The comparative effect of Leukotriene receptor antagonist add on therapy and step up inhaled Corticosteroid in partially controlled asthma: an open-labeled randomized controlled trial

Background No studies are comparing the impact of the add-on leukotriene-receptor antagonist (LTRA) with a step-up dose of inhaled corticosteroids (ICS) in partly controlled asthma patients with asthma control test (ACT) score ˂ 23.Objective To study the effect of LTRA add-on therapy in comparison to a step-up to medium dose of ICS in partially controlled asthma.Methods An open-labeled randomized controlled trial was conducted in asthma subjects with partly controlled asthma who had been in regular receipt of low dose ICS. All subjects were assessed for asthma using ACT, daytime and nighttime symptoms, rate of relievers used, spirometry, and impulse oscillometry (IOS) at 3 and 6 months. Subjects were randomized to receive daily oral LTRA 10 mg or step-up medium dose of ICS.Results Between June 2020 and January 2021, 50 participants were enrolled, all patients completing the study. After treatment, mean ACT scores were increased to more than 23 indicating well-controlled asthma in both groups, control being sustained throughout the whole 6-month study period (P ˂ 0.001). Within each group, ACT scores were improved by a minimal clinical important difference (MCID) ≥ 3 points at 6 months, compared to baseline values. There were significant decreases in nighttime and daytime symptoms, and the numbers of rescue relievers used in 4 weeks in both groups compared to baseline (P ˂ 0.001).Conclusions LTRA add-on therapy in partially controlled asthma patients is comparable with step-up to medium dose of ICS/LABA as regards asthma control (AU)

Therapeutic effect of montelukast in hepatic ischemia-reperfusion injury in rats

Hepatic ischemia-reperfusion injury (IRI) occurs in a number of clinical conditions such as trauma, hypovolemic shock, hepatic resection, and liver transplantation. Although several drugs are effective in attenuating hepatic ischemia-reperfusion (I/R) injury, there are still no satisfying treatment strategies available to prevent hepatic I/R injury. Sixty rats were randomly assigned to 3 groups: control group, I/R model group, and I/R + M group (7 mg/kg montelukast pretreatment). The total hepatic ischemia was induced for 45 minutes by clamping the hepatic artery, portal vein, and bile duct using a vascular clamp. The rats were then allowed reperfusion at 1, 3, 6 and 12 hours. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) activity, and proinflammatory cytokines (i.e., tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-1ß)) were measured in blood samples. Malondialdehyde (MDA), and glutathione (GSH) levels and myeloperoxidase (MPO) and Na+, K+-ATPase activities were determined in the liver tissue samples while formation of reactive oxygen species was monitored by using the chemiluminescence (CL) technique with luminol and lucigenin probes. Tissues were also analyzed histologically. Hepatic IRI induced a marked increase in CysLTR1, Caspase-8 and Caspase-9 protein expression in the liver, which were markedly reduced by preconditioning with a 7 mg/kg montelukast. Preconditioning with 7 mg/kg montelukast significantly attenuated liver tissue injury and liver damage and decreased plasma AST, ALT, LDH, TNF-alpha, IL-1ß, MDA and MPO levels after a hepatic IRI. In conclusion, preconditioning with montelukast could attenuate hepatic IRI and the subsequent systemic inflammatory response in rats

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The efficacy of single-high dose inhaled corticosteroid versus oral prednisone treatment on exhaled leukotriene and 8-isoprostane levels in mild to moderate asthmatic children with asthma exacerbation

