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Indian J Pediatr ; 85(8): 651-657, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29139062


The goals of asthma management are accurate diagnosis, prompt initiation of treatment and monitoring of disease progression to limit potential morbidity and mortality. While the diagnosis and management is largely based on history taking and clinical examination, there are an increasing number of tools available that could be used to aid diagnosis, define phenotypes, monitor progress and assess response to treatment. Tools such as the Asthma Predictive Index could help in making predictions about the possibility of asthma in childhood based on certain clinical parameters in pre-schoolers. Lung function measurements such as peak expiratory flow, spirometry, bronchodilator responsiveness, and bronchial provocation tests help establish airway obstruction and variability over time. Tools such as asthma questionnaires, lung function measurements and markers of airway inflammation could be used in combination with clinical assessments to assess ongoing asthma control. Recent advances in digital technology, which open up new frontiers in asthma management, need to be evaluated and embraced if proven to be of value. This review summarises the role of currently available tools in asthma diagnosis and management. While many of the tools are readily available in resource rich settings, it becomes more challenging when working in resource poor settings. A rational approach to the use of these tools is recommended.

Asma/diagnóstico , Testes de Provocação Brônquica , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Criança , Humanos , Testes de Função Respiratória , Espirometria , Inquéritos e Questionários
Pediatrics ; 140(1)2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28759391


Patients with severe cystic lung disease are considered to be at risk for cyst rupture during air travel because of the possibility of increase in cyst size and impaired equilibration of pressure between the cysts and other parts of the lung. This may have clinically devastating consequences for the patient but may also result in significant costs for emergency alteration of flight schedule. We report the use of a hypobaric chamber to simulate cabin pressure changes encountered on a commercial flight to assess the safety to fly of a child with severe cystic lung disease secondary to Langerhans cell histiocytosis. The test did not result in an air leak, and the child subsequently undertook air travel without mishap. This is the first reported use of a hypobaric chamber test in a child with severe cystic lung disease. This test has the potential to be used as a fitness to fly test in children at risk for air leak syndromes who are being considered for air travel.

Medicina Aeroespacial/métodos , Histiocitose de Células de Langerhans/complicações , Pneumopatias/complicações , Simulação de Ambiente Espacial/métodos , Aeronaves , Criança , Cistos , Humanos , Hipóxia , Pneumopatias/diagnóstico , Masculino , Fatores de Risco , Tomografia Computadorizada por Raios X , Viagem
Am J Respir Crit Care Med ; 184(1): 75-81, 2011 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-21493738


RATIONALE: Better understanding of evolution of lung function in infants with cystic fibrosis (CF) and its association with pulmonary inflammation and infection is crucial in informing both early intervention studies aimed at limiting lung damage and the role of lung function as outcomes in such studies. OBJECTIVES: To describe longitudinal change in lung function in infants with CF and its association with pulmonary infection and inflammation. METHODS: Infants diagnosed after newborn screening or clinical presentation were recruited prospectively. FVC, forced expiratory volume in 0.5 seconds (FEV(0.5)), and forced expiratory flows at 75% of exhaled vital capacity (FEF(75)) were measured using the raised-volume technique, and z-scores were calculated from published reference equations. Pulmonary infection and inflammation were measured in bronchoalveolar lavage within 48 hours of lung function testing. MEASUREMENTS AND MAIN RESULTS: Thirty-seven infants had at least two successful repeat lung function measurements. Mean (SD) z-scores for FVC were -0.8 (1.0), -0.9 (1.1), and -1.7 (1.2) when measured at the first visit, 1-year visit, or 2-year visit, respectively. Mean (SD) z-scores for FEV(0.5) were -1.4 (1.2), -2.4 (1.1), and -4.3 (1.6), respectively. In those infants in whom free neutrophil elastase was detected, FVC z-scores were 0.81 lower (P=0.003), and FEV(0.5) z-scores 0.96 lower (P=0.001), respectively. Significantly greater decline in FEV(0.5) z-scores occurred in those infected with Staphylococcus aureus (P=0.018) or Pseudomonas aeruginosa (P=0.021). CONCLUSIONS: In infants with CF, pulmonary inflammation is associated with lower lung function, whereas pulmonary infection is associated with a greater rate of decline in lung function. Strategies targeting pulmonary inflammation and infection are required to prevent early decline in lung function in infants with CF.

Fibrose Cística/fisiopatologia , Pneumonia/complicações , Infecções por Pseudomonas/complicações , Testes de Função Respiratória , Infecções Respiratórias/complicações , Infecções Estafilocócicas/complicações , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/citologia , Fibrose Cística/complicações , Fibrose Cística/diagnóstico , Fibrose Cística/microbiologia , Progressão da Doença , Feminino , Volume Expiratório Forçado , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal , Capacidade Vital
Free Radic Biol Med ; 49(9): 1354-60, 2010 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-20647044


We aimed to determine whether myeloperoxidase (MPO) is the main peroxidase present in the airways of children with cystic fibrosis (CF) and to assess which oxidants it produces and whether they are associated with clinical features of CF. Children with CF (n=54) and without CF (n=16) underwent bronchoscopy and bronchoalveolar lavage (BAL) for assessment of pulmonary infection and inflammation. BAL fluid was analyzed for MPO, halogenated tyrosines as markers of hypohalous acids, thiocyanate, and protein carbonyls. MPO was the only peroxidase detected in BAL samples from children with CF and its concentration was markedly higher than in controls. Levels of 3-chlorotyrosine and 3-bromotyrosine in proteins were higher in the CF group. They correlated with neutrophils and MPO. The concentration of thiocyanate in BAL samples was below 1µM. Protein carbonyl levels correlated with MPO and halogenated tyrosines in patients with CF. Levels of MPO and halogenated tyrosines were higher in children with infections, especially Pseudomonas aeruginosa, and in the presence of respiratory symptoms. They also correlated with the Kanga clinical score. Our findings suggest that MPO produces hypobromous acid as well as hypochlorous acid in the airways of children with CF and that these oxidants are involved in the early pathogenesis of CF.

Líquido da Lavagem Broncoalveolar/química , Fibrose Cística/enzimologia , Neutrófilos/metabolismo , Peroxidase/metabolismo , Pseudomonas aeruginosa/imunologia , Infecções Respiratórias/enzimologia , Líquido da Lavagem Broncoalveolar/citologia , Criança , Pré-Escolar , Fibrose Cística/complicações , Fibrose Cística/fisiopatologia , Progressão da Doença , Feminino , Humanos , Lactente , Inflamação , Masculino , Neutrófilos/patologia , Oxirredução , Pseudomonas aeruginosa/patogenicidade , Infecções Respiratórias/complicações , Infecções Respiratórias/fisiopatologia , Tirosina/análogos & derivados , Tirosina/análise
Respirology ; 15(6): 1009-11, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20456672


There is emerging evidence that cystic fibrosis lung disease begins early in infancy. Newborn screening allows early detection and surveillance of pulmonary disease and the possibility of early intervention in this life-shortening condition. We report two children with cystic fibrosis who underwent a comprehensive assessment from diagnosis that included measurement of lung function, limited-slice high-resolution CT and BAL performed annually. Early aggressive surveillance enabled significant lung disease and bronchiectasis to be detected during the first few years of life and led to a change in management, highlighting a clinical role for CT scanning during the preschool years in children with cystic fibrosis.

Bronquiectasia/diagnóstico por imagem , Fibrose Cística/diagnóstico por imagem , Antibacterianos/uso terapêutico , Bronquiectasia/genética , Líquido da Lavagem Broncoalveolar/microbiologia , Fibrose Cística/tratamento farmacológico , Fibrose Cística/genética , Diagnóstico Precoce , Feminino , Humanos , Lactente , Masculino , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento