RESUMO
Pulmonary aspiration of gastric refluxate (PAGR) has been demonstrated in association with pulmonary inflammation in school aged children with Cystic Fibrosis (CF). We sought to determine if similar findings were present in preschool children. Pepsin was measured in Broncho-alveolar lavage (BAL) fluid collected from clinically stable preschool children with CF and controls. Elevated pepsin levels were found in a subgroup of children with CF, but this was not found to be associated with pulmonary infection, pulmonary inflammation or respiratory or gastrointestinal symptoms.
Assuntos
Líquido da Lavagem Broncoalveolar , Fibrose Cística/diagnóstico , Fibrose Cística/fisiopatologia , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/fisiopatologia , Lavagem Broncoalveolar , Broncoscopia/métodos , Criança , Pré-Escolar , Fibrose Cística/epidemiologia , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Lactente , Masculino , Estudos Prospectivos , Aspiração Respiratória/epidemiologiaRESUMO
Summary: Background. Asthma is a common childhood respiratory disease, affecting around 20% of Irish children. In other populations, vitamin D receptor (VDR) polymorphisms have been associated with asthma risk. We aimed to investigate the association between 2 VDR polymorphisms and uncontrolled paediatric asthma. Methods. 44 asthmatic children and 57 healthy volunteers were studied. The VDR TaqI gene variant in exon 9 (T/C) (rs731236) and ApaI (rs7975232) in intron 8 (C/T) were determined, using TaqMan® Assays. The lung function, serum 25-hydroxyvitamin D (25OHD) levels and other biomarkers of allergy, immunity, airway and systemic inflammation were as-sessed. Results. The distribution of T and C alleles and genotype frequencies differed significantly between asthmatics and controls for both polymorphisms (p < 0.05). A significant association was found between both TaqI [OR = 2.37, 95% CI (1.27 - 4.45), p = 0.007] and ApaI polymorphisms, and asthma risk [OR = 2.93, 95% CI (1.62 - 5.3), p = 0.0004]. No association was observed between genotypes and 25OHD levels, lung function and other biomarkers, with the exception of Interleukin-10 (IL-10) and white blood cells count (WBC). IL-10 levels were lower in asthmatics with TC genotype for TaqI polymorphism (p < 0.01) and were higher in patients with TT genotype for ApaI (p < 0.01). WBC were higher in patients with TC and CC genotypes for TaqI (p < 0.05) and lower in TT genotype for ApaI (p < 0.05). Conclusion. TaqI and ApaI polymorphisms are associated with asthma in Irish children. Further studies are warranted to investigate the importance of decreased IL-10 levels in paediatric asthmatics with specific genotypes.
Assuntos
Asma/genética , Predisposição Genética para Doença/genética , Interleucina-10/sangue , Receptores de Calcitriol/genética , Vitamina D/análogos & derivados , Asma/tratamento farmacológico , Criança , Suplementos Nutricionais , Feminino , Humanos , Irlanda , Masculino , Polimorfismo de Nucleotídeo Único/genética , Vitamina D/administração & dosagem , Vitamina D/sangueRESUMO
Sleep related breathing disorders (SRBD) have historically been under-recognised and under-treated. Obstructive sleep apnoea (OSA) affects approximately 3% of children. In line with the increased recognition of SRBD there has been an increase in demand for diagnostic services. We determined the awareness of SRBD amongst Irish paediatricians, examined the provision of sleep services to children throughout the country between 2007 and 2011 and audited diagnostic sleep services in a tertiary centre in 2011. Amongst respondents there was an awareness of SRBD but a poor understanding of diagnostic evaluation with 31/46 (67) referring to inappropriate services. There has been a sharp increase in both diagnostic sleep tests (433-1793 [414]) and in the use of non-invasive ventilation (NIV) (31-186 [627]) for treatment of SRBD between 2007 and 2011. Paediatric sleep services are organized in an ad-hoc manner nationally with significant service variation. The use of domiciliary overnight oximetry reduced the requirement for more formal polysomnography by 70%.
