Exhaled nitric oxide (FENO) may be a useful biomarker for asthma and is derived from enzymatic activity on the amino acid L-arginine. The aim of the present pilot study was to study the effect of L-arginine ingestion on FENO and also NO production in the proximal and distal airways.Asthmatic and control children were enrolled and phenotyped by skin prick reactivity and spirometry. FENO was measured before and after ingestion of 0.2 g/kg L-arginine. Proximal and distal NO production (J'awNO and CANO) were derived using the method of Tsoukias.Twenty children were recruited, 11 steroid-treated asthmatics, 1 steroid-naïve asthmatic, and 8 healthy controls. The median baseline FENO before L-arginine administration was 31 ppb (interquartile range, IQR, 15, 61). At baseline, the median J'awNO was 1000 nl/sec (IQR 650, 2880) and the median CANO was 2.3 ppb (IQR 1.8, 4.5). FENO rose by an average of 5.5 ppb [95% CI 3.5, 7.5] (P < 0.001) 60 min after ingestion of L-arginine and 1.5 ppb [95% CI -0.9, 4.0] (P = 0.188) after 120 min. One hour after L-arginine ingestion, J'awNO did not change but CANO rose by an average of 2.6 ppb [95% CI 0.5, 4.7], P = 0.020.The rise in FENO after dietary exposure to L-arginine is modest, transient, and of little or no clinical significance. Pediatr Pulmonol. © 2010 Wiley-Liss, Inc. more >>

Reports in adults and children have correlated history of wheezing or asthma with the presence of obstructive sleep-disordered breathing but the mechanism of this epidemiologic association is unknown. The goal of the present study was to examine whether tonsillar hypertophy can explain this association.Children were recruited from the Emergency Department and the Pediatric Pulmonology Clinic. History of wheezing requiring treatment (explanatory variable) and snoring [ge]1 night/week (outcome) were recorded and presence of tonsillar hypertrophy (outcome) was assessed.Four hundred forty-two children were recruited (mean age: 7.6 ± 3.6 years) and 210 of them had history of wheezing. History of wheezing was significantly associated with the presence of tonsillar hypertrophy and snoring even after adjustment for age, gender, obesity, and passive smoking [odds ratio (95% confidence interval): 2.23 (1.37-3.63); P = 0.001 and 1.73 (1.12-2.67); P = 0.013, respectively]. When only children with tonsillar hypertrophy were considered (n = 92), history of wheezing was significantly related to the presence of snoring, whereas in subjects without tonsillar hypertrophy (n = 350) wheezing did not affect snoring [odds ratio: 2.76 (1.10-6.93); P = 0.031 and 1.49 (0.92-2.43); P = 0.107, respectively].Children with history of wheezing have more frequently tonsillar hypertrophy than those without wheezing. Tonsillar hypertrophy may mediate at least in part the reported association between asthma and obstructive sleep-disordered breathing in childhood. Pediatr Pulmonol. © 2010 Wiley-Liss, Inc. more >>

Maternal smoking during pregnancy increases the incidence and severity of respiratory infections in neonates. Surfactant proteins A and D (SP-A and SP-D, respectively) are components of pulmonary innate immunity and have an important role in defense against inhaled pathogens. The purpose of this study was to determine if nicotine exposure during the third trimester of pregnancy alters the expression of SP-A and SP-D of fetal lung epithelia. Pregnant ewes were assigned to four groups; a nicotine-exposed full-term and pre-term group, and control full-term and pre-term group. Lung tissue was collected for Western blot and IHC analysis of SP-A level, Western blot analysis of SP-D level and qPCR analysis of SP-A and SP-D mRNA expression. Exposure to nicotine significantly decreased SP-A gene expression (P = 0.01) and SP-A protein level in pre-term lambs. This finding suggests that maternal nicotine exposure during the last trimester of pregnancy alters a key component of lung innate immunity in offspring. Pediatr Pulmonol. ©2010 Wiley-Liss, Inc. more >>

Late presentation of congenital diaphragmatic hernia (CDH) is unusual, especially in patients with cystic fibrosis (CF). To our knowledge, cases of CDH in CF patients and the combined effects on lung function have not been previously described. Here we report two cases of late presenting CDH in CF patients and describe effects on lung function. Late presentation of CDH in CF patients can cause gastrointestinal or respiratory symptoms and requires a high index of suspicion as well as proper interpretation of imaging. In patients with CF and CDH, lung function abnormalities could include obstructive, restrictive defects, or combined defects. Pediatr Pulmonol. ©2010 Wiley-Liss, Inc. more >>

