Pediatric pulmonology
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Pediatric pulmonology · Mar 2010
Short-term effect of physiotherapy on variability of the lung clearance index in children with cystic fibrosis.
Multiple breath washout (MBW) for measuring the lung clearance index (LCI) has been proposed as a non-invasive tool for detecting early cystic fibrosis (CF) lung disease. The LCI is highly repeatable and reproducible in healthy subjects. In patients with CF, within-test variability is low. ⋯ Repeatability was slightly poorer than published for healthy subjects possibly reflecting variable mucus plugging, and, thus, variable trapped air in patients with CF. Reproducibility was good and independent on intervention. From our data, we conclude that timing of PT in relation to MBW can be ignored when designing study protocols or when interpreting longitudinal data and treatment effects.
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Pediatric pulmonology · Mar 2010
How much do primary care givers know about tracheostomy and home ventilator emergency care?
Children on home mechanical ventilation are a high-risk population. How much do primary caregivers (PC) know about handling unexpected situations with tracheostomies or malfunction of their ventilators? To answer this, we prospectively studied the knowledge of 152 PC (108 parents and 44 nurses), using a 25-question survey regarding emergency situations at home. ⋯ their mean score was 20.2 correct answers (81%). However, 96 PC (63%) did not know that the low pressure ventilator alarm would not sound if the tracheostomy tube decannulated while still connected to the ventilator. Seventy-nine PC (52%) failed to understand high pressure alarms sound and mucous plugging. Sixty-six PC (43%) did not know how much power a battery stored after the suction machine was fully charged. Sixty-one PC (40%) did not know when the low pressure or low minute volume alarm sounds. Fifty-six PC (37%) relied on the ventilator alarm to determine the presence of mucous plugs. There were no significant differences in the scores of PC who used continuous flow ventilators, nor in English-speaking PC versus Spanish-speaking PC. The experience of the PC did not make a difference in their knowledge of HMV emergency care. Having professional training did not pose an advantage in the score for nurses. We conclude that most PC had a good understanding of emergency care. We speculate that more in depth education on the technical aspects of ventilator alarms and tracheal mucous plugging may help to reduce or prevent emergencies of children on HMV.
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Pediatric pulmonology · Feb 2010
A child's asthma quality of life rating does not significantly influence management of their asthma.
Children of parents who perceive their children have increased asthma severity use more medical services and reliever medication. ⋯ Parent's QOL perception, and not the child's, is associated with asthma management. RAP decreased the parent's QOL symptoms assessment and was important in determining the child's asthma management.
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Pediatric pulmonology · Feb 2010
ReviewCystic fibrosis lung disease starts in the small airways: can we treat it more effectively?
The aims of this article are to summarize existing knowledge regarding the pathophysiology of small airways disease in cystic fibrosis (CF), to speculate about additional mechanisms that might play a role, and to consider the available or potential options to treat it. In the first section, we review the evidence provided by pathologic, physiologic, and imaging studies suggesting that obstruction of small airways begins early in life and is progressive. In the second section we discuss how the relationships between CF transmembrane conductance regulator (CFTR), ion transport, the volume of the periciliary liquid layer and airway mucus might lead to defective mucociliary clearance in small airways. ⋯ In the final section, we discuss how established therapies impact small airways disease and new directions that may lead to improvement in the treatment of small airways disease. We conclude that there are many reasons to believe that small airways play an important role in the pathophysiology of (early) CF lung disease. Therapy should be aimed to target the small airways more efficiently, especially with drugs that can correct the basic defect at an early stage of disease.
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Pediatric pulmonology · Jan 2010
Randomized Controlled Trial Comparative StudyHigh volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis.
The objective of this study was to investigate the effectivenesses of nebulized salbutamol, epinephrin, 3% saline, and normal saline (0.9% NaCl) in the treatment of mildly affected infants with acute bronchiolitis. We enrolled 186 children (mean age 9.5 +/- 5.3 months, range 1.5-24 months, 65.1% male) with a first episode of wheezing diagnosed as mild bronchiolitis in emergency department. Patients were randomized in a double-blind fashion to receive 4 ml dose either of 1.5 mg epinephrine plus normal saline (group 1; n = 38) or 1.5 mg epinephrine plus 3% saline (group 2; n = 39) or 2.5 mg salbutamol plus normal saline (group 3; n = 36) or 2.5 mg salbutamol plus 3% saline (group 4; n = 36) or normal saline alone (group 5; n = 37) at 0 and 30 min. ⋯ There were no significant differences between the outcome variables of the groups (P > 0.05). No adverse effects attributable to nebulized therapy were seen. In conclusion, all treatment modalities used in this study, including a total of 8 ml normal saline inhalation at 30-min interval showed clinically significant and swift improvement in mildly affected ambulatory infants with acute bronchiolitis.