Assuntos
Serviços de Diagnóstico/estatística & dados numéricos , Gerenciamento Clínico , Síndromes da Apneia do Sono , Criança , Serviços de Saúde da Criança/métodos , Serviços de Saúde da Criança/estatística & dados numéricos , Técnicas de Diagnóstico do Sistema Respiratório , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Irlanda/epidemiologia , Polissonografia/estatística & dados numéricos , Prevalência , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/etiologia , Síndromes da Apneia do Sono/terapiaAssuntos
Bronquiolite Viral/terapia , Oxigenoterapia Hiperbárica , Bronquiolite Viral/economia , Bronquiolite Viral/epidemiologia , Bronquiolite Viral/virologia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Humanos , Oxigenoterapia Hiperbárica/economia , Oxigenoterapia Hiperbárica/métodos , Lactente , Recém-Nascido , Irlanda , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Vírus Sinciciais RespiratóriosRESUMO
Bronchiolitis affects one third of babies in their first year of life. We investigated all bronchiolitis admissions to Tallaght Hospital in the last five years, with the hope of providing an insight into the epidemic in an Irish population. We analysed these 1,202 admissions on the basis of time of year (busiest being December at 24.20%), length of stay (mean 2.92 days), gender (62% male) and age (mean 30.29 weeks). There was a 102% increase in the average incidence of bronchiolitis in the first six months of 2011 and 2012 (186) compared to the previous four years (92.25). P value was statistically significant at 0.0469. Our findings were backed up by comparable data from OLCH, Crumlin (149.5 for 2011-2012 vs 36.25 for 2007-2010). There has been in a significant shift in the timing and incidence of bronchiolitis in Tallaght Hospital in the last two years. We explored the possible reasons for this, with special attention to RSV incidence, climate causes and vaccine programs.
Assuntos
Bronquiolite/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Feminino , Humanos , Lactente , Irlanda/epidemiologia , Tempo de Internação , MasculinoRESUMO
Although the clinical signs of cardiovascular disease (CVD) are not evident until adulthood, many of the risk factors have their roots in early childhood. The aim of this study was to examine physical activity levels (PA) and the incidence of CVD risk factors in a small population (n=102) of primary school children in Dublin. Risk factors measured included overweight/obesity, blood lipids, blood pressure (BP), physical fitness and PA levels. Over a quarter of the group were overweight/obese (n = 29, 28%). Despite relatively good fitness levels, PA levels were low with less than half the group (n = 44, 46%) participating in the recommended 1 hour/day. Fewer girls reported spending > 1 hour/day at PA compared to boys (n = 14 v n = 30). Six children had elevated cholesterol levels and five children had higher than normal BP values. Sixteen children demonstrated clustering of CVD risk factors and in those who were inactive the risk was greater. Our data suggest that in children as young as 10 years significant risk factors already exist. Furthermore, the low level of PA in girls provides a target for health promotion programmes.
Assuntos
Doenças Cardiovasculares/epidemiologia , Atividade Motora , Determinação da Pressão Arterial , Criança , Feminino , Humanos , Incidência , Irlanda/epidemiologia , Lipídeos/sangue , Masculino , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Fatores de Risco , População UrbanaRESUMO
BACKGROUND: Gastro-oesophageal reflux is common in children with cystic fibrosis (CF) and is thought to be associated with pulmonary aspiration of gastric contents. The measurement of pepsin in bronchoalveolar lavage (BAL) fluid has recently been suggested to be a reliable indicator of aspiration. The prevalence of pulmonary aspiration in a group of children with CF was assessed and its association with lung inflammation investigated. METHODS: This was a cross-sectional case-control study. BAL fluid was collected from individuals with CF (n=31) and healthy controls (n=7). Interleukin-8 (IL-8), pepsin, neutrophil numbers and neutrophil elastase activity levels were measured in all samples. Clinical, microbiological and lung function data were collected from medical notes. RESULTS: The pepsin concentration in BAL fluid was higher in the CF group than in controls (mean (SD) 24.4 (27.4) ng/ml vs 4.3 (4.0) ng/ml, p=0.03). Those with CF who had raised pepsin concentrations had higher levels of IL-8 in the BAL fluid than those with a concentration comparable to controls (3.7 (2.7) ng/ml vs 1.4 (0.9) ng/ml, p=0.004). Within the CF group there was a moderate positive correlation between pepsin concentration and IL-8 in BAL fluid (r=0.48, p=0.04). There was no association between BAL fluid pepsin concentrations and age, sex, body mass index z score, forced expiratory volume in 1 s or Pseudomonas aeruginosa colonisation status. CONCLUSIONS: Many children with CF have increased levels of pepsin in the BAL fluid compared with normal controls. Increased pepsin levels were associated with higher IL-8 concentrations in BAL fluid. These data suggest that aspiration of gastric contents occurs in a subset of patients with CF and is associated with more pronounced lung inflammation.