BACKGROUND: The anti-inflammatory effect of high-dose inhaled corticosteroids (ICS) in children with asthma exacerbation is unknown. We aimed to investigate the efficacy of single-high dose ICS versus oral prednisone treatment followed by a course of six day high-dose ICS or oral prednisone (P) treatment on the concentrations of Cys-LTs and 8-isoprostane levels in the exhaled breath condensate (EBC) of children with asthma exacerbation. METHODS: Ninety-four children with moderate-severe asthma exacerbation were evaluated with asthma scores, peak expiratory flow rate (PEF), forced expiratory volume in first second (FEV1) and exhaled Cys-LT and 8-isoprostane levels before and after treatment. EBC was collected from 52 patients before and four hours after treatment with inhaled fluticasone propionate (FP) (4000 μg) or P and after six days of treatment with FP-1000 μg/day or P. Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit. RESULTS: Both single high-dose FP (n = 59) and p (n = 35) treatment resulted in a significant improvement in asthma score (p < 0.0001), PEF (p < 0.0001), and FEV1 (p < 0.0001). Cys-LT concentration in the EBC decreased significantly both after the initial treatment (p = 0.001), and at the end of the six-day period in the FP group (p < 0.0001). 8-Isoprostane concentration was lower only after six days of treatment with FP-1000 μg/day in the FP group (p = 0.023). There was a significant decrease in exhaled Cys-LTs after four hours (p = 0.012) and six days of P treatment (p = 0.018) in children with asthma exacerbation. CONCLUSIONS: High-dose ICS treatment may be useful in the treatment of children with asthma exacerbation. The effects start as early as after four hours. The suppression of Cys-LTs production contributes to the early effects. Suppression of both Cys-LTs and oxidants may favourably contribute to the effects observed later

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Urinary leukotriene and Bcl I polymorphism of glucocorticoid receptor gene in preschoolers with recurrent wheezing and high risk of asthma

BACKGROUND: Urinary leukotriene (LTE4) is an important marker of airway inflammation presence. A relationship between single nucleotide polymorphism in the glucocorticoid receptor (GCR) gene promoter (Bcl I polymorphism), development of asthma and sensitivity to glucocorticoids has been hypothesised. OBJECTIVE: To explore the possible association between the Bcl I polymorphism and baseline levels of urinary LTE4 in preschoolers with recurrent wheezing episodes. We prospectively enrolled and classified 86 preschoolers based on the risk of developing asthma (by the Asthma Predictive Index [API]). METHODS: At admission standardised questionnaires for demographics and respiratory illness characteristics were completed. The Bcl I polymorphism of the GCR was determined by a PCR-RFLP assay from blood samples, and urinary leukotriene was assessed from urine samples by an enzyme immunoassay. RESULTS: We enrolled 86 preschoolers (46 with positive API and 40 with negative API). There were no statistical differences in demographic, respiratory illnesses and wheezing episodes characteristics between both groups. Also, the prevalence of Bcl I polymorphism was similar between positive vs. negative API groups (34.8% vs. 38.9% for homozygote GG, 56.5% vs. 52.8% for heterozygote GC, 8.7% vs. 8.3% for homozygote CC, respectively, p = 0.94). However, urinary LTE4 (median [IQR]) was higher in preschoolers with positive than negative API (7.18 [5.57-8.96 pg/ml] vs. 6.42 [3.96-8.07 pg/ml], p = 0.02, respectively). CONCLUSIONS: In our population, wheezing preschoolers with positive API exhibit higher levels of urinary LTE4 than those with negative API; but there were no differences in Bcl I polymorphism of the GCR

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Termoplastía bronquial para el manejo del asma severo: experiencia inicial en Chile / Bronchial thermoplasty for severe asthma: Initial experience in Chile

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The treatment of allergic respiratory disease during pregnancy

Pregnancy may be complicated by new-onset or preexisting asthma and allergic rhinitis. This article reviews the recognition and management f asthma and allergic rhinitis during pregnancy, paying close attention to the general principles of allergy and use of asthma medication during pregnancy. Both allergic rhinitis and asthma can adversely affect both maternal quality of life and, in the case of maternal asthma, perinatal outcomes. Optimal management is thus important for both mother and baby. This article reviews the safety of asthma and allergy medications commonly used during pregnancy (AU)

El embarazo puede complicarse por una nueva presentación de un asma y rinitis alérgica preexistentes. En este artículo se revisa el reconocimiento y manejo del asma y la rinitis alérgica durante el embarazo, con atención especial a los principios generales del tratamiento de la alergia y el asma durante esta situación. Ambas patologías pueden afectar de forma adversa a la calidad de vida de la madre y al periodo perinatal. El manejo óptimo de esta situación es muy importante tanto para la madre como para el hijo. Este artículo revisa la seguridad del tratamiento habitualmente utilizado durante el embarazo del asma bronquial (AU)

