Paediatric respiratory reviews
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This review examines specific mucoactive agents from three classes: expectorants, which add water to the airway; ion-transport modifiers, which promote ion and water transport across the epithelium of the airway; and mucokinetics, which improve cough-mediated clearance by increasing airflow or reducing sputum adhesivity. The agents are isotonic and hypertonic saline, mannitol, denufosol and beta-agonists. Our understanding of these agents has recently improved through pre-clinical research, clinical trials and, in particular, extensive research into the nature of the liquid lining the surface of the airway, both in health and in cystic fibrosis (CF). For each agent, recent research is reviewed, highlighting the evidence for possible mechanisms of action and for clinical efficacy in CF, as well as the implications for the optimal clinical application of the agent.
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The biophysical properties of airway secretions are largely determined by the polymeric components. In normal airway mucus, the gel-forming mucins, MUC5AC and MUC5B, are responsible not only for the viscoelastic properties essential for clearance and protecting the airway epithelium from invaders and water evaporation. ⋯ Sputum viscoelastic and surface properties determine how well secretions can be cleared by cilia or cough. In this mini-Symposium on Airway Clearance in Cystic Fibrosis, the physiology of CF secretion structure and rheology is discussed in the context of medications and physical maneuvers for enhancing sputum clearance.
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Paediatr Respir Rev · Dec 2006
ReviewEffect of bariatric surgery on obstructive sleep apnoea in adolescents.
Obese adolescents, particularly those with extreme obesity (body mass index > or =40 kg/m(2)), are developing serious medical complications at an unexpectedly high rate. As non-operative approaches to weight loss have shown less than optimal results, paediatric patients are increasingly seeking bariatric surgical intervention. Bariatric surgical procedures are designed to restrict stomach size or impair macronutrient absorption. ⋯ As with adult studies, paediatric studies generally report good obstructive sleep apnoea (OSA)-related outcomes after bariatric surgery. Therefore, in patients meeting eligibility criteria, bariatric surgery can be a valuable approach for achieving significant weight loss and resolution of serious comorbidities such as OSA. Studies that focus on long-term assessment of OSA are needed to understand whether OSA resolution after adolescent bariatric surgery is sustainable over the lifetime.
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Progressive respiratory failure is a common modality of death in children with a terminal illness. The management of respiratory failure, and in particular symptoms of dyspnoea and musculoskeletal chest pain in children receiving palliative care, remains challenging. The emergence of palliative care paediatricians and the application of non-invasive ventilation to children with progressive respiratory failure are the two major advances in the care of children with respiratory complaints in the palliative care setting. This article outlines current approaches to palliative care in children with progressive respiratory symptoms.
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Paediatr Respir Rev · Sep 2006
ReviewChest computed tomography scans should be considered as a routine investigation in cystic fibrosis.
Cystic fibrosis (CF) patients demonstrate lung inflammation and infection beginning early in life. Both inflammation and infection lead to irreversible structural lung damage, primarily as bronchiectasis and fibrosis. The course of CF varies widely between patients due to genotypic and environmental differences. ⋯ PFTs, however, are only an indirect measure of lung structure and are insensitive to localised or early damage. By contrast, computed tomography (CT) is currently the most sensitive tool to monitor lung structure. As up to 50% of patients will have discordant staging of lung disease when PFTs are compared to CT findings, both methods are needed to adequately assess a patient's pulmonary condition and tailor the treatment strategy to the patient's needs.