Assuntos
Líquido da Lavagem Broncoalveolar/química , Fibrose Cística/metabolismo , Interleucina-8/análise , Pepsina A/análise , Adolescente , Biomarcadores/análise , Estudos de Casos e Controles , Criança , Pré-Escolar , Fibrose Cística/complicações , Feminino , Humanos , Lactente , Masculino , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/etiologiaRESUMO
This study aimed to determine the aetiology, clinical presentation, co-morbidity, severity and the lobar distribution of non cystic fibrosis bronchiectasis (NCFB). We performed a retrospective review of clinical, radiological, immunological and microbiological data from 92 non-CF patients with a High resolution thoracic CT (HRCT) diagnosis of bronchiectasis in the three Dublin Children's referral Hospitals for the period 1996-2006. Of 92 patients (50 female), the median age at diagnosis was 6.4 years. The aetiology of bronchiectasis was as follows; idiopathic 29 (32%), post-pneumonia 16 (17%), immune deficiency 15 (16%), recurrent aspiration 15 (16%), primary ciliary dyskinesia 8 (9%), chronic aspiration with immune deficiency 5 (5%), post foreign body inhalation 2 (2%), tracheomalacia 1 (1%) and Obliterative bronchiolitis 1 (1%). Bronchial asthma and gastroesophageal reflux disease (GORD) were concurrently present in 18 (20%) and 10 (11%) respectively. Left lower lobe was commonly involved followed next by the right middle lobe. The common isolates were Haemophilus influenza (50), Streptococcus pneumoniae (34) and Staphylococcus aureus (14), Moraxella catarrhalis (9) and Pseudomonas auerginosa (8). Surgical interventions were performed in 23 (25%) of patients, lobectomy 11 (12%), pneumectomy 2 (2%), laryngeal cleft repair 4 (5%), rigid bronchoscopy for foreign body removal 2 (2%), Nissan's fundoplication 2 (2%), tracheoesophageal fistula repair 2 (2%). We conclude NCFB is under-recognised in Irish children and diagnosis is often delayed and Bronchial Asthma and GORD are common co morbidity. A high index of suspicion and early HRCT can expedite the diagnosis.
Assuntos
Bronquiectasia/epidemiologia , Adolescente , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/etiologia , Bronquiectasia/terapia , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Irlanda/epidemiologia , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
Pleuropulmonary blastoma (PPB) is an aggressive tumour accounting for less than 1% of all primary malignant lung tumours in the paediatric population. It can be associated with cystic pulmonary lesions, which may be evident at the time of diagnosis or predate the appearance of the tumour. There are contradictory reports about the value of prophylactic resection of pulmonary cysts in protecting patients from developing PPB. We report an individual case where asymptomatic congenital lobar emphysema was incidentally picked up on CXR. Following a period of surveillance the lesion was resected due to increasing size. The histology of the lesion revealed PPB Type I.
Assuntos
Neoplasias Pulmonares/diagnóstico , Blastoma Pulmonar/diagnóstico , Humanos , Achados Incidentais , Lactente , Neoplasias Pulmonares/cirurgia , Masculino , Blastoma Pulmonar/cirurgia , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/cirurgiaRESUMO
Allergic bronchopulmonary aspergillosis (ABPA) can cause a significant clinical deterioration in patients with cystic fibrosis. There is very little research in the current literature with regard to alternatives for treatment, apart from long courses of steroids. We conducted a retrospective review of all our patients with ABPA treated with the antifungal voriconazole and found there was a significant drop in IgE levels post treatment as well as a decrease in steroid dosing. The improvement in FEV was not statistically significant; however there was a very wide variation in pre-treatment levels.
