Small airways targeted treatment with smart nebulizer technology could improve severe asthma in children: a retrospective analysis.

OBJECTIVE: Conventional inhaler devices have a low efficacy in targeting small airways. Smart nebulizers can be used to increase deposition to small airways by adjusting the flow and depth of each inhalation based on patients 'individual inspiratory capacity. We investigated whether targeting of high dose inhaled corticosteroids (ICS) to small airways with a smart nebulizer could reduce exacerbation rate in children with severe asthma (SA). METHODS: We conducted a retrospective study in children with SA using a smart nebulizer (Akita® Jet nebulizer) for the administration of high dose ICS in our outpatient clinic at the Erasmus MC - Sophia Children's Hospital. Clinical data before and after start of treatment were collected. The primary outcome was exacerbation rate, defined as: number of asthma exacerbations for which oral corticosteroid courses (OCS) were prescribed. The exacerbation rate 1 year before treatment was compared with the exacerbation rate 1 year after start of treatment. Secondary outcomes were changes in spirometry parameters, hospital admissions and medication use. RESULTS: Data on OCS use was available for 28/31 patients. Median number of asthma exacerbations requiring OCS courses 1 year before decreased from 2 (interquartile range(IQR) 2) to 0.5 (IQR 3) 1 year after treatment (p = 0.021). Hospital admission decreased from 1 (IQR 3) to 0 (IQR 1)(p = 0.028). FEV1, FEF25-75 and FEF75 were not significantly improved after one year of treatment with the smart nebulizer (p = 0.191; p = 0.248; p = 0.572). CONCLUSION: Targeting small airways with high dose ICS using a smart nebulizer resulted in a significant reduction in exacerbations requiring OCS after one year of treatment.

[Haemoptysis in children: diagnose and act]. / Kinderen die bloed ophoesten: lokaliseren en handelen.

BACKGROUND: Haemoptysis, coughing up blood from the respiratory tract distal to the vocal cords, is a rare symptom in children, and the cause is difficult to determine. The symptom can cause anxiety for the child, parents and treating physician. CASE DESCRIPTION: We describe two cases of adolescents who presented at the Accident and Emergency Unit with acute onset dyspnoea and haemoptysis. In patient A, the haemoptysis was caused by tuberculosis, a known but rare cause of haemoptysis in the Netherlands. Patient B was found to have pseudohaemoptysis, which always has to be differentiated from haemoptysis. CONCLUSION: Although haemoptysis in children is usually mild and self-limiting, knowledge about the possible underlying causes and necessary diagnostic workup is essential in order to reach the right diagnosis promptly and start appropriate treatment in case of life threatening haemoptysis.