Spiroergometrijsko testiranje djece s gastroezofagusnom refluksnom bolesti

OBJECTIVE: To determine the prevalence of exercise - induced bronchoconstriction (EIB) and symptoms-induced cessation of cardiopulmonary exercise testing (CPET) among children with gastroesophageal reflux disease (GERD), GERD + asthma and asthma. METHODS: This was a retrospective study involving 98 children previously divided into a three groups: GERD (N=32), GERD+asthma (N=32), asthma (N=34). Following parameters were analysed: parameters of vital functions, anthropological measurements, clinical examination, basic laboratory parameters, lung function testing (spirometry, diffusing capacity), 24-hour esophageal pH-metry, CPET according to the modified Bruce protocol. RESULTS: Among children with GERD + asthma there was not statistically frequent prevalence of EIB in relation to the other two groups. There was also no statistically significant difference in the incidence of symptom-induced cessation of CPET among the examined groups. The most common symptom-induced cessation of CPET was a dyspnea, followed by coughing, wheezing, nausea / vomiting and dizziness. A statistically significant difference was observed only for stridor that was most frequent in the GERD group. Multivariate analysis revealed a statistically significant correlation between symptoms of coughing and the number of reflux episodes, degree of load and PEF; dyspnea with MEF75, BMI percentile, VCO2max and pretest blood pressure; stridor with MET, and breathing reserve. CPET parameters showed statistically significant differences in the achieved load, which was the lowest in the asthma group in relation to asthma+GERD and for maximum oxygen uptake and oxygen pulse, which were significantly lower in the asthma group compared to the other two groups. CONCLUSION: There was no difference in the prevalence of EIB in asthma+GERD group compared to group with GERD without asthma. Also there is no difference in the incidence of symptom-induced cessation of CPET among the studied groups. Exercise intolerance in patients with GERD has no specific pattern of CPET parameters. There was correlation between the symptom-induced cessation of CPET and specific CPET parameters. Further prospective study in patients with GERD who do not handle physical effort is of particular interest because of the size of the problem in the pediatric population

Pulmonary function tests in preschool children

Mjerenje plućne funkcije kod predškolske djece predstavlja jedno od najdinamičnijih i najizazovnijih područja istraživanja fiziologije dišnog sustava te integralnu komponentu kliničkog praćenja i liječenja. Cilj ovoga preglednog članka jest pružiti uvid o metodi i primjeni najčešćih testova plućne funkcije u djece predškolske dobi koji su nam dostupni (spirometrija, impulsna oscilometrija, tjelesna pletizmografija), kao i potencijalne probleme ispitivanja plućne funkcije u toj dobi. Spirometrija je najčešće primjenjivani test plućne funkcije koji se izvodi u pedijatrijskoj populaciji na standardiziran način kao i kod odraslih. U predškolskoj dobi primjena spirometrije ima nekoliko izazova poput dobi ispitanika, osiguravanja maksimalnog napora kod izvođenja, duljine izdisaja tijekom spirometrijskog manevra, pouzdanosti dobivenih parametra. Mjerenje specifičnog otpora dišnih putova putem tjelesne pletizmografije kao i impulsna oscilometrija također daju uvid u plućnu funkciju, a glavna im je prednost što se izvode tijekom mirnog disanja te zahtijevaju samo minimalnu suradnju. Kod odabira metode procjene plućne funkcije važno je odrediti moguću kliničku dijagnozu, a ne da se izbor pretrage temelji na dostupnoj opremi. Važno je i primijeniti odgovarajuće dostupne referentne intervale za pojedine pretrage. Potrebna su dodatna istraživanja koja će odrediti ulogu pojedinih testova, standardizirati postupak i odrediti prikladne referentne vrijednosti što bi olakšalo praćenje bolesnika, ali i omogućilo uspoređivanje različitih metoda u cilju dobivanja kompletnije kliničke slike.Lung function testing in preschool children represents one of the most dynamic and challenging areas of respiratory physiology research and an integral component of clinical monitoring and treatment. The aim of this review article is to provide insight into the method and application of the most common lung function tests in preschool children currently available (spirometry, impulse oscillometry, body plethysmography), as well as potential problems of lung function testing in that age group. Spirometry is the most commonly used lung function test, performed in the pediatric population by standardized procedure. Use of spirometry in preschool age has several challenges, such as the age of the subject, ensuring the maximum effort during performance, the length of exhalation during the spirometric maneuver, the reliability of the obtained parameters. Measurement of the specific resistance of the airways by body plethysmography as well as impulse oscillometry also provide insight into lung function, and their main advantage is that these tests are performed during tidal breathing and require only minimal cooperation. When choosing a method of lung function assessment, it is important to determine the question of a possible clinical diagnosis and not to base the choice of test on the available equipment. It is also important to apply the appropriate available reference intervals. There is a need for additional studies that will determine the role of individual tests, standardize the procedure and determine reference values, which would facilitate the monitoring of patients, enable the comparison of different methods in order to obtain a more complete clinical picture

