The Value of Induced Sputum in the Diagnosis and Management of Children with Bronchial Asthma.

BACKGROUND: Induced sputum in children with bronchial asthma represents a non-invasive method of bronchial inflammation assessment. The main objective of our study was to analyze the cellularity of sputum in patients with bronchial asthma according to the level of disease control and the controlling therapy (with/without inhaled glucocorticoids). The second objective was to establish the correlation between sputum cellularity and other indirect parameters used to evidence bronchial inflammation (exhaled nitric oxide) and obstruction (forced expiratory volume in 1 second). METHODS: The study included children with bronchial asthma that were assessed clinically (physical exam, questionnaire on the control of bronchial asthma in children) and by medical tests (induced sputum, exhaled nitric oxide, spirometry). RESULTS: In patients with partially controlled asthma and those with uncontrolled asthma, the eosinophils percentage in the sputum was higher than in patients with controlled asthma (19.8±26.4% respectively 9.2±20.5% versus 4.5±14.6%, p<0.001). Higher percentage of neutrophils in the sputum was found in the partially controlled and uncontrolled asthma than in the controlled asthma (43.9±20.1% respectively 51.6±38.3% versus 35±19.7%, p=0.009). We also evidenced a direct and statistically significant correlation between the exhaled nitric oxide and the neutrophils percentage in the sputum (r=0.67, p=0.0003). Also, an indirect, moderate to good correlation (r=-0.56, p=0.005) was evidenced between the values of the forced expiratory volume in 1 second and the high eosinophils percentage in the sputum. CONCLUSIONS: In partially controlled and uncontrolled bronchial asthma the eosinophils and neutrophils count in the sputum is significantly higher than in patients with controlled asthma. There is an indirect correlation between the high eosinophils count in the sputum and the forced expiratory volume in 1 second, as well as a direct correlation between the neutrophils count and the exhaled nitric oxide, suggesting that induced sputum should be used in combination with other indirect parameters for the evidence of bronchial inflammation.

Epidemiological survey 6 years apart: increased prevalence of asthma and other allergic diseases in schoolchildren aged 13-14 years in cluj-napoca, romania (based on isaac questionnaire).

BACKGROUND: The prevalence of asthma and allergy has increased during recent decades. OBJECTIVE: We investigate the prevalence of asthma and other allergic diseases in children aged 13-14 years and we evaluate the trend of prevalence after an interval of 6 years. MATERIAL AND METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children. In 1991, the questionnaire was administered to 2,866 children from a Romanian city and during 2001 to 1,657 children from the same area. RESULTS: The prevalence of asthma increased from 3.3% in 1995 to 5.5% in 2001 (p<0.001). In 1995, 4.3% of children reported asthma-related symptoms, significantly fewer than the percentage 6 years later (13.6%; p<0.00001). Similar results were obtained with regard to allergic rhinitis (13.6% versus 20%; p<0.00001) and eczema (11.5% versus 16.2%; p=0.00015). As far as gender differences are concerned, in the first stage of study all three allergic disorders were found to occur more frequently in females. In the study undertaken in 2001, females proved to have a higher prevalence of asthma (p=0.226), but a lower prevalence for allergic rhinitis (p=0.121) and eczema (p=0.064). CONCLUSIONS: The prevalence of asthma and allergy increased significantly during the past 6 years.

Romanian experience in child celiac disease diagnosis.

Last consensus in celiac disease in 2008 conducted under the aegis of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition jointly with North American Society of Pediatric Gastroenterology, Hepatology and Nutrition reveals the following: "celiac disease is a chronic immune-mediated enteropathy characterized by sensitization to gluten. That can affect any organ or system, with a wide range of clinical manifestations of variable severity". Thus, in recent years, clinical picture of celiac disease has changed the old paradigm--bowel disease with villous atrophy and malnutrition, being replaced with the new paradigm--multi-organ autoimmune disease, affecting many organs and systems throughout but with more less specific symptoms, which undiagnosed leads to delayed diagnosis, at a late-onset disease and long-term major complications as the risk of cancer. According to this consensus "the serological diagnosis of celiac disease is based on high sensitivity and specificity tests", but in line with changing clinical features of celiac disease, its diagnosis has undergone significant changes in recent years. These changes in the diagnosis of celiac disease, we have decided to analyze them.