Assuntos
Antifúngicos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Fibrose Cística/complicações , Pirimidinas/uso terapêutico , Triazóis/uso terapêutico , Adolescente , Aspergilose Broncopulmonar Alérgica/etiologia , Intervalos de Confiança , Fibrose Cística/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/efeitos dos fármacos , Masculino , Estudos Retrospectivos , VoriconazolRESUMO
Decreased bone mineral density (BMD) is an emerging problem for clinicians who care for children with Cystic fibrosis (CF). The aim of this study was to determine prevalence and assess risk factors for reduced BMD in our adolescent population with CF. All bone densitometry scans (n=99) performed on children (n=79) with a mean age 13.6 (10-19.2) years over a 7 year period (2000-2007) were reviewed. Patient records were reviewed for correlating clinical data. Low BMD is frequently present in adults and children with variable reports (36-66%). In our study, BMD expressed as z score of L2-L4 spine was reduced in a total of 50% children with a preponderance of males. Bone demineralization was strongly associated with increasing age (p=0.03), diminished lung function (p=0.027), reduced body mass index (p=0.001) and treatment with oral corticosteroids (p=0.02).
Assuntos
Desmineralização Patológica Óssea/epidemiologia , Densidade Óssea , Fibrose Cística/complicações , Absorciometria de Fóton , Adolescente , Corticosteroides , Adulto , Fatores Etários , Índice de Massa Corporal , Desmineralização Patológica Óssea/etiologia , Desmineralização Patológica Óssea/fisiopatologia , Criança , Fibrose Cística/mortalidade , Fibrose Cística/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Irlanda/epidemiologia , Masculino , Mutação , Prevalência , Fatores de Risco , Adulto JovemRESUMO
Irish asthma guidelines, published in 2000, are based on the Global Initiative for Asthma (GINA) international asthma management guidelines and provide recommendations for optimal asthma management and control. Using the same methodology as employed in the Asthma Insights and Reality in Europe (AIRE) survey, which assessed whether specific goals of asthma management based on GINA were being realised, 400 patients with current asthma in Ireland were interviewed in the Asthma Insights and Reality in Ireland (AIRI) survey to determine their healthcare utilisation, symptom severity, activity limitations and level of asthma control. Of those surveyed, acute services were utilised by a significant number of respondents. Over the previous year, 27% had either an emergency visit to the hospital or their general practitioner (GP) and 7% were hospitalised for asthma. In terms of asthma control, 19% experienced sleep disturbance at least once a week, 29% missed work or school and 37% of respondents experienced symptoms during physical activity over the previous 4-week period. Based on these findings, the level of asthma control and asthma management in Ireland falls short of recommended national and international asthma guidelines.
Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Adolescente , Adulto , Asma/epidemiologia , Asma/fisiopatologia , Criança , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Irlanda/epidemiologia , Masculino , Guias de Prática Clínica como Assunto , Índice de Gravidade de DoençaRESUMO
BACKGROUND: In children with cystic fibrosis there is a decrease in peak work capacity and oxygen consumption on maximal exercise testing when compared to controls. Previous studies have shown that peripheral muscle force is decreased in children with cystic fibrosis even in those with minimal changes in lung function. However, no studies have examined peripheral muscle strength using isokinetic dynamometry which permits measurement of muscle strength throughout range and is considered the gold standard in orthopaedics and sports medicine. METHODS: Isokinetic muscle strength was measured in the knee flexors and extensors and shoulder flexors and extensors at two speeds of movement in children with cystic fibrosis and matched controls. Activity levels in both groups were calculated. RESULTS: Thirteen subjects and 13 age and height matched controls were assessed. Average peak torque was calculated and expressed in terms of body weight. There was a significant difference in peak torque/body weight in children with cystic fibrosis when compared to controls. FEV1 was significantly correlated with knee muscle strength and shoulder flexion at 90 degrees /s in subjects with CF. CONCLUSION: Children with CF had lower muscle strength than control subjects. Airflow limitation was associated with decreased muscle strength. The relationship between muscle strength and exercise tolerance requires investigation.