Desensibilización al ácido acetil salicílico en la nueva era del intervencionismo coronario percutáneo / Acetylsalicylic acid desensitization in the new era of percutaneous coronary intervention

El tratamiento con doble antiagregación plaquetaria es imprescindible en los pacientes que van a ser sometidos a un intervencionismo coronario percutáneo con implante de stent. La hipersensibilidad al ácido acetil salicílico (AAS) limita las posibilidades terapéuticas. La desensibilización al AAS ha sido clásicamente estudiada en pacientes con enfermedad del tracto respiratorio. En los últimos años se han descrito varios protocolos de desensibilización en pacientes con cardiopatía isquémica, incluyendo el síndrome coronario agudo y la necesidad de implante de stent coronario. Es importante conocer la eficacia y seguridad de la desensibilización al AAS en estos pacientes (AU)

Dual antiplatelet therapy is essential in patients undergoing percutaneous coronary intervention with stent implantation. Hypersensitivity to acetylsalicylic acid (ASA) limits treatment options. Desensitization to ASA has classically been studied in patients with respiratory tract disease. Over the last years, many protocols have been described about ASA desensitization in patients with ischemic heart disease, including acute coronary syndrome and the need for coronary stent implantation. It is important to know the efficacy and safety of ASA desensitization in these patients (AU)

Hypersensitivity to nonsteroidal anti-inflammatory drugs in children and adolescents: cross-intolerance reactions

Los antiinflamatorios no esteroideos (AINEs) son ampliamente utilizados en todo el mundo y en todos los tramos de edad. Son responsables de un número importante de reacciones de hipersensibilidad a fármacos (RHFs), que no sólo afectan a adultos sino también a niños y adolescentes. Existen dos grandes grupos: reacciones selectivas, inducidas por mecanismos inmunológicos específicos, y de intolerancia cruzada (IC), donde se liberan mediadores inflamatorios en ausencia de reconocimiento inmunológico específico. En esta revisión nos ocuparemos de la IC, que es la causa más frecuente de RHFs y resulta de gran interés en niños y adolescentes. El paracetamol y el ibuprofeno son los medicamentos más frecuentemente implicados en las RHFs en niños. El uso diagnóstico de los tests in vivo e in vitro es muy limitado, con algunas excepciones en las reacciones selectivas. En las de IC, la historia clínica y la administración controlada son en ocasiones la única vía para confirmar el diagnóstico y determinar las alternativas terapéuticas más adecuadas. La historia clínica tiene valor diagnóstico cuando se reproducen síntomas consistentes repetidamente tras la exposición a AINEs no relacionados estructuralmente. En niños de corta edad es especialmente frecuente la combinación de síntomas cutáneos y respiratorios. Aunque se desconoce la historia natural de la IC en niños, es probable que se desarrolle tolerancia a lo largo de la vida. El fenotipado detallado junto con la información proporcionada por la fármaco-genética no sólo proporcionarán un conocimiento más preciso de la IC sino que también facilitará el manejo clínico de estos pacientes (AU)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used worldwide and are responsible for several types of drug hypersensitivity reactions (DHRs) in all age groups. The 2 major groups of DHRs to NSAIDs are those induced by immunological mechanisms (selective reactions) and those where inflammatory mediators are released through activation of the prostaglandin-leukotriene pathway without specific immunological recognition (cross-intolerance). In the present review, we focus on cross-intolerance reactions, which are the most frequent DHRs and are becoming a topic of major interest in children and adolescents. Paracetamol and ibuprofen are the drugs that most frequently cause DHRs in children; other NSAIDs are responsible for reactions in adolescents. In vivo and in vitro tests are of limited diagnostic value, with some exceptions for the less common selective reactions. In cross-intolerance, the clinical history and controlled administration are in many instances the only way to establish a diagnosis and look for alternatives. The clinical history is diagnostic when consistent symptoms occur repeatedly after exposure to NSAIDs with different chemical structures. Cutaneous and respiratory symptoms often co-occur in young children. The natural history of these reactions in children is unknown, and some patients can develop tolerance over time. Atopy remains a major risk factor for cross-intolerant reactions. The increasing interest in hypersensitivity to NSAIDs with improvements in patient phenotyping and the information provided by pharmacogenetics will improve our understanding and management of these reactions in the near future (AU)

