Inducible Laryngeal Obstruction in the Paediatric Population – Review of the Literature and Current Understanding

nducible laryngeal obstruction (ILO) is a complex entity and its exact mechanisms are still unclear. It is characterised by transiente and reversible narrowing of the larynx in response to external triggers, resulting in symptoms such as cough, dyspnoea and noisy breathing. The prevalence of this condition in adult or paediatric populations is uncertain. Management of ILO starts by establishing an accurate diagnosis, and treatment includes control of trigger factors, breathing and relaxation techniques, and speech and respiratory therapy. The aim of this article is to summarise current understanding and provide a review of the literature of ILO in the paediatric population.info:eu-repo/semantics/publishedVersio

Non-invasive Biomarkers in Asthma: Promises and Pitfalls

The asthma concept has evolved throughout the years: one major step in asthma management is the recognition of the chronic (airway) inflammation; another major step is further understanding of asthma heterogeneity and subsequent development of targeted therapies. While the concept of chronic inflammation, airway structural changes and their variability over time are widely accepted, their measurement and monitoring have gone through many hardships

A Literature Review

Even though respiratory viruses are one of the most common triggers for asthma exacerbations, not all of these viruses affect patients equally. There is no strong evidence supporting that patients with asthma have a higher risk of becoming seriously ill from coronavirus disease 2019 (CO-VID-19), although recent reports from the USA and the UK suggest that asthma is much more common in children and adults with mild to severe COVID-19 than has previously been reported in Asia and in Europe. As in previous severe acute respiratory syndrome (SARS) outbreaks, patients with asthma, especially children, appear to be less susceptible to the coronavirus with a low rate of asthma exacerbations. A different expression of viral receptors and T2 inflammation can be responsible for different outcomes. Future studies focused on asthma and on other allergic disorders are needed to provide a greater understanding of the impact of underlying asthma and allergic inflammation on COVID-19 susceptibility and disease severity. However, for the moment, it is crucial that asthmatic patients maintain their controller medication, from inhaled corticosteroids to biologics, without making any dose adjustments on their own or stopping the medication. New data are emerging daily, rapidly updating our understanding of this novel coronavirus.publishersversionpublishe

What do asthmatic patients think about telemedicine visits?

Introduction. Due to the Coronavirus disease 2019 (COVID-19) outbreak and the national emergency state, virtual visits were implemented as an alternative to in-person visits. With this study we aimed to establish asthma patients' general satisfaction with the quality of health care provided by virtual visits (phone or video calls). Materials and methods. A questionnaire (9 questions) was published on the Facebook page of the Portuguese Association of Asthmatics. It was available online for general self-reported asthmatic patients to answer during one month, starting on 11st May 2020. The survey only allowed one answer per registered user. Results. Fifty-five responses were obtained. Patients were satisfied with communication with providers (> 88%); nevertheless, one-half evaluated the virtual visit as inferior when compared to in-person visits. About one third attributed a classification of 6 or less (0-10 scale, 0 being the worst and 10 the best consultation possible), but still most of the patients would either recommend it or use this kind of medical visits in the future, even outside the actual pandemic context. Patients also referred some important limitations, as lack of physical examination and the fact that the medical visit was more impersonal. Only 27% had technical issues accessing virtual visits. Positive aspects were also named, such as virtual visits being practical and avoiding the need to move to the hospital. Discussion and conclusions. Our survey revealed that small changes could further increase patients' satisfaction, adherence and confidence in telemedicine. Although presenting some limitations, virtual visits seem to be generally well accepted by asthmatic patients and it might be a good alternative for in-person visits, at leastin such difficult times when social distancing is recommended.info:eu-repo/semantics/publishedVersio

Current perspectives

The increasing knowledge of the mechanisms involved in metabolism is shifting the paradigms by which the pathophysiology of many pulmonary diseases is understood. Metabolic dysfunction is recognized in obesity-associated asthma, but other metabolic conditions have been shown to be independently related to asthma. Novel insights have also recently been brought by metabolomics in this filed. The purpose of this review is to discuss current perspectives regarding metabolic dysfunction in asthma, from obesity-related asthma to other metabolic conditions and the role of current pharmacological therapeutic strategies and lifestyle interventions. Obesity is a well-recognized risk factor for asthma across the lifespan, which is generally associated with poorer response to current available treatments, rendering a more severe, refractory disease status. Besides the epidemiological and clinical link, untargeted metabolomics studies have recently supported the obesity-associated asthma phenotype at the molecular level. Not only obesity-related, but also other aspects of metabolic dysregulation can be independently linked to asthma. These include hyperinsulinemia, dyslipidemia and hypertension, which need to be taken into account, even in the non-obese patient. Untargeted metabolomics studies have further highlighted several other metabolic pathways that can be altered in asthma, namely regarding oxidative stress and systemic inflammation, and also suggesting the importance of microbiota in asthma pathogenesis. Considering the reduced response to corticosteroids, other pharmacologic treatments have been shown to be effective regardless of body mass index. Non-pharmacologic treatments (namely weight reduction and dietary changes) may bring substantial benefit to the asthmatic patient. Taken together, this evidence points towards the need to improve our knowledge in this filed and, in particular, to address the influence of environmental factors in metabolic dysfunction and asthma development. Personalized medicine is definitely needed to optimize treatment, including a holistic view of the asthmatic patient in order to set accurate pharmacologic therapy together with dietary, physical exercise and lifestyle interventions.publishersversionpublishe

Lower airway flow influences peak nasal inspiratory flow in school-aged children*

Background: Rhinitis and asthma frequently coexist. Peak nasal inspiratory flow (PNIF) objectively evaluates nasal obstruction. Lower airway flow’s impact on PNIF has seldom been analysed in children. We aimed to study the associations between PNIF and: (1)forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in children with allergic rhinitis and asthma and healthy controls; (2)allergic rhinitis and asthma control subjective evaluation. Methods: Sequential assessments of PNIF before and after nasal decongestion and spirometry with bronchodilation test were performed in 65 children (6-12 years) with allergic rhinitis and asthma, and 24 gender, age-matched healthy controls. The Control of Allergic Rhinitis and Asthma Test in children (CARATkids) was used for control assessment. Associations were investigated by multiple linear regression models. Results: Baseline and decongested PNIF correlated with baseline and post-bronchodilation FEV1 and PEF, observed independently of rhinitis and asthma diagnosis. The best model for PNIF included PEF, age and gender. No association was found between PNIF and CARATkids scores, except for nasal obstruction self-report. Conclusion: In school-aged children, besides age and gender, PEF values should ideally be known to interpret PNIF values. PNIF can be complementary to subjective control assessment in children with allergic rhinitis and asthma.publishersversionpublishe

Development process and cognitive testing of CARATkids - Control of Allergic Rhinitis and Asthma Test for children

Funding Information: The authors would like to thank the children and caregivers and the physicians that participated in the study and the Sociedade Portuguesa de Alerglogia e Imunologia Clínica and Associação Portuguesa de Asmáticos e Alérgicos for the help and support the CARAT project. The consensus meetings had logistic and unrestricted financial support from MSD Portugal.Background: Allergic rhinitis and asthma (ARA) are chronic inflammatory diseases of the airways that often coexist in children. The only tool to assess the ARA control, the Control of Allergic Rhinitis and Asthma Test (CARAT) is to be used by adults. We aimed to develop the Pediatric version of Control of Allergic Rhinitis and Asthma Test (CARATkids) and to test its comprehensibility in children with 4 to 12 years of age.Methods: The questionnaire development included a literature review of pediatric questionnaires on asthma and/or rhinitis control and two consensus meetings of a multidisciplinary group. Cognitive testing was carried out in a cross-sectional qualitative study using cognitive interviews.Results: Four questionnaires to assess asthma and none to assess rhinitis control in children were identified. The multidisciplinary group produced a questionnaire version for children with 17 questions with illustrations and dichotomous (yes/no) response format. The version for caregivers had 4-points and dichotomous scales. Twenty-nine children, 4 to 12 years old, and their caregivers were interviewed. Only children over 6 years old could adequately answer the questionnaire. A few words/expressions were not fully understood by children of 6 to 8 years old. The drawings illustrating the questions were considered helpful by children and caregivers. Caregivers considered the questionnaire complete and clear and preferred dichotomous over the 4-points scales. The proportion of agreement between children and their caregivers was 61%. The words/expressions that were difficult to understand were amended.Conclusion: CARATkids, the first questionnaire to assess a child's asthma and rhinitis control was developed and its content validity was assured. Cognitive testing showed that CARATKids is well-understood by children 6 to 12 years old. The questionnaire's measurement properties can now be assessed in a validation study.publishersversionpublishe

Monitorization of fungal spores in Lisbon, 2014-2016

Objetivo: Avaliar a distribuição dos esporos de fungos potencialmente alergizantes em Lisboa no triénio 2014 -2016, caracterizar a sua prevalência na atmosfera e estudar a influência dos fatores meteorológicos nas suas concentrações. Métodos: Monitorizaram -se os esporos de fungos presentes no ar atmosférico de Lisboa entre 1 de janeiro de 2014 e 31 de dezembro de 2016. A amostragem foi efetuada através um captador Burkard Seven Day Volumetric Spore -trap®. Para identificação e quantificação de esporos de fungos recorreu -se a um sistema de leitura ao microscópio ótico baseado na análise de uma linha longitudinal ao centro da lâmina com uma ampliação de 600x. A influência dos factores meteorológicos sobre as concentrações dos esporos foi realizada pela análise da correlação de Spearman. Resultados: Neste estudo obteve -se uma concentração média diária de 3118 esporos/m3 de ar. A concentração anual total de esporos de fungos de 2014 foi a mais elevada (1 258 580 esporos/m3 de ar). Os tipos de esporos com maior prevalência na atmosfera de Lisboa foram Cladosporium cladosporoides (48,2%), Coprinus (4,5%), Leptosphaeria (2,5%), Agaricus (2,0%), Cladosporium herbarum (1,9%), Ustilago (1,5%) e Alternaria (1,2%). As concentrações mais elevadas registaram -se nos meses de verão e outono. Constatou -se um claro efeito dos parâmetros meteorológicos sobre as concentrações dos esporos de fungos. A temperatura média apresentou uma correlação positiva com a concentração total de esporos Cladosporium, Alternaria e Ustilago e negativa com Coprinus, Agaricus e Leptosphaeria. A humidade relativa e a precipitação, relacionadas com a concentração total de esporos fúngicos, tiveram um efeito positivo significativo sobre os níveis de Coprinus, Agaricus e Leptosphaeria, apresentando uma correlação negativa com os níveis de Cladosporium, Alternaria e Ustilago. Conclusão: Este estudo permitiu conhecer o tipo e a distribuição dos esporos de fungos presentes na atmosfera de Lisboa. Verificou -se uma tendência sazonal semelhante nos três anos estudados. Os níveis de esporos de fungos mais elevados foram registados no verão e no outono. O género Cladosporium representou 50% do total dos esporos coletados. A variação dos parâmetros meteorológicos influencia, claramente, as concentrações dos esporos de fungos. A temperatura média foi o fator que exerceu maior influência nos níveis de esporos.Objectives: To evaluate the distribution of potentially allergenic spores in the city of Lisbon in the triennium 2014- -2016, to charactere its prevalence in the outdoor atmosphere and to study the influence of the meteorological factors on the concentrations. Methodology: Monitoring data from the Lisbon station of the Portuguese Aerobiology Network of fungal spores from 1 January 2014 to 31 December 2016 were analyzed. A Burkard Seven Day Volumetric Spore -trap® collector and optical microscope reading system based on the analysis of a longitudinal line at the center of the slide with a magnification of 600x were used. The influence of the meteorological factors on the concentrations of fungal spores was examined with the Spearman correlation analysis. Results: In this study, a mean daily concentration of 3.118 spore fungal/ m3 spores was obtained. The highest annual concentration observed was in 2014 (1.258.580 spore fungal/m3). The most abundant types of fungi spores were Cladosporium cladosporoides (48,2%), Coprinus (4,5%), Leptosphaeria (2,5%), Agaricus (2,0%), Cladosporium herbarum (1,9%), Ustilago (1,5%) and Alternaria (1,2%). The highest concentrations of fungal spores occurred in the summer and autumn months, being particularly highest in the autumn. A clear effect of meteorological factors on the fungal spores concentrations was observed. The mean temperature presented a positive correlation with total spores, Cladosporium, Alternaria and Ustilago concentrations and a negative correlation with Coprinus, Agaricus and Leptosphaeria levels. Relative humidity and precipitation had a positive effect with Coprinus, Agaricus and Leptosphaeria concentrations but negative with total spores, Cladosporium, Alternaria and Ustilago concentrations. Conclusions: This study allowed to know the type and the distribution of fungal spores present in the atmosphere of Lisbon. There was a similar seasonal trend in the three years studied. The highest levels of fungal spores were recorded in summer and autumn. The genus Cladosporium represented 50% of the total spores collected. The variation of the meteorological parameters clearly influences the concentrations of fungal spores. The mean temperature was the factor that exerted the greatest influence on the spore levels.info:eu-repo/semantics/publishedVersio