Assuntos
Fibrose Cística/fisiopatologia , Tolerância ao Exercício/fisiologia , Músculo Esquelético/fisiopatologia , Adolescente , Corticosteroides/uso terapêutico , Criança , Fibrose Cística/tratamento farmacológico , Exercício Físico/fisiologia , Volume Expiratório Forçado/fisiologia , Humanos , Pneumopatias/tratamento farmacológico , Pneumopatias/fisiopatologia , Masculino , Atividade Motora/fisiologiaRESUMO
Infants born with severe congenital diaphragmatic hernia (DH) characteristically have pulmonary hypoplasia. Airway hyperresponsiveness during the first 4 weeks of life can be demonstrated in most of these neonates. Early postnatal pulmonary development in infants with severe DH has not been well characterized. We examined lung growth in patients with congenital DH by using the forced deflation method to study pulmonary function in 18 infants on mechanical ventilation who survived neonatal repair of their congenital DH. Thirteen infants without primary pulmonary pathology who required general anesthesia for other surgery served as controls. Infants were further divided according to age at the time of testing into early (age < or = 7 days at time of testing) and late (age > or = 29 days) groups, yielding four groups of subjects: early diaphragmatic hernia (EDH): n = 9; mean age, 4.2 days; range, 1-7 days; early controls (EC): n = 8; mean age, 3.1 days; range, 1-6 days; late diaphragmatic hernia (LDH): n = 11; mean age, 57.7 days, range, 28-120 days; and late controls (LC); n = 5; mean age, 52.2 days; range 32-90 days. All infants were studied once, with the exception of two infants with DH who were studied on two occasions at EDH and LDH stages. A marked reduction in weight-corrected forced vital capacity (FVC) was seen in the EDH group (13.9 +/- 3.9 ml/kg) as compared to the EC group (44.4 +/- 4.9 ml/kg). During the ensuing 4 months of life, FVC in patients with LDH (24.5 +/- 1.9 ml/kg) was much higher than FVC in patients with EDH (P < 0.05). These findings demonstrate the presence of pulmonary hypoplasia in the EDH group and suggest subsequent rapid postnatal lung growth. An index of rate constant, MEF25/FVC, as compared with control groups was abnormally elevated in EDH subjects (1.87 +/- 0.30/second vs 1.16 +/- 0.32/ second, P < 0.05), indicating significantly increased lower airway caliber relative to lung volume. The severe reduction of the rate constant in the LDH group (0.36 +/- 0.05/second vs 0.73 +/- 0.07/second, P < 0.05) suggests the development of lower airway obstruction. After the administration of a nebulized bronchodilator (BD), an increase in MEF25 (32.9%) in the EDH group was not significant, but an increase of 134.7% in the LDH group was significant (P < 0.05). Although the study utilized a cross-sectional design with most of the infants in either the early or late group, present findings suggest that infants with EDH have lung restriction reflecting pulmonary hypoplasia. These infants developed lower airway obstruction and airway hyperresponsiveness with only mild fixed obstruction over the first 4 months of life.
Assuntos
Hérnias Diafragmáticas Congênitas , Pulmão/anormalidades , Resistência das Vias Respiratórias , Broncodilatadores , Oxigenação por Membrana Extracorpórea , Hérnia Diafragmática/fisiopatologia , Hérnia Diafragmática/cirurgia , Humanos , Lactente , Recém-Nascido , Pulmão/fisiopatologia , Testes de Função RespiratóriaRESUMO
Lobar atelectasis is a common complication of cystic fibrosis. The majority of cases respond to intravenous antibiotics and chest physiotherapy. In a subgroup of patients, atelectasis is resistant to medical therapy, and its persistence in the pediatric population is associated with a poor prognosis. Bronchoscopic instillation of human recombinant DNase expanded atelectatic lobes in three children resistant to at least 2 weeks of medical therapy. This method of administration of DNase has been successful in resistant cases of lobar atelectasis in patients with chronic obstructive pulmonary disease, quadriplegia, and status asthmaticus. Purulent cystic fibrosis sputum has a very high DNA content, and DNA has been shown to become more pourable in vitro when treated with rhDNase. Bronchoscopic instillation of rhDNase should be considered in cases of persistent lobar atelectasis unresponsive to medical therapy.
