26 males and 13 females) with syndrome of bronchial obstruction (SBO) were included. The level of bronchial obstruction was measured with the modified Score of Tal before and after a single CPT session. Through the Wilcoxon test, comparisons of the bronchial obstruction levels were made of the whole group, males, females, and in those younger and older than 9 months as well. RESULTS: Significant reductions in bronchial obstruction levels were seen in all the children, an effect that was also seen in the males, females, and in those younger and older than 9 months (p<.05) after a single CPT session. CONCLUSION: A single CPT session was effective in reducing the bronchial obstruction levels in children with SBO, younger than three years old