The role of ultrasonography in the evaluation of maxillary sinusitis in pediatrics.

UNLABELLED: Sinusitis in children may sometimes present non-specific signs and symptoms. The imaging techniques used for its diagnosis are computed tomography and magnetic resonance imaging, the standard radiography being used less and less. Ultrasonography is seldom mentioned in literature as a diagnosis method of sinusitis. OBJECTIVE: The purpose of this study is to evaluate the value of ultrasonography compared with the standard X-ray in the diagnosis of maxillary sinusitis in children. METHOD: The study was prospectively conducted. The study group included 76 patients who had an ultrasound of the maxillary sinuses. The including criteria were represented by uncontrolled or partially controlled asthma, symptomatology suggesting rhinosinusitis and age over 4. Patients with radiological anomalies of the maxillary sinuses were excluded from the study as well as the patients who were not examined through X-ray and the ultrasonography on the same day. The ultrasound was performed with a pediatric convex transducer with the patient in a sitting position. The ultrasonographic exam evaluated the presence of fluid collection and mucosal thickening within the maxillary sinuses. Signs evaluated by X-ray exam were: total opacity of the maxillary sinus, air-fluid level and mucosal thickening. The Wilcoxon matched-pairs tests was used in order correlate the results obtained through ultrasonography and radiograph. It was considered statistic significant p<0.05. Using the ROC curve the sensitivity and the specificity of the ultrasound compared with the standard radiograph were determined. RESULTS: Based on the excluding criteria a number of 67 patients (35 male) were selected from the study group. The patient's mean age+/-standard deviation was 9 years 2 months+/-3 years 9 months. 134 maxillary sinuses were analyzed ultrasonographically and radiologically. There was a diagnosis agreement between the two techniques in 112 out of 134 sinuses (83.5%). Compared to the standard X-ray, ultrasonography had a 94.9 % sensitivity and a 98.4 % specificity. The error of the ultrasound exam compared to the standard X-ray evaluated in a divided interpretation was low for the normal aspect (1.58%) and for the fluid collection (5.12%), but the error for the thickening of the mucosa was high, over 50% (59.37%). IN CONCLUSION: Ultrasonography may come to represent, on a larger scale, an accessible imaging alternative to the more invasive investigations used in the present in evaluating fluid collections in the maxillary sinus in pediatrics.

[Quality of life in children with bronchial asthma and allergic rhinitis]. / Calitatea vietii la copilul cu astm bronsic si rinita alergica.

The quality of life is a subjective parameter that evaluates the impact of asthma on daily life of the child. The authors evaluated the evolution of the quality of life score in children with persistent asthma and analyzed the impact of association of allergic rhinitis on this parameter. The evaluation of the quality of life was based on a questionnaire with 23 items (PAQLQ), which was applied on 54 children with asthma (35 of them having rhinitis allergic associated to asthma). The quality of life score was evaluated initial and every 3 months, during one year. At the end of the study the authors revealed the improvement of the quality of life score in 87% of children, with significant improvement of the scores for symptoms, activities and emotions (p=0.002). There were no significant differences between the 19 patients with only asthma as compared with the 35 patients that had both asthma and allergic rhinitis either at the beginning of the study (p = 0,19) or after 12 months of follow-up (p = 0,34). In conclusion, allergic rhinitis is frequently associated with asthma in children, but its impact on the quality of life is not significant.

[Askin tumor. Consideration on a case]. / Tumora askin. Consideratii pe marginea unui caz.

The authors present the case of a male patient of 9 years of age admitted for thoracic pain. The clinical evaluation and the imaging exams (chest X-ray, ultrasonography exam of the chest and thoracic computer tomography) reveal a tumor of the thoracic wall. The child was referred to the surgery. It was revealed an invasive tumoral mass of bone origin. At the pathological exam the tumor presented an aspect of Askin tumor. The authors discuss the theoretical aspects correlated with the diagnosis of Askin tumor, based on the presented case.

