Bronchial or Laryngeal Obstruction Induced by Exercise?

A child suspected of exercise-induced laryngeal obstruction and asthma is examined by laryngoscopy and respiratory resistance (Rrs) after exercise challenge. Immediately at exercise cessation, the visualized adduction of the larynx in inspiration is reflected in a paroxystic increase in Rrs. While normal breathing has apparently resumed later on during recovery from exercise, the pattern of Rrs in inspiration is observed to reoccur following a deep breath or swallowing. The procedure may thus help diagnosing the site of exercise-induced obstruction when laryngoscopy is not available and identify re-inducers of laryngeal dysfunction

More Relaxation by Deep Breath on Methacholine- Than on Exercise-Induced bronchoconstriction during the Routine Testing of Asthmatic Children

Deep inspiration (DI) dilates normal airway precontracted with methacholine. The fact that this effect is diminished or absent in asthma could be explained by the presence of bronchial inflammation. The hypothesis was tested that DI induces more relaxation in methacholine induced bronchoconstriction—solely determined by the smooth muscle contraction—than in exercise induced bronchoconstriction, which is contributed to by both smooth muscle contraction and airway wall inflammation. The respiratory conductance (Grs) response to DI was monitored in asthmatic children presenting a moderately positive airway response to challenge by methacholine (n = 36) or exercise (n = 37), and expressed as the post- to pre-DI Grs ratio (GrsDI). Both groups showed similar change in FEV1 after challenge and performed a DI of similar amplitude. GrsDI however was significantly larger in methacholine than in exercise induced bronchoconstriction (p < 0.02). The bronchodilatory effect of DI is thus less during exercise- than methacholine-induced bronchoconstriction. The observation is consistent with airway wall inflammation—that characterizes exercise induced bronchoconstriction—rendering the airways less responsive to DI. More generally, it is surmised that less relief of bronchoconstriction by DI is to be expected during indirect than direct airway challenge. The current suggestion that airway smooth muscle constriction and airway wall inflammation may result in opposing effects on the bronchomotor action of DI opens important perspective to the routine testing of asthmatic children. New crossover research protocols comparing the mechanical consequences of the DI maneuver are warranted during direct and indirect bronchial challenges

Obstructive Sleep disorder breathing in children : from the physiopatogeny to the therapeutic management

L’incidence du syndrome d’apnée obstructif du sommeil SAOS de l’enfant est importante. Trois catégories de SAOS sont à distinguer : I) Enfant avec hypertrophie adénoamygdalienne II) enfant et adolescent en surpoids III) enfant avec pathologie génétique ou neuromusculaire. Malgré des progrès ces dernières années sur le plan physiopathogénique, diagnostique et thérapeutique, le diagnostic et la mise en route des thérapeutiques sont encore trop tardifs, ce qui impacte la morbidité. Les objectifs du travail de thèse étaient : 1) de s’appuyer sur des études cliniques avec analyse complète du sommeil en polysomnographie afin de mieux comprendre les mécanismes physiopathogéniques et optimiser les stratégies diagnostiques et thérapeutiques du SAOS de l’enfant 2) de participer à l’harmonisation de la prise en charge multidisciplinaire du SAOS de l’enfant et de l’adolescent. Nous avons évalué l’impact du décubitus ventral sur le sommeil et la respiration chez les nourrissons avec séquence de Pierre Robin SPR (type III). Le décubitus ventral permet d’améliorer largement la qualité du sommeil mais corrige insuffisamment les évènements obstructifs. Ensuite, nous avons comparé la mesure des évènements obstructifs entre polygraphie PV et polysomnographie PSG en unité du sommeil chez les nourrissons avec SPR. La PV en unité du sommeil constitue une alternative de qualité à la PSG. Chez l’enfant avec suspicion de SAOS, nous avons évalué la faisabilité de la PSG ambulatoire qui s’avère faisable et interprétable. Actuellement, nous menons une étude multicentrique sur l’implication de la dysfonction du tronc cérébral dans la physiopathogénie de la SPR dont les résultats devraient permettent d’améliorer la prise en charge de ces patients. En parallèle des études cliniques, nous avons participé à la proposition de recommandations de prise en charge du SAOS chez l’adolescent. Nous avons publié une synthèse des recommandations de prise en charge du SAOS chez l’enfant et l’adolescentThe incidence of Obstructive Sleep Apnea Syndrome OSAS in child is significant. Three categories of OSAS have to be distinguished : 1) child with adeno-tonsillary hypertrophy 2) obese child and obese adolescent 3) child with genetic or neuromuscular pathology. Despite progress in recent years in terms of pathophysiology, diagnosis and initiation of therapy are still too late, which has an impact on morbidity. The aims of the work were: 1) to conduct clinical studies with complete sleep analysis in polysomnography PSG in order to better understand the physiopatogenic mechanisms and optimize the diagnostic and therapeutic strategies of OSAS in child 2) to participate in harmonization of OSAS multidisciplinary management in child and adolescents. We assessed the impact of prone sleep position and breathing in infants with Pierre Robin Sequence PRS (type III). Prone sleep position can greatly improve the quality of sleep but lead to an incomplete correction of OSAS. Next, we compared the measurement of obstructive events between polygraphy PV and PSG in sleep units in infants with PRS. PV in sleep unit is an interesting alternative to PSG for OSAS evaluation in PRS infants. In child with suspicion of OSAS, we assessed the feasibility of ambulatory PSG which has been shown to be feasible and interpretable. Currently, we are conducting a multicenter study on the involvement of brainstem dysfunction in the pathophysiology of PRS, which should improve the management of these patients. In parallel, we participated in the proposal of recommendations for the management of OSAS in adolescents. We published a summary of recommendations for the management of OSAS in child and adolescent

Troubles respiratoires obstructifs du sommeil de l'enfant : de la physiopathogénie à la thérapeutique

The incidence of Obstructive Sleep Apnea Syndrome OSAS in child is significant. Three categories of OSAS have to be distinguished : 1) child with adeno-tonsillary hypertrophy 2) obese child and obese adolescent 3) child with genetic or neuromuscular pathology. Despite progress in recent years in terms of pathophysiology, diagnosis and initiation of therapy are still too late, which has an impact on morbidity. The aims of the work were: 1) to conduct clinical studies with complete sleep analysis in polysomnography PSG in order to better understand the physiopatogenic mechanisms and optimize the diagnostic and therapeutic strategies of OSAS in child 2) to participate in harmonization of OSAS multidisciplinary management in child and adolescents. We assessed the impact of prone sleep position and breathing in infants with Pierre Robin Sequence PRS (type III). Prone sleep position can greatly improve the quality of sleep but lead to an incomplete correction of OSAS. Next, we compared the measurement of obstructive events between polygraphy PV and PSG in sleep units in infants with PRS. PV in sleep unit is an interesting alternative to PSG for OSAS evaluation in PRS infants. In child with suspicion of OSAS, we assessed the feasibility of ambulatory PSG which has been shown to be feasible and interpretable. Currently, we are conducting a multicenter study on the involvement of brainstem dysfunction in the pathophysiology of PRS, which should improve the management of these patients. In parallel, we participated in the proposal of recommendations for the management of OSAS in adolescents. We published a summary of recommendations for the management of OSAS in child and adolescentsL’incidence du syndrome d’apnée obstructif du sommeil SAOS de l’enfant est importante. Trois catégories de SAOS sont à distinguer : I) Enfant avec hypertrophie adénoamygdalienne II) enfant et adolescent en surpoids III) enfant avec pathologie génétique ou neuromusculaire. Malgré des progrès ces dernières années sur le plan physiopathogénique, diagnostique et thérapeutique, le diagnostic et la mise en route des thérapeutiques sont encore trop tardifs, ce qui impacte la morbidité. Les objectifs du travail de thèse étaient : 1) de s’appuyer sur des études cliniques avec analyse complète du sommeil en polysomnographie afin de mieux comprendre les mécanismes physiopathogéniques et optimiser les stratégies diagnostiques et thérapeutiques du SAOS de l’enfant 2) de participer à l’harmonisation de la prise en charge multidisciplinaire du SAOS de l’enfant et de l’adolescent. Nous avons évalué l’impact du décubitus ventral sur le sommeil et la respiration chez les nourrissons avec séquence de Pierre Robin SPR (type III). Le décubitus ventral permet d’améliorer largement la qualité du sommeil mais corrige insuffisamment les évènements obstructifs. Ensuite, nous avons comparé la mesure des évènements obstructifs entre polygraphie PV et polysomnographie PSG en unité du sommeil chez les nourrissons avec SPR. La PV en unité du sommeil constitue une alternative de qualité à la PSG. Chez l’enfant avec suspicion de SAOS, nous avons évalué la faisabilité de la PSG ambulatoire qui s’avère faisable et interprétable. Actuellement, nous menons une étude multicentrique sur l’implication de la dysfonction du tronc cérébral dans la physiopathogénie de la SPR dont les résultats devraient permettent d’améliorer la prise en charge de ces patients. En parallèle des études cliniques, nous avons participé à la proposition de recommandations de prise en charge du SAOS chez l’adolescent. Nous avons publié une synthèse des recommandations de prise en charge du SAOS chez l’enfant et l’adolescen

Troubles respiratoires obstructifs du sommeil chez l’enfant et l’adolescent : diagnostic, conséquences et comorbidités

Introduction : Chez l’enfant, le syndrome d’apnées obstructives du sommeil (SAOS) constitue un trouble du sommeil fréquent dont la prévalence est d’environ 3 % entre trois et huit ans. Matériels et méthodes : Son origine est multifactorielle (hypertrophie de tissus mous pharyngés, étroitesse des voies aérifères osseuses, atteinte du tonus neuromusculaire). Les symptômes et les signes cliniques diurnes et nocturnes à rechercher sont directement en rapport avec l’obstruction des voies aérifères supérieures (VAS) ou avec la mauvaise qualité de sommeil. Après une évaluation anamnestique et clinique complètes, incluant une nasofibroscopie, le spécialiste ORL s’orientera vers une adéno-amygdalectomie ou vers un enregistrement nocturne par polysomnographie ou polygraphie pour confirmer le diagnostic chez l’enfant. Chez l’adolescent, la prévalence du SAOS serait entre 0,5 et 6 %. Les facteurs de risque principaux sont l’obésité, le sexe masculin et les antécédents d’amygdalo-adénoïdectomie. Outre les symptômes classiques du SAOS de l’enfant, ce syndrome peut, chez l’adolescent, se manifester par une sémiologie trompeuse à type de dyssomnie, somnolence diurne excessive et/ou troubles de l’humeur. Les diagnostics différentiels à type de conduites à risque, retard de phase ou narcolepsie doivent être systématiquement évoqués. L’enregistrement de la respiration pendant le sommeil s’impose. Même si l’index d’apnées/hypopnées obstructives est faible, il doit être considéré. Conclusion : Chez l’enfant comme chez l’adolescent, la prise en charge multidisciplinaire (ORL, orthodontiste, kinésithérapeute maxillo-facial, pneumologue) doit être précoce afin d’éviter les complications neurocognitives, comportementales, cardiovasculaires et métaboliques. Une chirurgie maxillo-faciale pourra être discutée à partir de l’âge de 15 ans. Il ne faudra pas oublier de veiller aux règles d’hygiène de vie et de sommeil ainsi qu’à la prise en charge de l’obésité

An impulse oscillometry system is less efficient than spirometry in tracking lung function improvements after intravenous antibiotic therapy in pediatric patients with cystic fibrosis

International audienceA literature search identified one retrospective study on the responsiveness of impulse oscillometry (IOS) in pediatric patients with cystic fibrosis. The aim of this prospective observational study was to assess this property in an adequately powered study after intravenous antibiotic therapy (IVAT) administered for an acute episode of pulmonary exacerbation. Spirometry and IOS were done on the same day as the start and the end of IVAT. Data from 34 patients’ of mean age 11.9 years (range, 5–17 years) were studied. The mean FEV1 at the start and at the end of the IVAT was 73.1 ± 23.8% (range, 23.4–122%) and 88.3 ± 21.3% (range, 29.4–131%), respectively. The mean relative change (mean ± SD) was 20.2 ± 14.2% for FEV1 (ΔFEV1), −21.9 ± 23.8% for reactance at 5 Hz (ΔX5) and –13.4 ± 18.9% for resistance at 5 Hz (Δ R5) (all P-values <0.05). There was a weak but significant correlation between ΔFEV1 and ΔX5 (r =–0.473; p = 0.01). The magnitude of improvement of ΔX5 was not statistically different between patients with normal versus abnormal lung function at the start of IVAT. Furthermore, using ΔX5 alone as an outcome measure of IVAT efficiency resulted in a significant improvement in 44% of the patients, while it was 79% with ΔFEV1. These results indicate that IOS may track changes after IVAT, but that this improvement may be insufficiently evaluated using IOS alone

Hypoventilation in patients with Prader‐Willi syndrome across the pediatric age

International audienceAbstract Objectives Few data on alveolar hypoventilation in Prader‐Willi syndrome (PWS) are available and the respiratory follow‐up of these patients is not standardized. The objectives of this study were to evaluate the prevalence of alveolar hypoventilation in children with PWS and identify potential risk factors. Study Design This retrospective study included children with PWS recorded by polysomnography (PSG) with transcutaneous carbon dioxide pressure (PtcCO2) or end‐tidal CO2 (ETCO2) measurements, between 2007 and 2021, in a tertiary hospital center. The primary outcome was the presence of alveolar hypoventilation defined as partial pressure of carbon dioxide (pCO2) ≥ 50 mmHg during ≥2% of total sleep time (TST) or more than five consecutive minutes. Results Among the 57 included children (38 boys, median age 4.8 years, range 0.1–15.6, 60% treated with growth hormone [GH], 37% obese), 19 (33%) had moderate‐to‐severe obstructive sleep apnea syndrome (defined as obstructive apnea‐hypopnea index ≥5/h) and 20 (35%) had hypoventilation. The median (range) pCO2 max was 49 mmHg (38–69). Among the children with hypoventilation, 25% were asymptomatic. Median age and GH treatment were significantly higher in children with hypoventilation compared to those without. There was no significant difference in terms of sex, BMI, obstructive or central apnea‐hypopnea index between both groups. Conclusion The frequency of alveolar hypoventilation in children and adolescents with PWS is of concern and may increase with age and GH treatment. A regular screening by oximetry‐capnography appears to be indicated whatever the sex, BMI, and rate of obstructive or central apneas

Parents' views on artificial intelligence for the daily management of childhood asthma: a survey

International audienc

Specific airway resistance in children: Panting or tidal breathing?

International audienceBACKGROUND:The measurement of specific airway resistance during tidal breathing (sRaw(tb)) has gained popularity in children, but methodological concerns have been raised regarding the electronic compensation for the thermal artifact. The panting method (sRaw(p)) is efficient in minimizing the latter, but may be associated with a change in end expiratory lung volume if the effort is not properly balanced. The aim of the study was to compare sRaw(tb) with sRaw(p) in children.METHODS:Fifty-five children aged 6.5-11.5 years were studied. sRaw(tb) was measured in a commercial plethysmograph. sRaw(p) was measured with a home made equipment that allowed breath by breath analysis (sRaw(p1)) as well as with the commercial body box (sRaw(p2)).RESULTS:sRaw(tb) was significantly larger than either sRaw(p1) or sRaw(p2) (P < 0.0001). The mean (95% CI) difference sRaw(p1)  - sRaw(tb) was -0.374 (-0.835 to 0.088) kPa s. The difference between sRaw(p1) and sRaw(p2) was significant (P < 0.005) but not clinically relevant, and mean (95% CI) difference sRaw(p1) - sRaw(p2) was 0.115 (-0.094 to 0.324) kPa s. The breath by breath analysis showed small but significant increase in sRaw(p1) throughout the maneuver (P < 0.001), whatever the pattern of end expiratory level.CONCLUSION:Tidal breathing is associated with an overestimation of sRaw compared with panting in children. Although the latter results in small increase throughout the panting maneuver, sRaw(p) is probably more trustful than sRaw(tb)