12 research outputs found
Annual lung function changes in young patients with chronic lung disease
Reference equations for ventilatory function that use different
statistical models may introduce artifacts that affect the estimated
change of lung function during growth in young subjects. The effect of
differently modelled reference equations on the estimated annual change of
forced expiratory volume in one second (FEV1) and forced vital capacity
(FVC) in young patients with chronic lung disease was assessed. Four
frequently used reference equations were used to describe the longitudinal
changes of FEV1 and FVC in 52 patients (23 females) with cystic fibrosis
(CF) during a mean follow-up of 3.9 yrs. Choice of reference equations
directly affected value and, most importantly, estimated annual change of
FVC and FEV1. Mean+/-SD annual change of FEV1 varied from 2.2+/-6.2 to
-2.2+/-3.6% of predicted. For two reference equations the estimated
individual changes of FEV1 and FVC in CF were positively correlated wit
Bronchiectasis in children after renal or liver transplantation: A report of five cases
More effective immunosuppressive treatment in children following organ transplantation has significantly improved the survival of the grafts. Therefore, quality of life, long-term prognosis and adverse drug reactions have become more important. One of the main complications of immunosuppressive drugs is infections of the respiratory tract, but irreversible damage to the airways has not been described after renal or liver transplantation. Five children following transplantation of kidney or liver were referred to the Paediatric Pulmonology department because of chronic respiratory complaints. Pulmonary function tests and HRCT scan were performed as routine patient care. Four children with a renal transplant and one with a liver transplant showed chronic bronchitis and moderate to severe airways obstruction. HRCT showed bronchiectasis in all of them. We speculate that the immunosuppressive treatment (in) directly contributes to irreversible airway damage. We recommend including follow-up of lung function in the post-transplantation protocol and considering bronchiectasis in case of respiratory symptoms, to try preventing further damage to the lung
DNase treatment for atelectasis in infants with severe respiratory syncytial virus bronchiolitis
Respiratory insufficiency due to respiratory syncytial virus (RSV)
bronchiolitis is partly due to the abundance of thickened mucus and the
inability to clear it from the airways. Mucus in RSV bronchiolitis
contains necrotic inflammatory and epithelial cells. The viscoelastic
properties of purulent airway secretions are largely due to the presence
of highly polymerized deoxyribonucleic acid (DNA). Recombinant human
deoxyribonuclease (rhDNase) is known to liquefy such mucus in patients
with cystic fibrosis, whereas case reports described a beneficial effect
in other respiratory disorders. The authors hypothesized that rhDNase
would diminish atelectasis and mucus plugging in infants with severe RSV
bronchiolitis. Two infants with RSV bronchiolitis with massive unilateral
atelectasis in whom mechanical ventilation was imminent due to exhaustion,
and three mechanically ventilated infants (two neonates, one with
bronchopulmonary dysplasia) with RSV bronchiolitis with pneumonia received
treatment with 2.5 mg nebulized rhDNase twice daily. Following
administration of nebulized recombinant human deoxyribonuclease, clinical
and radiological parameters improved quickly. Mechanical ventilation could
be avoided in two infants while in three infants on artificial
ventilation, clinical recovery started following the first dose of the
drug. A therapeutic trial of recombinant human deoxyribonuclease may be an
option in the treatment for atelectasis in severe or
Interrupter resistance in preschool children: measurement characteristics and reference values
There is a need for quick, reliable, and noninvasive lung function tests
to assess airway obstruction in preschool chil
Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey
Most pediatric asthma guidelines offer evidence-based or best practice approaches to the management of asthma exacerbations but struggle with evidence-based approaches for severe acute asthma (SAA). We aimed to investigate current practices in children with SAA admitted to European pediatric intensive care units (PICUs), in particular, adjunct therapies, use of an asthma severity score, and availability of a SAA guideline. We designed a cross-sectional electronic survey across European PICUs. Thirty-seven PICUs from 11 European countries responded. In 8 PICUs (22%), a guideline for SAA management was unavailable. Inhaled beta-agonists and anticholinergics, combined with systemic steroids and IV MgSO4 was central in SAA treatment. Seven PICUs (30%) used a loading dose of a short-acting beta-agonist. Eighteen PICUs (49%) used an asthma severity score, with 8 different scores applied. Seventeen PICUs (46%) observed an increasing trend in SAA admissions. Conclusion: Variations in the treatment of children with SAA mainly existed in the use of adjunct therapies and asthma severity scores. Importantl
Measurements of interrupter resistance: reference values for children 3-13 yrs of age
The interrupter technique is a convenient and sensitive technique for
studying airway function in subjects who cannot actively participate in
(forced) ventilatory function tests. Reference values for preschool
children exist but are lacking for children >7 yrs. Reference values were
obtained for expiratory interrupter resistance (R(int,e)) in 208 healthy
Dutch Caucasian children 3-13 yrs of age. A curvilinear relationship
between R(int,e) and height was observed, similar to published airways
resistance data measured by plethysmography. No significant differences in
cross-sectional trend or level of R(int,e) were observed according to sex.
