Publication year: 2012 Source: Paediatric Respiratory Reviews, Available online 17 January 2012 Sam Mehr, Nicholas Wood Invasive pneumococcal infection remains a leading global cause of morbidity and mortality in young children. In developed nations, a substantial decrease in the incidence of IPD has been achieved with inclusion of the 7 valent protein conjugated pneumococcal vaccines (7vPCV) into paediatric vaccine schedules. In contrast, the incidence of IPD has changed little in developing nations. This is likely due to poor access to medical care and pneumococcal vaccination, the accompanying HIV and malnutrition burden, and the fact that 7vPCV does not contain the most common serotypes (1,5, 6A) responsible for IPD in many developing nations. The battle against IPD in developed nations is not over, with the rise of non-7vPCV serotypes since routine 7vPCV vaccination. This has necessitated the development and distribution of pneumococcal vaccines containing 3 or 6 additional serotypes. This article provides an overview on pneumococcal carriage and risk factors for IPD, the rise of non-7vCPV serotypes in the era of 7vPCV vaccination, and the current and newly available broader valent pneumococcal vaccines.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 24 December 2011 Tuomas Jartti, Maria Wendelin-Saarenhovi, Inka Heinonen, Jaakko Hartiala, Timo Vanto The fraction of exhaled nitric oxide (FeNO) has gained interest as a non-invasive tool to measure airway inflammation in asthma since it reflects allergic inflammation. Recent controlled clinical studies have, however, questioned its role in the management of asthma in children. To assess the clinical value of FeNO in paediatric asthma management, a meta-analysis was performed on the controlled studies of childhood asthma management guided by repeated FeNO measurements, and relevant publications on the confounders of FeNO were reviewed. The data suggests that utilising FeNO to tailor the dose of inhaled corticosteroids in children cannot be recommended for routine clinical practice since there is a danger of excessive inhaled corticosteroid doses in children without meaningful changes in clinical outcomes. Many disease and non-disease related factors (most importantly atopy, height/age and infection) affect FeNO levels which can easily confound the interpretation.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 8 December 2011 Maria Francesca Patria, Susanna Esposito Many children are affected by recurrent lower respiratory tract infections (LRTIs), but the majority of them do not suffer from serious lung or extrapulmonary disease. The challenge for clinicians is to distinguish the recurrent RTIs with self-limiting or minor problems from those with underlying disease. The aim of this review is to describe a practical approach to children with recurrent LRTIs that limits unnecessary, expensive and time-consuming investigations. The children can be divided into three groups on the basis of their personal and family history and clinical findings: 1) otherwise healthy children who do not need further investigations; 2) those with risk factors for respiratory infections for whom a wait-and-see approach can be recommended; and 3) those in whom further investigations are mandatory. However, regardless of the origin of the recurrent LRTIs, it is important to remember that prevention by means of vaccines against respiratory pathogens (i.e. type bHaemophilus influenzae, pertussis, pneumococcal and influenza vaccines) can play a key role.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 30 November 2011 Heinz Burtscher, Karen Schüepp Interest in ultrafine particles (UFP) has been increasing due to their specific physico-chemical characteristics. Ultrafine particles are those with an aerodynamic diameter of < 0.1 μm and are also commonly know as nanoparticles (0.1 μm = 100 nm). Due to their small size UFP contribute mostly to particle number concentrations and are therefore underestimated in actual pollution measurements, which commonly measure mass concentration. Children represent the most vulnerable group in regard to particulate exposure due to their developing status and different exposures compared to adults. This review discusses the sources of ultrafine particles as well as the specific exposures of children highlighting the importance and uniqueness of this age group.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 30 November 2011 G. Biskos, A. Schmidt-Ott Engineered nanoparticles (ENPs) are the building blocks of novel materials and consumer products that hold great promise for our societies. When ENPs are released to the environment, however, they can induce irreversible processes that can affect human health. To ensure safety for all nanoparticle-based products throughout their life cycle we urgently need to develop techniques for determining their toxic effects and the exposure levels of humans to ENPs. In an attempt to estimate whether nanotechnology can threaten more sensitive parts of the population such as children, we provide a brief overview of the potential pathways of introducing ENPs into the environment and the state-of-the-art techniques for assessing human exposure, as well as our current knowledge on their toxic effects.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 21 November 2011 F. Nicole Dijk, Julie Curtin, David Lord, Dominic A. Fitzgerald Unlike in adults, pulmonary embolism (PE) is an infrequent event in children. It has a marked bimodal distribution during the paediatric years, occurring predominantly in neonates and adolescents. The most important predisposing factors to PE in children are the presence of a central venous line (CVL), infection, and congenital heart disease. Clinical signs of PE are non-specific in children or can be masked by underlying conditions. Diagnostic testing is necessary in children, especially with the lack of clinical prediction rules. Recommendations for tests are derived from adult studies with ventilation/perfusion (V/Q) scintigraphy being well established. There exists an increasing role for computerised tomography pulmonary angiography (CTPA) and magnetic resonance pulmonary angiography (MRPA). Thrombotic events in children are initially treated with unfractionated heparin (UFH) or low molecular weight heparin (LMWH). For the extended anticoagulant therapy LMWH or vitamin K antagonists can be used with duration of treatment recommendations extrapolated from adult data. Mortality rates for PE in children are reported to be around 10%, with death usually related to the underlying disease processes. Exact data about recurrence risk in children is unknown. Because of the difference in aetiology, presentation, diagnostic methods and treatment between adults and children further research is necessary to assess the validity of recommendations for children.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 28 September 2011 Bruce K. Rubin A highlight of many journals is a review of pertinent literature in a specific field that has been published in the preceding year. Although such “Year in Review” presentations are important, at PRR we are pleased to present the news that has not yet happened. In this manuscript, which is a combination of science and fiction, I will present the very best research that has not yet been conducted but will be published sometime in 2012 or 2013. This will cover all aspects of pediatric pulmonary disease. Any resemblance to real research that is actually published during this time period is strictly coincidental and the product of a fertile imagination. However, if these ideas inspire you to do these studies and publish the results it would make this science fiction even more interesting. To quote the famous baseball player, Yogi Berra, “It's difficult to make predictions, especially about the future.”