Relationship between exhaled leukotriene and 8-isoprostane levels and asthma severity, asthma control level, and asthma control test score

OBJECTIVE: Exhaled breath condensate (EBC) is a completely non-invasive method for the collection of airway secretions to measure intense inflammation in the airways of asthmatics. It has been shown that the childhood asthma control test (c-ACT) is a good tool for use in the evaluation of asthmatics. Whether the c-ACT score and asthma control level correlate with the airway inflammation is not well known. We aimed to evaluate the relationship between exhaled cysteinyl leukotrienes (Cys-LTs) and 8-isoprostane levels and asthma severity, asthma control level and c-ACT score in asthmatic children. METHODS: Thirty asthmatic children were evaluated with c-ACT score and pulmonary function tests. Asthma severity and asthma control level were assessed according to GINA. EBC was collected and Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit. RESULTS: Exhaled 8-isoprostane level in patients with moderate persistent asthma [114 (55-146) pg/ml] was higher than in the mild persistent group [52 (21-91) pg/ml] (p = 0.05, Mann-Whitney U [MWU]). EBC 8-isoprostane in children with 1-4 asthma exacerbations/year [52 (16-80) pg/ml] was significantly lower than in children with > 4 asthma exacerbations/year [114 (57-129) pg/ml] (p < 0.05, MWU). No significant relation was determined between exhaled 8-isoprostane and Cys-LTs levels and c-ACT score and asthma control level. Exhaled 8-isoprostane correlated negatively with bronchodilator response (p = 0.015, r = −0.45). CONCLUSIONS: Exhaled 8-isoprostane, as an oxidative stress specifier, was found to be increased in relation with asthma exacerbation frequency and oxidative stress increases with the severity of asthma. In contrast to asthma severity level, c-ACT score and asthma control level may not reflect airway inflammation

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Utilización de montelukast en población pediátrica: estudio en tres farmacias comunitarias / Using montelukast in pediatric population: a study in three community pharmacies

Objetivo: El objetivo de este trabajo es analizar, desde tres farmacias comunitarias, el uso que se está haciendo de montelukast en la población pediátrica. Método: Estudio observacional de prescripción de montelukast realizado en tres oficinas de farmacia en niños (≤15 años) a los que se dispensó el fármaco; la recopilación de datos de los pacientes (edad, patologías, régimen de dosificación, duración del tratamiento, medicación asociada) se hizo a través de encuesta. Se remitió al médico cuando se detectó un tratamiento inadecuado, para su revisión. Resultados: Se recogieron un total de 75 prescripciones médicas. Sólo el 36% de los niños eran asmáticos; de ellos, al 70% se les pautó montelukast como terapia inicial, y el 45% no seguían las recomendaciones de la Guía Española para el Manejo del Asma. El 64% de los niños no eran asmáticos y estaban recibiendo montelukast fuera de indicación (off-label) (44% rinitis alérgica, 56% bronquiolitis), el 21% de ellos en monoterapia y el resto en combinación con otros fármacos. Conclusiones: Se está haciendo un uso fuera de indicación de montelukast en niños no asmáticos con rinitis alérgica o bronquiolitis, y en este último caso no existe evidencia de efectividad. El uso inadecuado podría acarrear problemas de seguridad para los pacientes. Se evidencia la necesidad de proporcionar información independiente a los profesionales sanitarios sobre el papel de montelukast en la terapéutica (AU)

Objective: The objective of this paper is to analyze, from 3 community pharmacies, the use that is being made of montelukast in pediatric population. Method: Observational study of montelukast prescriptions in children (≤15 years). A survey was done in 3 community pharmacies when dispensing this drug to collects patients' data (age, dosing regimen, pathologies, duration of treatment, associated medication). Referral to doctor was done, when inappropriate treatment was detected, for review of drug treatment. Results: There were a total of 75 medical prescriptions. Children diagnosis of asthma was in only 36% and of those, 70% were receiving montelukast as initial therapy; 45% of them were not following the recommendations of the Spanish Guidelines for Asthma Management. 64% of children were not asthmatic and are receiving «off-label» montelukast (44% allergic rhinitis, 56% bronchiolitis): 21% of them were in a monotherapy regimen, and the rest, in combination with other drugs. Conclusions: A use of «off-label» montelukast is being made in children with allergic rhinitis or bronchiolitis, without asthma diagnosis, with no evidence of effectiveness in bronchiolitis. Inappropriate use could result in security issues for the patients. This study shows the need to provide independent information on the role of montelukast in therapeutic practice to health professionals (AU)

Markers of Airway Inflammation in the Exhaled Breath Condensate of Preschool Wheezers

Antecedentes: Los leucotrienos (LT), isoprostanos y nitritos/nitratos, que son biomarcadores de la inflamación de las vías aéreas, y el estrés oxidativo, pueden ser detectados en el condensado del aire exhalado (CAE). El objetivo de este estudio fue evaluar el LTB4, LTE4, 8-isoprostano, nitritos y nitratos en el CAE de niños preescolares sanos y con sibilancias. Material y métodos: Se realizó un estudio transversal en el que se incluyeron 21 niños sanos no atópicos y 25 pacientes con sibilancias recurrentes. El LTB4, LTE4 y 8-isoprostano, se midieron en el CAE mediante enzimoinmunoensayo, y los nitritos/nitratos mediante método colorimétrico. Resultados: Las concentraciones de LTB4 fueron mayores en los niños con episodios de sibilancias que en controles sanos (76 pg/ml vs 20 pg/ml, p<0,001); El LTE4 se incrementó también en niños con episodios de sibilancias en comparación con niños sanos (68 pg/ml vs 35 pg/ml, p<0,001). Las concentraciones de nitritos fueron mayores en los niños con episodios de sibilancias que en los controles (14 pg/ml vs 9,7 pg/ml, p<0,03). No hubo diferencias en las concentraciones de 8-isoprostano y nitratos entre el grupo de niños enfermos y el grupo control. Conclusiones: Nuestros hallazgos sugieren que el CAE es un método no invasivo para la evaluación de la inflamación de las vías respiratorias y del estrés oxidativo en lactantes y niños en edad preescolar. Las concentraciones de LTB4, LTE4 y de nitritos, se incrementaron en niños con episodios recurrentes de sibilancias en comparación con los controles sanos (AU)

Background: Leukotrienes (LT), isoprostanes, and nitrites/nitrates are biomarkers of airway inflammation and oxidative stress that can be detected in exhaled breath condensate (EBC). The aim of this study was to evaluate LTB4, LTE4, 8-isoprostane, and nitrite/nitrate levels in the EBC of healthy and wheezing preschool children. Methods: We included 21 healthy nonatopic children and 25 patients with recurrent wheezing episodes in a cross-sectional study. LTB4, LTE4, and 8-isoprostane concentrations were measured directly in EBC using a specific enzyme immunoassay; nitrite/nitrate concentrations were measured using a colorimetric assay. Results: LTB4 concentrations were higher in children with wheezing episodes than in healthy controls (76 pg/mL vs 20 pg/mL, P<.001). LTE4 was increased in children with wheezing episodes than in healthy controls (68 pg/mL vs 35 pg/mL, P<.001). Nitrite concentrations were higher in children with wheezing episodes than in healthy controls (14 pg/mL vs 9.7 pg/mL, P<.03). We found no differences in 8-isoprostane and nitrate concentrations between the patients and the healthy controls. Conclusions: Our findings suggest that EBC is a suitable noninvasive method for the assessment of airway inflammation and oxidative stress in preschool children. Levels of LTB4, LTE4, and nitrites were higher in children with recurrent wheezing episodes than in healthy controls (AU)

Premenstrual asthma and leukotriene variations in the menstrual cycle

Background: Several authors have reported an increase in leukotriene C4 in the premenstrual phase in women with severe premenstrual asthma, indicating that antileukotrienes could be used in treatment. Objective: To analyse the role of leukotrienes in premenstrual asthma. Methods: A questionnaire on respiratory symptoms and peak flow during one complete menstrual cycle was given to women of fertile age to define them as asthmatics who suffered from premenstrual asthma or not. Premenstrual asthma (PMA) was defined as a clinical or functional deterioration (major=20%) in the premenstrual phase compared with the preovulatory phase. Blood samples to measure leukotriene C4 were taken during the preovulatory and premenstrual phases. Results: Blood samples were taken in 62 asthmatic women, 34 of whom (54.3%) presented PMA criteria, all with a premenstrual deterioration of between 20 and 40%. There was no difference in leukotriene C4 levels between the preovulatory and premenstrual phases in the women who suffered from PMA (1.50ng/mL vs. 1.31ng/mL; p=0.32) and those who did not (1.40ng/mL vs. 1.29ng/mL; p=0.62). Neither were there any differences in leukotriene levels between women with or without PMA. The results were similar for each category of asthma severity. Conclusions: Our data show that leukotriene C4 does not appear to be involved in the pathogenesis of premenstrual asthma, or support the use of anti-leukotrienes in the specific treatment of premenstrual asthma, at least in women with a moderate premenstrual deterioration. No differences appeared in any of the categories of asthma severity(AU)

Telangiectasia macularis eruptive perstans (TMEP) in childhood: A case report and literature review

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Urinary leukotriene excretion profile in children with exercise-induced asthma compared with controls: A preliminary study

Background: Leukotrienes are among the most important mediators associated with inflammatory responses in patients with exercise induced asthma (EIA). The aim of this study was to investigate the impact of exercise on the urinary leukotriene profile. Hence, we compared post exercise changes of urinary leukotriene E4 (LTE4) concentration between children with EIA and healthy controls. Methods: Ten children with EIA and 15 controls were enrolled. Both groups underwent a standardised exercise challenge test (ECT). LTE4 concentration was measured in urine samples obtained pre and post ECT, using enzyme immunoassay and adjusted by urinary creatinine concentrations. Results: Median (minimum-maximum) pre ECT concentration of LTE4 was 17.82 (7.58-90.23pg/ml) in EIA and 17.24 (4.64-64.02pg/ml) in controls, p=0.86. LTE4 concentration post ECT were 23.37 (4.02-93.00pg/ml) in EIA and 11.74 (0.13-25.09pg/ml) in controls, p=0.02. Changes of LTE4 concentration post ECT were 2.54 (−31.98 to 43.31pg/ml) in cases and −13.53 (−46.00 to 11.02pg/ml) in controls, p=0.03. There was no significant correlation between basal predicted FEV1 [%] and changes in LTE4 concentration in cases (i.e., rs=0.14) nor controls (i.e., rs=0.12). There was a tendency towards more pronounced changes in LTE4 concentration post ECT in children with moderate/mild persistent asthma compared to those with mild but intermittent asthma. Conclusions: Children with EIA had significantly higher changes of urinary LTE4 concentrations post ECT compared to healthy controls. Urinary measurement of LTE4 may be an interesting and non-invasive option to assess control of EIA in children(AU)

Fisiopatología de los trastornos respiratorios del sueño en los niños / Physiopathology of sleep-disordered breathing in children

Los trastornos respiratorios del sueño representan un amplio espectro de alteraciones que van desde el ronquido habitual, pasando por la hipoventilación obstructiva hasta el síndrome de apnea hipopnea del sueño (SAHS); producen anomalías de la respiración y de la arquitectura durante el sueño. Hay discrepancias entre los mecanismos fisiopatológicos de los trastornos respiratorios del sueño y sus consecuencias metabólicas, neurocognitivas y cardiovasculares. Las causas de comorbilidad del SAHS en los niños no son todavía bien conocidas y pueden incluir anomalías gasométricas sanguíneas, fragmentación del sueño, inflamación local e inflamación sistémica moduladas por factores genéticos, ambientales, raza, etc. La patogénesis de los trastornos respiratorios del sueño pediátricos es, sin lugar a dudas, una compleja interacción entre factores anatómicos o estructurales y funcionales, entre una vía aérea predispuesta al colapso y una compensación neuromuscular deficiente. Además, es necesario tener en cuenta que el sueño del niño evoluciona de acuerdo a la maduración del sistema nervioso central y ésta varía con la edad. En este artículo se revisa el papel de los diferentes factores anatómicos, funcionales e inflamatorios en la fisiopatología de los trastornos respiratorios del sueño pediátricos (AU)

Sleep-disordered breathing represents a broad spectrum of alterations, ranging from habitual snoring, through obstructive hypoventilation to obstructive sleep apnea-hypopnea syndrome, and produces breathing and architecture anomalies during sleep. There are some controversies on the physiopathological mechanisms of sleep-disordered breathing and its metabolic, neurocognitive and cardiovascular effects. The causes of comorbidity in obstructive sleep apnea-hypopnea syndrome in children are not yet well known and can include blood gasometric anomalies, fragmented sleep, and local and systemic inflammation, modulated by genetic, environmental and ethnic factors. The pathogenesis of pediatric sleep-disordered breathing undoubtedly involves complex interactions between anatomical or structural and functional factors, an airway prone to collapse and deficient neuromuscular compensation. Moreover, in children, sleep progresses in accordance with central nervous system development, which varies with age. This article reviews the role of the distinct anatomic, functional and inflammatory factors in the pathophysiology of pediatric sleep-disordered breathing (AU)

Síndrome de apnea obstructiva en niños / Obstructive sleep apnoea syndrome in children

El síndrome de apnea obstructiva del sueño es una entidad bien conocida en adultos, pero hasta ahora ha sido menos estudiada en niños. Recientemente se ha producido un importante incremento en el reconocimiento de los trastornos del sueño en la etapa infantil. Nuestro objetivo es analizar los estudios científicos publicados en los últimos años. Hemos revisado artículos publicados acerca del síndrome de apnea obstructiva en edad pediátrica y hemos estudiado la sintomatología, el diagnóstico y las opciones de tratamiento. En conclusión, el curso natural y el pronóstico a largo plazo del síndrome de apnea obstructiva en la infancia no son bien conocidos, por lo que se necesitan más estudios en esta área (AU)

Obstructive sleep apnoea syndrome is a well-known clinical entity in adults but until now it has been less well studied in children. In recent years there has been a dramatic increase in the recognition of sleep disorders in children. Our goal is to analyze scientific data published in the last few years. We reviewed published articles regarding paediatric obstructive sleep apnea syndrome and extracted the clinical symptoms, diagnosis and treatment options. In conclusion, the natural course and long-term prognosis of childhood obstructive sleep apnoea syndrome are not well-known and further studies are needed in this area (AU)

Tratamiento de las sibilancias recurrentes/asma en el niño menor de 3 años de edad / No disponible

Las guías y consensos actuales enfatizan la importancia del control del asma para disminuirla morbilidad y mejorar la calidad de vida de estos pacientes. En niños menores de 3años, conseguir un adecuado control resulta más difícil que a otras edades debido a la heterogeneidadde fenotipos de sibilantes recurrentes, patrón inflamatorio predominante y factoresdesencadenantes, probablemente distintos y evolución y respuesta al tratamiento variables.Identificar el fenotipo sibilante podría ayudar a tomar decisiones terapéuticas,aunque en ocasiones se solapan en un mismo paciente características de distintos fenotiposy el tratamiento debería individualizarse en función de la respuesta.Se revisan los tres pilares básicos del tratamiento: educación, medidas preventivas y tratamientofarmacológico tanto del episodio agudo como de mantenimiento. Los fármacos recomendadospara el tratamiento de mantenimiento en menores de 3 años son los corticoides inhalados(CI) y los inhibidores de leucotrienos. Los CI son de elección en el asma y la respuestaes más satisfactoria ante niños con sibilancias y atopia. No existen evidencias para recomendardosis bajas de CI en la prevención de episodios de sibilancias desencadenadas exclusivamentepor virus a esta edad; los inhibidores de los leucotrienos estarían más indicados en estos casos.También constituyen una alternativa a los CI en el asma leve y podrían asociarse a ellos paradisminuir las exacerbaciones inducidas por virus. No obstante, algunos niños no responden aninguno de estos fármacos. Se recomienda revisar periódicamente el tratamiento y suspenderloo considerar un diagnóstico o tratamiento alternativo si no se observan beneficios(AU)

Today’s guides and consensus emphasize the importance of asthma control in diminishingmorbidity and improving these patients’ quality of life. This control is not easy in childrenunder 3 years of age due to: recurrent wheezing phenotype heterogeneity, triggeringfactors and predominant inflammatory pattern (probably different), and variable evolutionand treatment response. Identifying the wheezing phenotype could help making therapeutic decisions. However,characteristics from different phenotypes can sometimes overlap in a patient, so thetreatment should be adjusted according to the patient’s response.We review the 3 basic pillars of treatment: education, preventive measures and drugtreatment. We do this for the acute episode and for the treatment maintenance.The recommended drugs on children under 3 are inhaled corticoids (IC) and leukotrieneinhibitors. IC are the treatment of choice for asthma and there is a better response on childrenwith wheezing plus atopy. There is no evidence in the recommendation of low IC doses in theprevention of wheezing episodes exclusively triggered by virus on children of this age. Leukotrieneinhibitors are more appropriate in these cases. They are an alternative to IC on childrenwith mild asthma and they could be used to decrease exacerbations induced by virus.Some children, however, do not respond to any of these drugs. It is recommended toreview the treatment periodically and suspend it or consider an alternative treatment ordiagnosis if benefits are not observed(AU)

Analysis of 927T > C CYSLTR1 and –444A > C LTC4S polymorphisms in children with asthma

Introduction: The cysteinyl leukotrienes (Cys-LTs) are potent inflammatory mediators in asthma. It has been suggested that the different response of patients to Cys-LTs inhibitors could be due to the presence of polymorphisms in the genes implicated in this pathway. Methods: In this study, polymorphisms 927T > CCYSLTR1 and –444A > C LTC4S were analysed in a Spanish population of 188 individuals (109 asthmatic children and 79 controls). Standardised history, skinprick tests and lung function measurements were performed in all patients. Genotypes were determined by sequencing after PCR amplification. Results: Differences were observed in 927T > CCYSLTR1, regarding the severity of asthma in males. A greater presence of allele C in the population with persistent asthma versus the control group (Fisher’sp-value = 0.001; Monte Carlo p-value = 0.003; OR:12.35; 95 %CI: 2.18-70.00) was observed. Differences were also detected in the combined study of both polymorphisms, among controls and asthmatic patients (Monte Carlo p-value = 0.0002). In the group of males with asthma, an increase of AC variant (–444A LTC4S and 927C CYSLTR1) and a reduction in the AT genetic combination were detected. Conclusions: The combined study of polymorphisms in genes of the leukotriene pathway could explain the differences observed in the studies reported on polymorphism –444A < C LTC4S individually analysed

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“Pectus excavatum” y patron radiológico torácico anormal / Linear lichen planus: a case report

Se describe el caso clínico de una paciente de 7 años de edad con pectus excavatum, remitida a la Sección de Neumología Pediátrica del Hospital Universitario "Gregorio Marañón" por presentar imagen radiológica persistentemente anormal en radiografía de tórax, a pesar de haber recibido múltiples tratamientos, y con la sospecha de malformación broncopulmonar o aspiración de cuerpo extraño

We report the case of a 7-year-old girl with pectus excavatum who was referred to our service with persistently abnormal radiographic images, despite numerous treatments. Bronchopulmonary malformation or foreign body aspiration was suspected