[Evaluation of the effect of inhaled glucocorticosteroids by morning cortisolemia]. / Evaluarea efectului glucocorticoizilor administrati inhalator prin cortizolemia matinala.

The authors study the effect on adrenal function of a small dose of inhaled steroids in children with asthma. The study group consisting in 61 children treated with inhaled steroids (38 children treated with beclomethasone dipropionate and 23 treated with fluticasone propionate) who were compared with 17 controls (children with asthma treated with nonsteroidal therapy). In the study group, after 12 months of therapy morning cortisolemia was lower as compared with the values before the treatment. In children treated with beclomethasone the morning cortisol before therapy was 217.6 +/- 76.4 nmol/L and after therapy of 171.5 +/- 52 nmol/L (p < 0.077). In children treated with fluticasone initial cortisol was of 210.8 +/- 19.5 nmol/L and after treatment of 175.2 +/- 30.9 nmol/L (p < 0.027).

[Evaluation of quality of life in children with bronchial asthma]. / Evaluarea calitatii vietii la copilul cu astm bronsic.

Asthma affects children physically, psychologically and socially. The quality of life is a subjective parameter that evaluates the impact of asthma on daily life of the child. The authors evaluated the evolution of the quality of life score in children with persistent asthma treated with controllers, during one year, and the correlation between the quality of life score and pulmonary function parameters. The evaluation of the quality of life was based on a questionnaire with 23 items (PA QLQ), which was applied on 64 children with asthma. The quality of life score was evaluated initially and every 3 months. Pulmonary function tests were measured by spirometry every 3 months and children recorded PEF twice daily At the end of the study the authors revealed the improvement of the quality of life score in 87% of children. Initially the value of the general score of quality of life was of 4.78 +/- 1.09 and it increased up to 6.53 +/- 0.56 (p = 0.0001) after 12 months. We noticed significant improvement of the scores for symptoms, activities and emotions, and also of circadian variation of PEF (p = 0.002). We revealed a relatively poor reverse correlation between general score of the quality of life and circadian variation of PEF (r = - 0.330). In conclusion, the evaluation of quality of life might appreciate the clinical course of asthma patients. Based on this results the authors suggest the use of the evaluation of the quality of life as a complementary method to the classical methods used for asthma monitoring in children.

[Increase of the prevalence of bronchial asthma and related symptoms in students in Cluj-Napoca. Epidemiologic study with a five-years interval]. / Cresterea prevalentei astmului bronsic si simptomelor asociate la scolarul mare în Cluj-napoca. Studiu epidemiologic la 5 ani interval.

BACKGROUND: The prevalence of asthma is increasing in developed countries during the past decade. In Romania there are few studies on asthma epidemiology and no data on the trend of the prevalence. AIMS: The authors investigate the prevalence of asthma and associated symptoms in children and evaluate the trend of prevalence 5 years apart. METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children (ISAAC). The questionnaire was applied during 1995 in 2,866 children aged 13-14 years from a Romanian city, and during 2001 in 1,657 children from the same area. RESULTS: The prevalence of previous diagnosed asthma increased significant, from 3.3% in 1995 to 5.5% in 2001 (p = 0.0005). A higher percentage of pupils presented probable asthma (4.3% in 1995 and 13.6% in 2001; p < 0. 00001). Similar results were obtained regarding symptoms related to asthma like wheezing, cough during exercise and night cough. Previous diagnosed asthma was more frequent in boys, but probable asthma and symptoms related to asthma were more prevalent in girls both in 1995 and in 2001. The prevalence of asthma is similar with that reported in other central and eastern European countries that used the same core questionnaire provided by ISAAC. CONCLUSION: The prevalence of asthma and associated symptoms increased significantly during the past 5 years.

[The effects of long-term inhaled glucocorticoids on children's bones]. / Efectele glucocorticoizilor administrati de durata, pe cale inhalatorie, la copil, asupra osului.