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 28 September 2011 Andreas Jung, Irmela Heinrichs, Christian Geidel, Roger Lauener Inpatient pulmonary rehabilitation programs have evolved from tuberculosis sanatoriums to modern medical centres providing standardized comprehensive care in a multidiciplinatory environment. Goals of rehabilitation programs for children and adolescents include restoration of professional activity, improvement of health condition, compliance and disease management as well as restoration of quality of life. Eligibility for an intervention is assessed by defined social and medical criteria. Comprehensive pulmonary rehabilitation programs provide a wide range of health care recourses, including diagnostic procedures, specific medical care, educational interventions and a multiprofessional team. Paediatric rehabilitation programs for chronic respiratory diseases, such as asthma or cystic fibrosis, have been shown to reduce symptoms, increase aerobic fitness and physical strength, improve pulmonary function and inflammation and enhance compliance, self-management, quality of life and psychological symptoms. Regional climatic effects have demonstrated an additional positive effect on the rehabilitation outcome. In addition, first evidence suggests an overall reduction of health care costs.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 25 September 2011 Karen Schüepp, Peter D. Sly Nanoparticles have unique physico-chemical properties compared to larger particles that have the potential to provide promising new possibilities for biomedical applications. Considerable research is currently exploring these potentials of nanotechnology. In contrast, airborne particles as components of indoor air, ambient air pollution associated with traffic-related pollution, industry, power plants, and other combustion sources have the potential to harm children's health. However, a similar research effort into the potential health effects of exposure to nanoparticles is lacking. Children differ markedly from adults in their developmental biology rendering young children the most vulnerable group with regard to potentially harmful effects induced by particulate exposure. This review discusses the differences between children and adults in regard to nanoparticle exposure highlighting the uniqueness and vulnerability of children.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 25 September 2011 Karen Schüepp, Peter D. Sly Nanoparticles have unique physico-chemical properties compared to larger particles that have the potential to provide promising new possibilities for biomedical applications. Considerable research is currently exploring these potentials of nanotechnology. In contrast, airborne particles as components of indoor air, ambient air pollution associated with traffic-related pollution, industry, power plants, and other combustion sources have the potential to harm children's health. However, a similar research effort into the potential health effects of exposure to nanoparticles is lacking. Children differ markedly from adults in their developmental biology rendering young children the most vulnerable group with regard to potentially harmful effects induced by particulate exposure. This review discusses the differences between children and adults in regard to nanoparticle exposure highlighting the uniqueness and vulnerability of children.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 23 September 2011 Susanne I. Fuchs, Monika Gappa Multiple breath washout (MBW) has been demonstrated to be sensitive for assessing ventilation inhomogeneity (VI). VI is supposed to reflect changes in peripheral airways which are not apparent using spirometry. The lung clearance index (LCI) is the most robust parameter to quantify VI, and is largely independent of age; therefore, it potentially qualifies as a surrogate outcome parameter for clinical and research purposes, particularly during childhood.This review summarizes the current evidence regarding the clinical value of measuring LCI in children. Feasibility, reproducibility and diagnostic accuracy have been demonstrated; available data confirm that LCI is superior to spirometry in detecting small air way disease. However, there is little information regarding the value in the individual patient, and sparse longitudinal data looking at its prognostic value. Currently, only in patients with Cystic Fibrosis, it appears likely that knowledge of LCI will be useful for routine clinical management.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 17 September 2011 Paul L.P. Brand Although montelukast is claimed to be preferable to inhaled corticosteroids in children with asthma and allergic rhinitis, virus-induced exacerbations, exercise induced asthma, and in those experiencing difficulties with inhalation therapy, there is no scientific evidence to support any of these claims. In comparative trials and systematic reviews, inhaled corticosteroids are clearly more effective than montelukast in reducing asthma exacerbations, improving lung function, symptom scores, and rescue medication use. The effects on exercise induced bronchoconstriction appear to be similar. Because of their superior efficacy and excellent long-term efficacy and safety profile, inhaled corticosteroids are the treatment of first choice for the maintenance therapy of childhood asthma, irrespective of age or clinical phenotype.
Publication year: 2011 Source: Paediatric Respiratory Reviews, Available online 17 September 2011 Peter Paul van Asperen Asthma is a heterogeneous disease and it is therefore unrealistic to expect that inhaled corticosteroids (ICS) would be appropriate first line preventer therapy for all children with asthma. There is good theoretical and clinical trial evidence demonstrating that leukotriene receptor antagonists (LTRAs) are more effective than ICS for viral induced wheezing and equivalent to ICS for mild persistent asthma in children. LTRAS do not have the systemic adverse effects of ICS, are generally well tolerated and their once daily oral administration enhances adherence. LTRAs should therefore be first line preventer therapy for children with frequent intermittent or mild persistent asthma while ICS should be reserved as first line treatment for children with moderate to severe persistent asthma. Given the skew in paediatric asthma severity towards the milder end, this effectively means that LTRAs should be tried first in 2 of every 3 children with asthma requiring preventer treatment.