Hiperrespuesta bronquial a la metacolina en niños menores de 4 años con bronquitis de repetición / Bronchial Hyperresponsiveness to Methacholine in Children Under 4 Years with Recurrent Bronchitis

ObjetivoValorar la hiperespuesta bronquial en niños menores de 4 años con bronquitis sibilantes de repetición, y determinar si su presencia o ausencia permite predecir la evolución posterior hacia un fenotipo de bronquitis sibilantes transitorias o persistentes.Población y metodosSe realizó una prueba de broncoprovocación con metacolina utilizando un método modificado de respiración a volumen corriente, sin sedación a un grupo de pacientes de 8 a 47 meses de edad, con bronquitis sibilantes recurrentes y a un grupo control de niños sanos. Se valoró como respuesta positiva, la presencia de sibilantes, la disminución de la saturación de oxígeno ≥5% o el aumento de la frecuencia respiratoria >50% (PCwheeze [PCw]). Se realizó un seguimiento clínico posterior de los pacientes para valorar su evolución.ResultadosSe estudiaron 63 pacientes y 16 controles (edad media 23,9 vs. 25,2 meses). La PCw fue inferior a la del grupo control (≤4mg/ml) en 43 niños (68%) del grupo bronquitis (p<0,001). No se observaron efectos adversos significativos con la realización de la prueba. Tras un seguimiento medio de 28,5 meses, completado en 49 de los pacientes, no se observaron diferencias entre la presencia de hiperrespuesta bronquial al inicio del estudio y la evolución posterior a sibilantes transitorios, infrecuentes y frecuentes (p=0,63).ConclusionesUn porcentaje elevado de niños menores de 4 años afectos de bronquitis sibilantes presentaron hiperrespuesta bronquial. La evolución posterior a un fenotipo de bronquitis sibilantes transitorias o persistentes no se relacionó con la hiperrespuesta bronquial(AU)

ObjectiveTo evaluate bronchial hyperresponsiveness in children under 4 years of age with recurrent wheezing bronchitis, and to determine if its presence or absence can predict the subsequent progression to a transient or persistent wheezing bronchitis phenotype.Population and methodsA bronchial challenge test was performed with methacholine using a modified tidal volume method, without sedation in a group of patients from 8 to 47 months of age with recurrent wheezing bronchitis and a control group of healthy children. A decrease in oxygen saturation of ≥5% or an increase in respiration rate of >50% [PCwheeze (PCw)] was considered a positive response. The patients were subsequently clinically followed up to assess their progress.ResultsA total of 63 patients and 16 controls were studied (mean age 23.9 vs. 25.2 months). The PCw was lower than the control group (≤4mg/ml) in 43 (68%) children from the bronchitis group (P<0.001). No significant adverse effects were observed on performing the test. After a mean follow up of 28.5 months, completed in 49 of the patients, no differences were seen between the presence of bronchial hyperresponsiveness at the beginning of the study and the subsequent progression to transient, infrequent and frequent wheezing (P=0.63).ConclusionsA high percentage of children under 4 years of age affected by wheezing bronchitis had a bronchial hyperresponse. The subsequent progression to transient or persistent wheezing bronchitis phenotype is not associated with bronchial hyperresponsiveness(AU)

[Bronchial hyperresponsiveness to methacholine in children under 4 years with recurrent bronchitis]. / Hiperrespuesta bronquial a la metacolina en niños menores de 4 años con bronquitis de repetición.

OBJECTIVE: To evaluate bronchial hyperresponsiveness in children under 4 years of age with recurrent wheezing bronchitis, and to determine if its presence or absence can predict the subsequent progression to a transient or persistent wheezing bronchitis phenotype. POPULATION AND METHODS: A bronchial challenge test was performed with methacholine using a modified tidal volume method, without sedation in a group of patients from 8 to 47 months of age with recurrent wheezing bronchitis and a control group of healthy children. A decrease in oxygen saturation of ≥ 5% or an increase in respiration rate of >50% [PCwheeze (PCw)] was considered a positive response. The patients were subsequently clinically followed up to assess their progress. RESULTS: A total of 63 patients and 16 controls were studied (mean age 23.9 vs. 25.2 months). The PCw was lower than the control group (≤ 4 mg/ml) in 43 (68%) children from the bronchitis group (P<0.001). No significant adverse effects were observed on performing the test. After a mean follow up of 28.5 months, completed in 49 of the patients, no differences were seen between the presence of bronchial hyperresponsiveness at the beginning of the study and the subsequent progression to transient, infrequent and frequent wheezing (P=0.63). CONCLUSIONS: A high percentage of children under 4 years of age affected by wheezing bronchitis had a bronchial hyperresponse. The subsequent progression to transient or persistent wheezing bronchitis phenotype is not associated with bronchial hyperresponsiveness.