The authors study, by calcanean ultrasonographic method, the effects of inhaled steroids, administered for long term, on the bone status, in children with persistent asthma. The study group consisted in 33 children with persistent asthma, treated for 12 months with low or moderate doses of either beclomethasone dipropionate or fluticasone propionate. In all of them there were measured the main ultrasonographic parameters, before and after treatment. The results were compared with those recorded in a control group. The control group consisted in 16 children with asthma that did not receive long term inhaled steroids. In the study group the were no statistically significant differences between ultrasonographic parameters measured before and after steroids inhaled treatment. There were no statistically significant differences between ultrasonographic parameters measured after steroid treatment in the study group and the same parameters recorded in the control group. The results of our study reveal that long term inhaled steroids therapy do not influence the bone density at the calcanean level.

[Effectiveness of antireflux therapy in asthmatic children with gastroesophageal reflux disease]. / Eficienta terapiei antireflux la copiii astmatici cu boala de reflux gastroesofagian.

There is an increased interest within literature regarding the relationship between gastro-esophageal reflux disease and asthma. The study was performed to assess the efficiency of antireflux therapy in asthmatic children. In a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years) the pulmonary function tests were made by means of spirometry in those patients in which reflux disease was diagnosed by means of 24h esophageal pH-monitoring and upper digestive endoscopy. All these patients were reevaluated by means of spirometry 3 months after the antireflux therapy with ranitidine and cisapride added to antiasthmatic therapy. Three months later the results showed a significant decrease in frequency of asthma exacerbations from 3.18 +/- 4.86 to 0.45 +/- 0.80 (p = 0.016). There is also a significant increase of FEV1 (p = 0.04) and of FEV1/FVC (p = 0.018) in asthmatic patients with reflux disease and a positive symptomatic index, and of FEV1/FVC (p = 0.002) in all asthmatic children with abnormal gastro-esophageal reflux respectively. In conclusion, by adding antireflux therapy in asthmatic children there is a significant improvement in clinical and some of functional parameters.

[Gastroesophageal reflux in asthmatic children: prevalence and pathogenic role]. / Refluxul gastro-esofagian patologic la copii cu astm bronsic: prevalenta si rol patogenetic.

The relationship of gastroesophageal reflux disease and asthma is controversial. This study was performed to assess the prevalence of pathologic gastroesophageal reflux and its effect on pulmonary function tests in asthmatic children. The following study protocol was performed in a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years): diagnosis of pathologic gastroesophageal reflux by means of 24h esophageal pH-monitoring; diagnosis of reflux esophagitis by means of upper digestive endoscopy and pulmonary function tests by means of spirometry. The results show a high prevalence (87%) of pathologic gastroesophageal reflux in asthmatic children. Additionally, there is an inverse correlation (r = -0.67) between the severity of pathologic gastroesophageal reflux and FEV1/FVC. In conclusion, there is a high prevalence of pathologic gastro-esophageal reflux in asthmatic children, contributing to asthma severity.

[Prevalence of bronchial asthma in 7 years -old children in Cluj-Napoca, an ISAAC study]. / Prevalenta astmului bronsic la copiii de 7 ani din municipiul Cluj-Napoca. Studiu ISAAC.

The authors studied the prevalence of asthma in children of 7 years from Cluj Napoca and analyzed the possible risk factors. We used the questionnaire elaborated by International Study on Asthma and Allergic Diseases in Children (ISAAC) which allowed the comparison of our data with those from other countries. Anamnesis, functional tests and allergic skin tests were performed in children with positive answers for questionnaire. 1334 children completed the study, 52.5% being males. Prevalence of asthma diagnosed previous to the questionnaire was of 5.7%, and it was higher in males (6.1%). By anamnesis, functional and skin tests data the diagnosis of asthma was made in a total of 217 children, so that the real prevalence of asthma is of 16.3% in this age group. Maternal smoking during the first year of life was significantly higher in children with wheezing. The high number of respiratory tract infections in the first year of life could also play a role. In conclusion, prevalence of asthma diagnosed in children of 7 years of age from Cluj Napoca is of 5.7% with a real prevalence of disease that seems to be much higher, of 16.3%. Maternal smoking represents a risk factor correlated with wheezing.