Somatizing disorders affecting the respiratory tract

Respiratory disease in childhood is common but not all children presenting to the paediatrician have an underlying organic cause for their symptoms. This article reviews the spectrum of non-organic somatization disorders that might be encountered and advises about the diagnosis and treatment of habit cough, laryngeal dysfunction and hyperventilation.</p

Bronchoalveolar lavage

Bronchoalveolar lavage is a technique for sampling the epithelial lining fluid of the respiratory tract. Analysis of cellular and non-cellular components of returned fluid has the potential to provide valuable information about airways inflammation. Because of the invasive nature of the investigation, there are few conditions for which repeat sampling can be justified. Bronchoalveolar lavage has been used to study immune mechanisms in cystic fibrosis, interstitial lung diseases and asthma. This article reviews the usefulness of BAL assessments for lung inflammation in paediatric practice.</p

Day care and asthma morbidity

An association between attendance at day care centres and lower respiratory symptoms among pre‐school asthmatic children who were attending follow‐up appointments at a specialist respiratory outpatient clinic was studied. Parents of 69 children completed a questionnaire. Because of the variation in the age distribution of the two groups, analysis was restricted to children aged 2‐4 years old; results from 49 children were analysed. Cough, wheeze at night and wheeze on waking occurred significantly more frequently in the two weeks prior to clinic visits among asthmatics attending day care. Among asthmatic children requiring specialist outpatient follow up, those attending day care are more likely to be troubled by lower respiratory symptoms than those looked after at home.</p

Treating childhood asthma in Singapore: When West meets East

British Medical Journal30869391282-1284BMJO

Asthma severity and anxiety levels in secondary schoolchildren

Stress can adversely affect asthma and is a risk factor for fatal and near-fatal asthma attacks. Recent studies suggest that mental stress is increasing among children. This study investigated the relationship between emotional anxiety and asthma among secondary school children. Subjects completed Spielberger's State-Trait Anxiety Inventory for Children (STAIC). This measures current (State) and general (Trait) anxiety. Asthma severity was assessed in a structured interview with parents attending asthma clinics. Four measures of asthma severity were used: The Jones Morbidity Index, location of care, BTS treatment step and previous hospital admissions for asthma. Family structure and social factors were also recorded. The study was performed in three general practice clinics (n=29) and in the hospital's asthma clinic (n=58). A group of children from two local secondary schools (n=390) also completed the STAIC questionnaire. 17.9% self-reported having asthma and recorded higher STAIC-Trait scores than children who did not regard themselves as asthmatic (p=0.01). Clinic data suggested children with more severe asthma were more anxious than those with milder illness. This was highly significant (p&lt;0.001) for children who had been admitted with asthma in the previous 5 years (STAIC Trait: n=23, mean=37.13, SD=6.56) who were more anxious than those who had not been admitted (STAIC Trait: n=57, mean=31.11, SD=6.10). Data also demonstrated that family structure influences anxiety levels. Children in single-parent families were more anxious than children with two parents living at home (p&lt;0.05). In three of the four measures of asthma severity, children in single-parent families appeared to have more severe asthma. Asthma and anxiety appear to be related with the more severe illness occurring in children with higher levels of anxiety. Family structure might be important in generating anxiety in children.</p

Use of pulse oximetry in the hospital management of acute asthma in childhood

Oxyhemoglobin saturation values were recorded before and 10 minutes after 5 mg of nebulized salbutamol in 75 children (age, 1.5–14.6 years) admitted to hospital with acute asthma. Other assessments included heart rate, respiratory rate, peak expiratory flow rate, pulsus paradoxus, and an asthma severity score. All assessments were performed by the same observer (GC) and subsequent hospital care was transferred to the on‐call pediatricians, who were not told the initial saturation values. Six children required intravenous therapy after hospital admission when their symptoms were not improved after nebulized salbutamol. Cutoff points for each continuous variable were selected so that they identified at least 5 of these 6 children (i.e., with a sensitivity of at least 83 percent). The resulting specificities and positive predictive values were calculated for each variable before and after nebulized therapy. A postnebulizer saturation of less than 91 % had a sensitivity of 100% [95% confidence interval (CI), (54–1001 with a specificity of 98%] (95% CI, 92–100) and a positive predictive value of 86%. This was the best predictor of the need for intravenous (IV) therapy. Correlation coefficients were calculated for the 75 admissions and 2 others who required immediate IV treatment to determine how closely saturation values were related to the other recorded clinical variables. Saturation values were significantly, though weakly, correlated with asthma severity scores and prenebulizer heart rate, but they were not associated with any of the other variables. These results highlight the difficulties encountered when assessing acute asthma in a hospital population with a large number of preschool children. Saturation measurements are easy to obtain in all age groups and help identify those children who require intensive therapy and close supervision after hospital admission. © 1993 Wiley‐Liss, Inc.</p

The cost effectiveness of budesonide in severe asthmatics aged one to three years

The cost effectiveness of budesonide treatment was determined in a 6-month randomised, double blind, placebo controlled study of 40 asthmatic children aged one to three years with persistent asthma symptoms despite bronchodilator therapy. Budesonide produced a mean (± sd) of 62 (54) symptom-free days compared with 38 (36) for placebo. Direct costs were reduced with budesonide by fewer doctor consultations and fewer hospital admissions for shorter periods. Indirect cost benefits occurred through reductions in the days lost from work by parents and days lost from playgroup by the child because of asthma. Total costs/patient/year for a budesonide- and placebo-treated child were £1397.83 and £1891.43, respectively. The marginal cost effectiveness ratio was -£6.33 in favour of budesonide. Budesonide effectively reduces asthma symptoms compared to placebo and the additional drug costs are substantially offset by a reduced use of healthcare services and reduced indirect costs to childrens' families.</p