Assuntos
Broncoscopia , Fibrose Cística/complicações , Desoxirribonuclease I/administração & dosagem , Desoxirribonuclease I/uso terapêutico , Expectorantes/administração & dosagem , Expectorantes/uso terapêutico , Atelectasia Pulmonar/tratamento farmacológico , Atelectasia Pulmonar/etiologia , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Criança , Fibrose Cística/diagnóstico por imagem , Feminino , Humanos , Instilação de Medicamentos , Atelectasia Pulmonar/diagnóstico por imagem , RadiografiaRESUMO
Maximum expiratory and inspiratory flow-volume (MEFV, MIFV) curves, specific airway conductance (sGaw), and flexible fiberoptic laryngoscopy were examined in 8 pediatric lung transplant recipients with vocal cord paralysis (VCP). Six were heart-lung (H-L) and 2 double-lung (D-L) recipients, 7 had left VCP, and 1 had right VCP. Based on the pulmonary function tests (PFT), 2 subgroups could be distinguished in the 8 recipients with VCP. Group A (5/8 recipients; mean age, 13 +/- 3.4 years; mean height, 144.3 +/- 12.3 cm) had significantly reduced specific airway conductance (sGaw; < 2 SD from predicted) and normal MEF25, MEF50, peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and %FEV1/forced vital capacity (FVC); this pattern suggested variable extrathoracic airway obstruction. PIF was normal in 4/5 and reduced in 1/5 of these recipients. Group B (3/8 recipients with VCP; mean age, 17 +/- 2.4 years; mean height, 156.3 +/- 12.0 cm) had significantly reduced sGaw, MEF25, MEF50, PEF, FEV1, and %FEV1/FVC, implying primarily small airway obstruction. These recipients had bronchiolitis obliterans. The results suggest that a pattern of reduced sGaw and normal MEFs, PEF, FEV1, and PIF should raise the possibility of VCP in patients after lung transplantation. sGaw is more sensitive than PIF and PEF in identifying airway obstruction due to VCP, and should be routinely included in the follow-up evaluation of lung transplant recipients.
Assuntos
Transplante de Pulmão , Complicações Pós-Operatórias/fisiopatologia , Testes de Função Respiratória , Paralisia das Pregas Vocais/fisiopatologia , Adolescente , Criança , Feminino , Volume Expiratório Forçado , Humanos , Laringoscopia , Transplante de Pulmão/fisiologia , Masculino , Complicações Pós-Operatórias/etiologia , Ventilação Pulmonar , Paralisia das Pregas Vocais/etiologiaRESUMO
BACKGROUND: 1,25-Dihydroxycholecalciferol (1,25(OH)(2)D(3)) has been shown to mitigate epithelial inflammatory responses after antigen exposure. Patients with cystic fibrosis (CF) are at particular risk for vitamin D deficiency. This may contribute to the exaggerated inflammatory response to pulmonary infection in CF. METHODS: CF respiratory epithelial cell lines were exposed to Pseudomonas aeruginosa lipopolysaccharide (LPS) and Pseudomonas conditioned medium (PCM) in the presence or absence of 1,25(OH)(2)D(3) or a range of vitamin D receptor (VDR) agonists. Levels of IL-6 and IL-8 were measured in cell supernatants, and cellular total and phosphorylated IκBα were determined. Levels of human cathelicidin antimicrobial peptide (hCAP18) mRNA and protein were measured in cells after treatment with 1,25(OH)(2)D(3). RESULTS: Pretreatment with 1,25(OH)(2)D(3) was associated with significant reductions in IL-6 and IL-8 protein secretion after antigen exposure, a finding reproduced with a range of low calcaemic VDR agonists. 1,25(OH)(2)D(3) treatment led to a decrease in IκBα phosphorylation and increased total cellular IκBα. Treatment with 1,25(OH)(2)D(3) was associated with an increase in hCAP18/LL-37 mRNA and protein levels. CONCLUSIONS: Both 1,25(OH)(2)D(3) and other VDR agonists significantly reduce the pro-inflammatory response to antigen challenge in CF airway epithelial cells. VDR agonists have significant therapeutic potential in CF.
Assuntos
Calcitriol/farmacologia , Fibrose Cística/imunologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/imunologia , Interleucina-6/biossíntese , Interleucina-8/biossíntese , Receptores de Calcitriol/agonistas , Mucosa Respiratória/citologia , Mucosa Respiratória/imunologia , Vitaminas/farmacologia , Células Cultivadas , HumanosRESUMO
We present the case of a child with asthma who continued to have marked exercise induced dyspnea despite appropriate treatment, and in the face of adequate control of all other asthma symptoms. Spirometry showed a marked truncation of inspiratory flow, and laryngoscopy performed immediately after exercise showed laryngomalacia with dynamic, partial inspiratory obstruction. Exercise induced laryngomalacia (EIL) is a rare cause of exercise induced dyspnea which is diagnosed by post exercise flexible laryngoscopy and may require supraglottoplasty.