Publication year: 2010
Source: Paediatric Respiratory Reviews, Volume 11, Issue 1, March 2010, Pages 46-53
Marie D., Frazier , Ira M., Cheifetz
Helium-oxygen (heliox) gas mixtures have been studied for over 70 years as an adjunctive therapy for airway obstruction in a variety of respiratory diseases. The medical use of heliox is based on the physical properties of helium as its low density makes it advantageous in promoting more efficient flow through narrowed passages. Clinical evidence of the efficacy of heliox in treating paediatric respiratory diseases is increasing in the medical literature. This article consists of a comprehensive review of the literature investigating the utility of heliox in the treatment of paediatric respiratory disorders, including upper and lower airway obstruction, mechanical ventilation,... more >>

Publication year: 2010
Source: Paediatric Respiratory Reviews, Volume 11, Issue 1, March 2010, Pages 46-53
Marie D., Frazier , Ira M., Cheifetz
Helium-oxygen (heliox) gas mixtures have been studied for over 70 years as an adjunctive therapy for airway obstruction in a variety of respiratory diseases. The medical use of heliox is based on the physical properties of helium as its low density makes it advantageous in promoting more efficient flow through narrowed passages. Clinical evidence of the efficacy of heliox in treating paediatric respiratory diseases is increasing in the medical literature. This article consists of a comprehensive review of the literature investigating the utility of heliox in the treatment of paediatric respiratory disorders, including upper and lower airway obstruction, mechanical ventilation,... more >>

Publication year: 2010
Source: Paediatric Respiratory Reviews, In Press, Corrected Proof, Available online 25 January 2010
Dominic A., Fitzgerald more >>

Publication year: 2010
Source: Paediatric Respiratory Reviews, In Press, Corrected Proof, Available online 25 January 2010
Sven M., Schulzke , J. Jane, Pillow
Bronchopulmonary dysplasia (BPD) is associated with increased mortality and significant long-term cardiorespiratory and neurodevelopmental sequelae. Treatment of evolving BPD in the neonatal intensive care unit (NICU) is challenging due to the complex interplay of contributing risk factors which include preterm birth per se, supplemental oxygen, positive pressure ventilation, patent ductus arterious, and pre- and postnatal infection. Management of evolving BPD requires a multimodal approach including adequate nutrition, careful fluid management, effective and safe pharmacotherapy, and respiratory support aiming at minimal lung injury. Among pharmacological interventions, caffeine has the best risk-benefit profile. Systemic postnatal corticosteroids should be reserved to ventilated infants... more >>

Publication year: 2010
Source: Paediatric Respiratory Reviews, In Press, Corrected Proof, Available online 25 January 2010
Lucia J., Smith , Karen O., McKay , Peter P., van Asperen , Hiran, Selvadurai , Dominic A., Fitzgerald
The following review focuses on the normal development of the lung from conception to birth. The defined periods of lung development–Embryonic, Pseudoglandular, Canalicular, Saccular and Alveolar–will be explored in detail in relation to gestational age. Cellular differentiation, formation of the conducting airways and respiratory zone and development of the alveoli will be reviewed. Pulmonary vascular development will also be examined within these periods to relate the formation of the blood-air barrier to the lungs for their essential function of gas exchange after birth. The development of the surfactant and cortisol systems will also be discussed as these need to be... more >>

Publication year: 2010
Source: Paediatric Respiratory Reviews, In Press, Corrected Proof, Available online 25 January 2010
Robert, Primhak
The history of oxygen therapy in neonatology has been littered with error. Controversies remain in a number of areas of oxygen therapy, including targets and strategies in supplemental oxygen therapy in Chronic Neonatal Lung Disease (CNLD). This article reviews some of these controversies, and makes some recommendations based on the available evidence. In graduates of neonatal units who are left with CNLD, oxygen saturation should be kept above 93-95%, with levels below 90% being avoided as far as possible. Titration of oxygen should be done using oximetry recordings which include periods of different activities. Weaning of oxygen supplementation should only... more >>