Óxido nítrico exhalado en niños menores de 4 años con bronquitis de repetición / Exhaled Nitric Oxide in Children Under 4 Years of Age With Recurrent Bronchitis

Introducción: El objetivo del estudio ha sido valorar la inflamación bronquial en niños preescolares con bronquitis de repetición, mediante la determinación del óxido nítrico exhalado.Pacientes y métodos: Se incluyó en el estudio a pacientes menores de 4 años con antecedentes de 3 episodios desibilantes en el último año (n=63), así como un grupo control (n=30). Se determinó el óxido nítrico exhalado mediante la técnica de recogida off-line, con respiración espontánea a volumen corriente con mascarilla, recogida en bolsa de Mylar.Resultados: El grupo con bronquitis presentó como media una fracción de óxido nítrico en aire exhalado (FEno) más elevada (media +- desviación estándar: 5,3+-1,3ppb) que el grupo control( 4,6+-1,1) (p=0,02).Hubo una diferencia significativ (p<0,05) entre el grupo control y los niños con bronquitis que no recibíancorticoides inhalados, pero no con los que sí los recibían. Se observó una relación con el número de eosinófilos en sangre, de forma que los que tenían valores más elevados (>400/ml) presentaban concentraciones de FEno más altas (p<0,01). No se apreció relación entre la FEno y el hecho de tener una prueba de provocación bronquial positiva a la metacolina. Se realizó un seguimiento de los pacientesdurante más de 20 meses. No hubo diferencias significativas (p=0,36) en el valor inicial de la FENO entrelos pacientes que posteriormente presentaron sibilancias transitorias(5,2+0,98 ppb), infrecuentes(5,6+1,5ppb) o frecuentes(4,8+1,34ppb).Conclusiones: Los niños menores de 4 años afectados de bronquitis sibilantes de repetición en fase asintomática presentan una discreta elevación de la FEno, con una amplia superposición de valores con el grupo control(AU)

Background: The objective of the study was to assess bronchial inflammation in preschool children withrecurrent bronchitis by measuring exhaled nitric oxide.Patients and Methods: The study included patients under 4 years of age with at least 3 episodes of wheezing in the past year (n = 63) and a control group (n = 30). Exhaled nitric oxide was measured in samples collected offline during spontaneous tidal breathing with a face mask and stored in Mylarballoons.Results: The fractional exhaled nitric oxide concentration (FEno) was higher in the group with bronchitis (mean [SD], 5.3 [1.3] parts per billion [ppb])than in the control group (4.6 [1.1] ppb) (P=02). There was a significant difference between the control group and children in the bronchitis group not treated with inhaled corticosteroids (P<.05), but not between controls and corticosteroid-treated patients. Arelationship with eosinophil count was observed in that those with higher counts(>400 /mL) had higher FEno levels (P<.01).No relation ship was observed between FEno and a positive methacholine challenge test. Follow-up lasted at least 20 months. The initial FEno level did not differ significantly according to whether patients were subsequently transient, infrequent, or frequent wheezers (5.2 [0.98] ppb, 5.6[1.5] ppb, and 4.8 [1.34]ppb, respectively; P<.36). Conclusions: In children under 4 years of age with recurrent wheezing bronchitis who were asymptomaticat study entry, asmall in crease in FEno was observed although there was a good deal of overlap with the control group(AU)

[Exhaled nitric oxide in children under 4 years of age with recurrent bronchitis]. / Oxido nítrico exhalado en niños menores de 4 años con bronquitis de repetición.

BACKGROUND: The objective of the study was to assess bronchial inflammation in preschool children with recurrent bronchitis by measuring exhaled nitric oxide. PATIENTS AND METHODS: The study included patients under 4 years of age with at least 3 episodes of wheezing in the past year (n=63) and a control group (n=30). Exhaled nitric oxide was measured in samples collected offline during spontaneous tidal breathing with a face mask and stored in Mylar balloons. RESULTS: The fractional exhaled nitric oxide concentration (FE(NO)) was higher in the group with bronchitis (mean [SD], 5.3 [1.3] parts per billion [ppb]) than in the control group (4.6 [1.1]ppb) (P=.02). There was a significant difference between the control group and children in the bronchitis group not treated with inhaled corticosteroids (P<.05), but not between controls and corticosteroid-treated patients. A relationship with eosinophil count was observed in that those with higher counts (>400 microL) had higher FE(NO) levels (P<.01). No relationship was observed between FE(NO) and a positive methacholine challenge test. Follow-up lasted at least 20 months. The initial FE(NO) level did not differ significantly according to whether patients were subsequently transient, infrequent, or frequent wheezers (5.2 [0.98]ppb, 5.6 [1.5]ppb, and 4.8 [1.34]ppb, respectively; P=.36). CONCLUSIONS: In children under 4 years of age with recurrent wheezing bronchitis who were asymptomatic at study entry, a small increase in FE(NO) was observed although there was a good deal of overlap with the control group.

[Bronchial hyperresponsiveness to methacholine assessed by means of tracheal auscultation of healthy children aged under 4 years]. / Estudio de la hiperrespuesta bronquial a la metacolina mediante la auscultación traqueal en niños sanos menores de 4 años.