EXERCISE-INDUCED ASTHMA IN ATHLETES – A REVIEW

Profesionalni sportaši često su podvrgnuti treninzima izdržljivosti u okolišu u kojem su kronično izloženi inhalacijskim onečišćivačima/iritansima, alergenima ili hladnom zraku. Ti čimbenici dovode do povećanog rizika od razvoja disfunkcije gornjih i donjih dišnih putova. Upravo je u toj specifičnoj populaciji dijagnoza astme krucijalna zbog potencijalnog učinka ne samo na njihovo opće stanje nego i na natjecateljske sposobnosti. Simptomi astme u vrhunskih sportaša nisu nužno povezani s klasičnim obilježjima astme u općoj populaciji. I drugi klinički entiteti mogu stvarati simptome slične onima u astmi i zbog toga mogu voditi netočnoj dijagnozi i neuspješnu liječenju. Zbog toga je za postavljanje konačne dijagnoze potrebna kombinacija simptoma i pozitivnih laboratorijskih testova. Trenutačno ne postoji dokaz da se postupanje s astmom u sportaša treba razlikovati od postupanja s astmom u nesportaša. Međutim, neka specifična pitanja treba uzeti u obzir u vrhunskih sportaša, poput usklađenosti s pravilima Svjetske antidopinške agencije i Međunarodnog olimpijskog odbora.Elite athletes are often subjected to endurance training in the environment in which they are chronically exposed to pollutants/irritants, allergens or cold air. These factors lead to an increased risk of upper and lower respiratory tract dysfunction. The diagnosis of asthma is crucial in elite athletes because of potential implications on athlete’s general well–being as well as their competitive ability. Symptoms of asthma in elite athletes are not necessarily associated with the classic features of asthma seen in general population. Other clinical entities can create symptoms similar to those of asthma and therefore can lead to an incorrect diagnosis and ineffective treatment. The diagnosis requires a combination of symptoms and positive laboratory tests. Currently, there is no evidence that the treatment of asthma in athletes should be different from the treatment of asthma in non-athletes. However, some specific issues need to be considered in the elite athletes, such as compliance with the rules of World Anti-Doping Agency and International Olympic Committee

Pulmonary tuberculosis in pediatric practice

Pandemija COVID-19 uzrokovala je pad kvalitete medicinske skrbi oboljelih od tuberkuloze. Iako se broj prijavljenih novooboljelih slučajeva tijekom pandemije smanjio, povisio se broj umrlih od tuberkuloze uz pretpostavku povećanja broja novooboljelih. Tuberkuloza pluća u djece stoga je ostala izazov u zbrinjavanju pacijenata te važan javnozdravstveni problem. Osnova dijagnoze tuberkuloze u djece predstavlja dobro uzimanje anamnestičkih podataka koji se odnose na karakteristike izvornoga indeksnog pacijenta, karakteristike i vrstu kontakta te karakteristike djeteta, prvenstveno njegove dobi te imunološkog stanja. Karakteristični simptomi bolesti prisutni su u starije djece, dok mlađa djeca mogu biti i asimptomatska. Također, radiološki nalaz postaje specifičan u adolescentnoj dobi, dok u manje djece može pokazivati nekarakteristične promjene. Za dokaz infekcije s Mycobacterium tuberculosis koristi se interferon gamma releasing assay, brza i sigurna pretraga iz krvi kojom se dokazuje imunološka reakcija na Mycobacterium tuberculosis. Mikrobiološka obrada sputuma i želučanih lavata mikroskopski i uzgojem kultura neizostavan je stupanj obrade, no u mlađe djece također je smanjene osjetljivosti. Terapija u djece odnosi se na profilaktičku terapiju tuberkulozne infekcije kojoj je svrha spriječiti razvoj aktivnih oblika bolesti i punu intenzivnu antituberkulotsku terapiju kod aktivne tuberkuloze pluća. Praćenje i obrada djece sa suspektnom ili dokazanom tuberkulozom u domeni je dječjeg pulmologa u suradnji s primarnim pedijatrom i nadležnom epidemiološkom službom, a u svrhu pravodobne dijagnostike bilo latentne ili aktivne tuberkuloze te adekvatnog liječenja i suzbijanja bolesti.COVID-19 pandemic caused a decline in health care quality of patients with tuberculosis. Although the number of reported new tuberculosis cases has fell during the pandemic, the number of dead from the disease has increased as has the number of estimated disease cases. Lung tuberculosis in children has, therefore, remained a medical challenge and serious health care problem. The most important part of the diagnostic process is detailed patient history regarding the characteristics of the source index patient, characteristic and types of contact with the index patient and the age and immunologic characteristics of the child. Typical symptoms are evident in older children, while younger children can be asymptomatic. Also, radiological pulmonary examination is specific in the adolescent age group, while in the younger children it can present uncharacteristic changes. Interferon gamma releasing assay is used to detect Mycobacterium tuberculosis infection. It is a well established quick and sensitive blood test which determines an immunological reaction to the Mycobacterium tuberculosis. Microbiologic examination of the sputum or gastric lavates by microscopy and cultures is paramount in the diagnostic examination, but is also less reliable in younger children. Therapy in children involves prophylactic therapy of the tuberculosis infection which prevents progression of the infection to the active pulmonary tuberculotic disease. Full antituberculotic therapy is used when active tuberculosis has been diagnosed. Diagnostic examination and therapy is supervised by pediatric pulmologist in cooperation with primary health pediatrician and epidemiologist with the aim of early diagnosis of latent or active disease and early implementation of therapy to cure the disease

Changing Pattern of Sensitization in Croatia to Aeroallergens in Adult Population Referring to Allergy Clinic during a Period of 15 Years

Published data indicate that during the last decades there is a possible change in the pattern of sensitization to different aeroallergens in adult population with atopy. The aim of this investigation was based on the hypothesis that during last 15 years there has been a change in the structure of prevalence of sensitization to different aeroallergens in adult population of Zagreb and its surroundings with atopy. Medical records from outpatient allergy clinic were screened for the period 1991.–2004.We included 794 patients during years 1991–1994, 814 patients during years 1995–1999, and 969 patients during years 2000–2004. Following data were analyzed: age, gender, education level, residence, referral diagnosis, dominant symptoms, results of skin-prick test (SPT), total and specific serum immunoglobulin E. As risk factors for allergic sensitization we determined the decade of birth (p<0.0001), male gender (p<0.008), level of education (p<0.0001), and place of residence (p<0.05). Proportion of sensitized individuals to pollen significantly increased from the period 1991–1994 towards 2000–2004 (p<0.001 for the trend) with a significant increase in the proportion of sensitized individuals to weed pollen (p=0.002 for the trend) while the proportion of sensitized to other two groups of pollen (grasses and trees) was not significantly different. A significant increase in the proportion of sensitized individuals was determined for sensitization to ragweed pollen (p=0.004 for the trend), and to mugwort (p=0.005 for the trend). Despite all its limitations primarily based on the selection bias the results of this study are conclusive about the significant change in the proportion of sensitization to different aeroallergens and different pollen groups and individual pollen species during the investigated 15-year time interval

EXERCISE-INDUCED ANAPHYLAXIA – A REVIEW

Anafilaksija potaknuta naporom (EIA, od engl. exercise-induced anaphylaxis) rijedak je poremećaj čije je obilježje razvoj teške alergijske reakcije nakon tjelesne aktivnosti. Bolest se očituje postupnim razvojem sljedećih simptoma: svrbež, crvenilo kože, urtike, angioedem, anafilaktički šok u užem smislu (hipotenzija, sinkopa, gubitak svijesti, gušenje, stridor, mučnina i povraćanje) i završna faza, obilježena prolongiranom urtikarijom i glavoboljom. Čimbenici koji potiču EIA su izloženost višoj koncentraciji peluda, ubodi insekata, ekstremne temperature okoline, povećana vlažnost zraka, uzimanje nesteroidnih protuupalnih lijekova. Od nutritivnih alergena najčešći provokativni čimbenici su proteini pšenice, rakovi i školjke. Prevencija pojave EIA temelji se na izbjegavanju mogućih okidača. Radi lakšeg prepoznavanja EIA bolesnik bi uvijek trebao sa sobom nositi pisani dokument u kojem se navodi mogućnost nastanka EIA. Također je poželjno da vježbanje ili drugi potencijalni tjelesni napor bolesnik izvodi u prisutnosti osoba koje mu mogu pružiti medicinsku pomoć.Exercise-induced anaphylaxis (EIA) is a syndrome in which patients experience the symptoms of anaphylaxis, which occur only after increased physical activity. It is characterised by a gradual development of symptoms: itching, erythema, urticaria, angioedema, anaphylactic shock (hypotension, syncope, loss of consciousness, shortness of breath, wheezing, nausea and vomiting), and at the end of the late phase prolonged urticaria and headache. The triggering factors for EIA are as follows: significant exposure to airborne allergens, insect sting, weather extremes, higher air humidity, taking nonsteroidal anti-inflammatory drugs. The most frequent causative nutritive allergens include wheat, crabs and shells. Prophylactic management for EIA comprises avoding the triggers. Exercise or other physical activity should be performed in proximity of medically trained companion