Environmental Exposures Impact Pediatric Asthma Within the School Environment.

The school is a microenvironment well-known to host many indoor allergens and pollutants, with a strong association between school allergen exposure and childhood asthma morbidity. Despite advances in therapies, asthma continues to be one of the most common chronic conditions among children, associated with significant morbidity, health care utilization, and productivity loss. Asthma prevalence is also disproportionately high among children in minority communities. This review will focus on environmental exposures associated with asthma morbidity (cockroach, mouse, cat and dog, dust mite, fungus, air pollution). This review will also discuss recent school-based interventions to improve allergy morbidity among school-aged children. Understanding the multifaceted environmental factors which may contribute to asthma pathogenesis is necessary to help guide potential school-based interventions.

Incremental change in cross sectional area in small endotracheal tubes: A call for more size options.

OBJECTIVE: To elucidate the relatively large incremental percent change (IPC) in cross sectional area (CSA) in currently available small endotracheal tubes (ETTs), and to make recommendation for lesser incremental change in CSA in these smaller ETTs, in order to minimize iatrogenic airway injury. METHODS: The CSAs of a commercially available line of ETTs were calculated, and the IPC of the CSA between consecutive size ETTs was calculated and graphed. The average IPC in CSA with large ETTs was applied to calculate identical IPC in the CSA for a theoretical, smaller ETT series, and the dimensions of a new theoretical series of proposed small ETTs were defined. RESULTS: The IPC of CSA in the larger (5.0-8.0 mm inner diameter (ID)) ETTs was 17.07%, and the IPC of CSA in the smaller ETTs (2.0-4.0 mm ID) is remarkably larger (38.08%). Applying the relatively smaller IPC of CSA from larger ETTs to a theoretical sequence of small ETTs, starting with the 2.5 mm ID ETT, suggests that intermediate sizes of small ETTs (ID 2.745 mm, 3.254 mm, and 3.859 mm) should exist. CONCLUSION: We recommend manufacturers produce additional small ETT size options at the intuitive intermediate sizes of 2.75 mm, 3.25 mm, and 3.75 mm ID in order to improve airway management for infants and small children.