Editorial - Addressing research priorities in community-acquired pneumonia in children: A case of a missed opportunity

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The immunology of bronchiectasis - complex machinery unravelled

Bronchiectasis is a complex process of irreversible dilatation of the bronchi and bronchioles with associated structural damage to surrounding lung tissue. It has many causes including cystic fibrosis, primary ciliary dyskinesia, primary and secondary immune deficiency. The pathophysiological insult is dependent on the underlying cause but involves both the innate and adaptive immune systems. Interaction of these systems and a thorough understanding of the processes involved may uncover new diagnostic and therapeutic strategies.http://www.allergysa.org/journal.htmam2013ay201

The role of macrolides in childhood non-cystic fibrosis-related bronchiectasis

Non-cystic fibrosis-related bronchiectasis is a chronic inflammatory lung disease, which is regarded as an “orphan” lung disease, with little research devoted to the study of this condition. Bronchiectasis results in impaired quality of life and mortality if left untreated. The tools available in the armamentarium for the management of bronchiectasis entail antibiotic therapy traditionally used to treat exacerbations, stratagems to improve mucociliary clearance, and avoidance of toxins. Macrolides have been known for the last two decades to have not only anti-bacterial effects but immunomodulatory properties as well. In cystic fibrosis, the use of macrolides is well documented in subjects colonized with Pseudomonas aeruginosa, to improve quality of life and lung function. There is currently emerging evidence to suggest the benefit of macrolides in subjects not colonized with Pseudomonas aeruginosa. This beneficial effect has been less explored in the context of bronchiectasis from other causes. The purpose of this paper is to review the current literature on the use of macrolides in non-cystic fibrosis related bronchiectasis in paediatrics.http://www.hindawi.com/journals/mi

Determinants of lung health across the life course in sub-Saharan Africa

Lung health across the life course is influenced by factors affecting airway and alveolar development and growth during antenatal and perinatal periods, throughout childhood and adolescence, and into adulthood. Lung function trajectories are set in early life and childhood deficits may predispose to non-communicable respiratory diseases, such as asthma and chronic obstructive pulmonary disease, in later years. Potential risk factors are common in many sub-Saharan African (sSA) countries; adverse antenatal environments cause in utero growth restriction and prematurity; HIV and respiratory infections, including TB are common; exposure to air pollution is widespread, including household air pollution from biomass fuel use, traffic-related pollution in rapidly expanding cities, and tobacco smoke exposure. Multiple disadvantages experienced in early life require an integrated approach that addresses reproductive, maternal and child health. Public health strategies need to tackle multiple risk factors, emphasising Universal Health Coverage, to maximise lung health in the world’s poorest, most vulnerable populations. This review explores potential determinants of lung health across the life course. Due to the extensive topic and wide range of related literature, we prioritised more recent citations, especially those from sSA, focusing on risk factors for which there is most information, and which are most prevalent in the region

Dealing with spirometry in children under six years of age : challenges and opportunities in asthmatics

Pulmonary function tests are essential in the diagnosis of asthma but these are seldom performed in preschool children. Although pulmonary function tests are critical to the diagnosis and follow up of asthmatics, there are challenges faced when dealing with the child under the age of six years and this leads to the under-utilisation of these tests. There is now a better understanding of the respiratory physiology in children and newer spirometry equipment is available with updated reference values for the paediatric age group. In this article the current literature, with regards to spirometry in the pre-schooler, is reviewed and its value in the young asthmatic child is stated.http://www.allergysa.org/journal.htmam201

A guide to performing skin-prick testing in practice : tips and tricks of the trade

Atopy can manifest in childhood as infantile eczema (atopic dermatitis), allergic rhinitis and asthma. In practice, it is critical to identify the offending allergen in atopic individuals. This will not only influence therapeutic interventions, but may also have a significant impact on the individual’s quality of life. The most common clinical test for allergy detection is the introduction of an allergen directly into the skin in the form of a skin-prick test. Skin-prick testing is recommended in the diagnostic workup for allergies because it is reliable, safe, convenient, inexpensive, minimally invasive, and has the advantage of multiple allergen testing in one, 15- to 20-minute, test. Skin-prick testing can be performed from birth onwards. Although there is a small risk of developing anaphylaxis, the test remains safe to perform in a consultation room or at the patient’s bedside. Worldwide, a skin-prick test remains the test of choice for allergy because of its convenience and cost-effectiveness. A globally accepted guideline for skin-prick testing is still lacking and would be beneficial to both patient and physician.http://www.safpj.co.zaam201

Lung function decline is accelerated in South Africans with cystic fibrosis

BACKGROUND : Poor nutritional status has been shown to be associated with a significant decline in lung function in patients with cystic fibrosis. There are few data published on the lung function decline and the effects of nutritional status in cystic fibrosis (CF) in South Africa. AIM : To assess anthropometric parameters (weight, height, body mass index Z-score) in relation to lung function parameters in CF patients. METHODOLOGY : A retrospective chart review of clinical records of participants over the age of five years attending the CF clinic at Steve Biko Academic Hospital from 2005 to 2010. RESULTS : Twenty files were reviewed for lung function, anthropometric measurements, gender and CF-causing mutations. For anthropometric measurements the average changes were –0.8, –0.5 and 2.0 for weight, BMI and height Z-scores, respectively. A decline in FEV1 of –25.3 (95% CI 39.4; –13.3) over the five-year period was noted, with an average decline of 5.3% per year. For FEF25-75, the average change was –22.4 (95% CI-34.6; –10.2) with a decline of 4.5% per year. Using multivariate analysis, the FEV1 was found to be significantly influenced by: age –3.96 (95% CI –7.4; –0.5); p = 0.03, weight 1.8 (95% CI –3.4; –0.9); p = 0.04, BMI Z-score 4.3 (95% CI 5.3; 23.3); p = 0.02 and gender (p = 0.02). The FEF25-75 was significantly influenced by BMI Z-score and gender. CONCLUSION : The average lung function decline per year for FEV1 was higher than that seen in developed countries. The decline in FEV1 was related to gender, age, weight and BMI. The decline in FEF25-75 was affected only by BMI Z-score and gender.http://www.safpj.co.za/index.php/safpjhttp://medpharm.tandfonline.com/loi/ojfp20#.VgJFAVQaJHgam2016Paediatrics and Child Healt

Asthma care in sub-Saharan Africa: Mind the gap!

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The birth and life of the Pan African Thoracic Society Methods in Epidemiologic, Clinical and Operations Research (PATS MECOR) program: celebrating 15 years

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