OBJECTIVE: To assess the safety of the tracheal auscultation method for measuring bronchial hyperresponsiveness in healthy unsedated children aged less than 4 years and to establish a range of normal bronchial hyperresponsiveness values. POPULATION AND METHODS: The study population consisted of healthy children aged between 6 months and 4 years. A methacholine bronchial provocation test was administered to unsedated children, using the tidal volume breathing technique and applying an abbreviated protocol. The test was considered positive when wheezing was heard in the trachea, arterial oxygen saturation (SaO2) fell by 5% or more, or respiratory rate increased by 50% or more. RESULTS: A total of 16 children were studied. Ages ranged from 8 to 47 months, with a mean (SD) of 23.5 (12.2) months. There was no response to the methacholine in 11 children. In the other 5 children, there was a positive response at a concentration of 8 mg/mL. Response to the test was considered positive on the basis of tracheal wheezing in 3 cases, tracheal wheezing and a fall in SaO2 in 1 case, and a fall of SaO2 of 5% or more in 1 case. SaO2 never fell below 93%. CONCLUSIONS: As a means for assessing bronchial hyperresponsiveness, the tracheal auscultation method is appropriate, is simple to apply, and can be safely administered to unsedated children aged less than 4 years. The lowest concentration at which a response to methacholine occurs in healthy children of this age group is 8 mg/mL.

Estudio de la hiperrespuesta bronquial a la metacolina mediante la auscultación traqueal en niños sanos menores de 4 años / Bronchial hyperresponsiveness to methacholine assessed by means of tracheal auscultation of healthy children aged under 4 years

Objetivo: Valorar la seguridad del método de la auscultación traqueal para medir la hiperrespuesta bronquial en niños sanos menores de 4 años de edad, sin sedación, y establecer valores de normalidad. Población y métodos: Se incluyó en el estudio a niños sanos de entre 6 meses y 4 años de edad. Se les realizó una prueba de provocación bronquial con metacolina mediante la técnica de la respiración a volumen corriente, en niños no sedados, utilizando un protocolo acortado. Se consideró positiva la prueba cuando se auscultaron sibilantes en la tráquea, la saturación arterial de oxígeno (SaO2) disminuyó un 5% o más, o bien aumentó la frecuencia respiratoria un 50% o más. Resultados: Se estudió a 16 niños de 8 a 47 meses de edad (mediana: 23,5 meses; desviación estándar: 12,2 meses). En 11 niños no hubo respuesta a la metacolina, y en 5 la respuesta fue positiva a la concentración de 8 mg/ml. La prueba se consideró positiva en 3 casos por la auscultación de sibilancias traqueales, en uno por la auscultación de sibilancias y descenso de la SaO2, y en otro por un descenso de la SaO2 del 5% o superior. En ningún caso la SaO2 disminuyó por debajo del 93%. Conclusiones: El método de la auscultación traqueal es sencillo, adecuado y seguro para valorar la presencia de hiperrespuesta bronquial en niños menores de 4 años de edad, sin necesidad de sedarlos. La concentración mínima a la que los niños sanos de esta edad responden a la metacolina es 8 mg/ml

Objective: To assess the safety of the tracheal auscultation method for measuring bronchial hyperresponsiveness in healthy unsedated children aged less than 4 years and to establish a range of normal bronchial hyperresponsiveness values. Population and methods: The study population consisted of healthy children aged between 6 months and 4 years. A methacholine bronchial provocation test was administered to unsedated children, using the tidal volume breathing technique and applying an abbreviated protocol. The test was considered positive when wheezing was heard in the trachea, arterial oxygen saturation (SaO2) fell by 5% or more, or respiratory rate increased by 50% or more. Results: A total of 16 children were studied. Ages ranged from 8 to 47 months, with a mean (SD) of 23.5 (12.2) months. There was no response to the methacholine in 11 children. In the other 5 children, there was a positive response at a concentration of 8 mg/mL. Response to the test was considered positive on the basis of tracheal wheezing in 3 cases, tracheal wheezing and a fall in SaO2 in 1 case, and a fall of SaO2 of 5% or more in 1 case. SaO2 never fell below 93%. Conclusions: As a means for assessing bronchial hyperresponsiveness, the tracheal auscultation method is appropriate, is simple to apply, and can be safely administered to unsedated children aged less than 4 years. The lowest concentration at which a response to methacholine occurs in healthy children of this age group is 8 mg/mL

Asma infantil / Infant asthma

Con suma frecuencia nos encontramos con niños que siguen un tratamiento específico para combatir sus repetidos episodios de dificultad respiratoria y sibilancias. En muchos casos se trata de asma.Hipócrates definió el asma como "la situación en la que se origina una estrechez excesiva de los bronquios tras reaccionar con un estímulo provocador, que habitualmente no produce ningún efecto" (AU)

[Childhood asthma]. / Asma infantil.

Very frequently we have to deal with children who follow specific treatment to combat their repetitive episodes of breathing difficulty and wheezing. In many cases, they suffer from asthma. Hippocrates defined asthma as "the condition which causes an excessive narrowing of the bronchi after a reaction with a provocative stimulus which usually does not produce any effect".