It was found that Z-scores could be used to express individual R(int,e)
values and to describe intra- and interindividual differences based on the
reference equation: 10logR(int,e)=0.645-0.00668x standing height (cm) kPa
x L(-1) x s(-1) and residual SD (0.093 kPa x L(-1) x s(-1)). Expiratory
interrupter resistance provides a tool for clinical and epidemiological
assessment of airway function in a large age range
Estimation of lung growth using computed tomography
Anatomical studies suggest that normal lungs grow by rapid alveolar
addition until about 2 yrs of age followed by a gradual increase in
alveolar dimensions. The aim of this study was to examine the hypothesis
that normal lung growth can be monitored by computed tomography (CT).
Therefore, the gas volume per gram of lung tissue was estimated from
measurements of lung density obtained from CT scans performed on children
throughout the growth period. CT scans were performed on 17 males and 18
females, ranging in age from 15 days-17.6 yrs. CT-measured lung weight was
correlated with predicted post mortem values and CT measured gas volume
with predicted values of functional residual capacity. The median value
for lung expansion was 1.86 mL x g(-1) at 15 days, decreased to 0.79 mL x
g(-1) by 2 yrs and then increased steadily to 5.07 mL x g(-1) at 17 yrs.
Computed tomography scans can be used to estimate lung weight, gas volume
and expansion of normal lungs during the growth period. The increase in
the lung expansion after the age of 2 yrs suggests progressive alveolar
expansion with increasing lung volume
Inhaled corticosteroids and growth of airway function in asthmatic children
Airway inflammation and remodelling play an important role in the
pathophysiology of asthma. Remodelling may affect childhood lung function,
and this process may be reversed by anti-inflammatory treatment. The
current study assessed longitudinally whether asthma affects growth of
airway function relative to airspaces, and if so whether this is redressed
by inhaled corticosteroids (ICS). Every 4 months for up to 3 yrs, lung
function was assessed in 54 asthmatic children (initial age 7-16 yrs), who
inhaled 0.2 mg salbutamol t.i.d. and 0.2 mg budesonide t.i.d.
(beta2-agonist (BA)+ICS), or placebo (PL) t.i.d. (BA+PL) in a randomised,
double-blind design. Measurements were carried out before and after
maximal bronchodilation. Airway growth was assessed from the change of
forced expiratory volume in one second and of maximal expiratory flows (at
60% and 40% of total lung capacity (TLC) remaining in the lung) relative
to TLC, as measures of more central, intermediate and more peripheral
airways. Growth patterns were compared with the longitudinal findings in
376 healthy children. Airway patency after maximal bronchodilation in
patients on BA+PL remained reduced compared to healthy subjects, whereas
in patients on BA+ICS a marked improvement was observed to subnormal. No
differences between patients and controls could be demonstrated for growth
patterns of central and intermediate airway function. Compliance with
BA+ICS was 75% of the prescribed dose, resulting in significant, sustained
improvement of symptoms and postbronchodilator calibre of central and
intermediate airways to subnormal within 2 months, but postbronchodilator
small airway patency remained reduced, though improved compared to
patients on BA+PL. Anti-inflammatory treatment of asthmatic children is
associated with normal functional development of central and intermediate
airways. The persistently reduced postbronchodilator patency of peripheral
airways may reflect remodelling, or insufficient anti-inflammatory
treatment
Uniform Registration Agreements on Cholesteatoma Care: A Nationwide Consensus Procedure
Background: To coordinate and align the content for
registration of cholesteatoma care.
Methods: Systematic Delphi consensus procedure, consisting
three rounds: two written sessions followed by a face-to-face
meeting. Before this procedure, input on important patient
outcomes was obtained. Consensus was defined as at least
80% agreement by participants. Hundred-thirty-six adult
patients who had undergone cholesteatoma surgery and
all ENT surgeons of the Dutch ENT Society were invited. The
consensus rounds were att
Children with severe acute asthma admitted to Dutch PICUs: A changing landscape
The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased. Objectives: We investigated whether this trend in SAA PICU admissions is present in the Netherlands. Methods: A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality. Results: In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P<0.001) and fewer children needed invasive ventilation (P<0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P=0.005). The proportion of steroid-naïve patients increased from 35% to 54% (P=0.004), with a significant increase in both age groups (2-4 years [P=0.026] and 5-17 years [P=0.036]). Conclusions: The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals