European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years.

Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children.A Task Force (TF) supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine PICO (Population, Intervention, Comparator and Outcome) questions. The TF conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full text articles. All TF members approved the final decision for inclusion of research papers. The TF assessed the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.The TF then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The TF formulated recommendations using the GRADE Evidence to Decision framework.Based on the critical appraisal of the evidence and the Evidence to Decision Framework the TF recommends spirometry, bronchodilator reversibility testing and FeNO as first line diagnostic tests in children under investigation for asthma. The TF recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future

An experimental study of the influence of the aerodynamic mixing on flameless combustion regime

Une étude expérimentale de l'influence des mélanges gazeux sur le régime de combustion sans flamme a été menée sur l'installation pilote du CORIA, en collaboration avec GDF SUEZ. La première partie de cette étude a été consacrée à la caractérisation détaillée de ce régime de combustion particulier au méthane pur avec et sans préchauffage de l'air comburant. Des mesures locales de température et concentrations d'espèces stables ont été réalisées à l'aide de thermocouples à fil fin et sonde de prélèvement. Une attention particulière a aussi été portée au développement et l'adaptation de techniques d'imagerie sur ce type de four : l'imagerie de chimiluminescence OH* pour la visualisation des zones de réaction et la PIV endoscopique afin d'obtenir des champs de vitesse de grandes dimensions malgré le fort confinement à haute température. L'analyse des résultats obtenus a permis de mettre en évidence le rôle principal de l'aérodynamique des jets turbulents de réactifs dans le four assurant l'obtention et la stabilisation de ce régime de combustion massivement diluée. Dans la seconde partie de cette étude, la faisabilité de l'utilisation d'hydrogène dans un four pilote fonctionnant en régime de combustion sans flamme a été démontrée. On retrouve toutes les caractéristiques intrinsèques à ce régime de combustion en termes de forte efficacité énergétique (lors du préchauffage de l'air) et très faibles émissions polluantes (CO et NOx) de ce régime massivement dilué, associé à la réduction des émissions de CO2 avec l'augmentation de la teneur en hydrogène dans le combustible. En fonctionnement à l'hydrogène pur et sans préchauffage de l?air, le four n?émet plus aucune espèce carbonée et quasiment pas de NOx ; on se rapproche d'un four à "zéro émission".An experimental study of the influence of the aerodynamic mixing on flameless combustion regime has been carried out on the CORIA lab-scale facility with the collaboration of GDF SUEZ. A detailed characterisation of this innovating combustion mode, using pure methane as fuel, with and without air preheating is the first part of this study. Temperature and stable species concentrations measurements have been performed with fine wire thermocouple and sampling probe. Imaging techniques have been developed and adapted for in-furnace measurements: OH* chemiluminescence imaging for reaction zone visualization and endoscopic PIV in order to obtain large dimensions velocity fields in spite of the confinement. The results enable us to put in evidence the leading role of aerodynamic of the turbulent jets to ensure the stabilisation of this massive diluted combustion regime. The second part of this study concerns the use of hydrogen as fuel in the pilot furnace operating in flameless combustion regime. The main characteristics of this combustion regime have been found again: high efficiency and very low pollutant emissions (CO and NOx) associated to CO2 emissions reduction while increasing content of hydrogen in the fuel. With pure hydrogen and without air preheating, the furnace produces no carbon-species and nearly no NOx, condition close to a “zero-emission” furnace

Etude expérimentale de l'influence des mélanges gazeux sur la combustion sans flamme

An experimental study of the influence of the aerodynamic mixing on flameless combustion regime has been carried out on the CORIA lab-scale facility with the collaboration of GDF SUEZ. A detailed characterisation of this innovating combustion mode, using pure methane as fuel, with and without air preheating is the first part of this study. Temperature and stable species concentrations measurements have been performed with fine wire thermocouple and sampling probe. Imaging techniques have been developed and adapted for in-furnace measurements: OH* chemiluminescence imaging for reaction zone visualization and endoscopic PIV in order to obtain large dimensions velocity fields in spite of the confinement. The results enable us to put in evidence the leading role of aerodynamic of the turbulent jets to ensure the stabilisation of this massive diluted combustion regime. The second part of this study concerns the use of hydrogen as fuel in the pilot furnace operating in flameless combustion regime. The main characteristics of this combustion regime have been found again: high efficiency and very low pollutant emissions (CO and NOx) associated to CO2 emissions reduction while increasing content of hydrogen in the fuel. With pure hydrogen and without air preheating, the furnace produces no carbon-species and nearly no NOx, condition close to a “zero-emission” furnace.Une étude expérimentale de l'influence des mélanges gazeux sur le régime de combustion sans flamme a été menée sur l'installation pilote du CORIA, en collaboration avec GDF SUEZ. La première partie de cette étude a été consacrée à la caractérisation détaillée de ce régime de combustion particulier au méthane pur avec et sans préchauffage de l'air comburant. Des mesures locales de température et concentrations d'espèces stables ont été réalisées à l'aide de thermocouples à fil fin et sonde de prélèvement. Une attention particulière a aussi été portée au développement et l'adaptation de techniques d'imagerie sur ce type de four : l'imagerie de chimiluminescence OH* pour la visualisation des zones de réaction et la PIV endoscopique afin d'obtenir des champs de vitesse de grandes dimensions malgré le fort confinement à haute température. L'analyse des résultats obtenus a permis de mettre en évidence le rôle principal de l'aérodynamique des jets turbulents de réactifs dans le four assurant l'obtention et la stabilisation de ce régime de combustion massivement diluée. Dans la seconde partie de cette étude, la faisabilité de l'utilisation d'hydrogène dans un four pilote fonctionnant en régime de combustion sans flamme a été démontrée. On retrouve toutes les caractéristiques intrinsèques à ce régime de combustion en termes de forte efficacité énergétique (lors du préchauffage de l'air) et très faibles émissions polluantes (CO et NOx) de ce régime massivement dilué, associé à la réduction des émissions de CO2 avec l'augmentation de la teneur en hydrogène dans le combustible. En fonctionnement à l'hydrogène pur et sans préchauffage de l?air, le four n?émet plus aucune espèce carbonée et quasiment pas de NOx ; on se rapproche d'un four à "zéro émission"

Etude expérimentale de l'influence des mélanges gazeux sur la combustion sans flamme

Une étude expérimentale de l'influence des mélanges gazeux sur le régime de combustion sans flamme a été menée sur l'installation pilote du CORIA, en collaboration avec GDF SUEZ. La première partie de cette étude a été consacrée à la caractérisation détaillée de ce régime de combustion particulier au méthane pur avec et sans préchauffage de l'air comburant. Des mesures locales de température et concentrations d'espèces stables ont été réalisées à l'aide de thermocouples à fil fin et sonde de prélèvement. Une attention particulière a aussi été portée au développement et l'adaptation de techniques d'imagerie sur ce type de four : l'imagerie de chimiluminescence OH* pour la visualisation des zones de réaction et la PIV endoscopique afin d'obtenir des champs de vitesse de grandes dimensions malgré le fort confinement à haute température. L'analyse des résultats obtenus a permis de mettre en évidence le rôle principal de l'aérodynamique des jets turbulents de réactifs dans le four assurant l'obtention et la stabilisation de ce régime de combustion massivement diluée. Dans la seconde partie de cette étude, la faisabilité de l'utilisation d'hydrogène dans un four pilote fonctionnant en régime de combustion sans flamme a été démontrée. On retrouve toutes les caractéristiques intrinsèques à ce régime de combustion en termes de forte efficacité énergétique (lors du préchauffage de l'air) et très faibles émissions polluantes (CO et NOx) de ce régime massivement dilué, associé à la réduction des émissions de CO2 avec l'augmentation de la teneur en hydrogène dans le combustible. En fonctionnement à l'hydrogène pur et sans préchauffage de l?air, le four n?émet plus aucune espèce carbonée et quasiment pas de NOx ; on se rapproche d'un four à "zéro émission".An experimental study of the influence of the aerodynamic mixing on flameless combustion regime has been carried out on the CORIA lab-scale facility with the collaboration of GDF SUEZ. A detailed characterisation of this innovating combustion mode, using pure methane as fuel, with and without air preheating is the first part of this study. Temperature and stable species concentrations measurements have been performed with fine wire thermocouple and sampling probe. Imaging techniques have been developed and adapted for in-furnace measurements: OH* chemiluminescence imaging for reaction zone visualization and endoscopic PIV in order to obtain large dimensions velocity fields in spite of the confinement. The results enable us to put in evidence the leading role of aerodynamic of the turbulent jets to ensure the stabilisation of this massive diluted combustion regime. The second part of this study concerns the use of hydrogen as fuel in the pilot furnace operating in flameless combustion regime. The main characteristics of this combustion regime have been found again: high efficiency and very low pollutant emissions (CO and NOx) associated to CO2 emissions reduction while increasing content of hydrogen in the fuel. With pure hydrogen and without air preheating, the furnace produces no carbon-species and nearly no NOx, condition close to a zero-emission furnace.ROUEN-INSA Madrillet (765752301) / SudocSudocFranceF

Mucus composition and bacterial communities associated with the tissue and skeleton of three scleractinian corals maintained under culture conditions

International audienceCorals live in close association with bacterial communities, but the nature of the relationship is still poorly understood. In this study, three scleractinian coral species, Galaxea fascicularis, Pavona cactus and Turbinaria reniformis were incubated under different laboratory conditions, and the composition of the bacterial community associated with their tissue or skeleton was compared between species or between species and seawater using denaturing gradient gel electrophoresis (DGGE). The amount of dissolved organic carbon (DOC) excreted and the mucus glycoconjugate composition were also determined for each species. The aim of the study was to assess if the bacterial community composition was species-specific or linked either to the seawater composition, or to the quality and quantity of carbon released by each coral. Results obtained showed that DOC release was significantly different (P < 0.0001) for the three species, with the highest excretion rate for G. fascicularis. Also, the mucus of G. fascicularis and P. cactus mainly contained galactose and glucose whereas the mucus of T. reniformis contained more glucose and xylose. Cluster analyses of microbial community composition showed that the bacterial community was species-specific in the coral tissue but not in the skeleton, in all conditions. It remained specific when corals were incubated in the same or in different aquaria, and under different seawater renewal rates. Since DOC release rates and bacterial composition were both different according to the coral species considered, a link might be suggested between the two parameters. Sequencing of DGGE bands indicated that some bacterial phylotypes were consistently retrieved in all samples of a given species

European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years

Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children.A Task Force (TF) supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine PICO (Population, Intervention, Comparator and Outcome) questions. The TF conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full text articles. All TF members approved the final decision for inclusion of research papers. The TF assessed the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.The TF then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The TF formulated recommendations using the GRADE Evidence to Decision framework.Based on the critical appraisal of the evidence and the Evidence to Decision Framework the TF recommends spirometry, bronchodilator reversibility testing and FeNO as first line diagnostic tests in children under investigation for asthma. The TF recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.</p

European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years

BACKGROUND Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. METHODS A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework. CONCLUSION Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future

European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5 to 16 years

Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children.A Task Force (TF) supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5 to 16 years using nine PICO (Population, Intervention, Comparator and Outcome) questions. The TF conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full text articles. All TF members approved the final decision for inclusion of research papers. The TF assessed the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The TF then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The TF formulated recommendations using the GRADE Evidence to Decision framework. Based on the critical appraisal of the evidence and the Evidence to Decision Framework the TF recommends spirometry, bronchodilator reversibility testing and FeNO as first line diagnostic tests in children under investigation for asthma. The TF recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.<br/

Monitoring asthma in childhood: management-related issues

Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient’s illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention

Monitoring asthma in childhood: symptoms, exacerbations and quality of life

Monitoring asthma in children in clinical practice is primarily performed by reviewing disease activity (daytime and night-time symptoms, use of reliever medication, exacerbations requiring frequent use of reliever medication and urgent visits to the healthcare professional) and the impact of the disease on children’s daily activities, including sports and play, in a clinical interview. In such an interview, most task force members also discuss adherence to maintenance therapy and the patients’ (and parents’) views and beliefs on the goals of treatment and the amount of treatment required to achieve those goals. Composite asthma control and quality of life measures, although potentially useful in research, have limited value in clinical practice because they have a short recall window and do not cover the entire spectrum of asthma control. Telemonitoring of children with asthma cannot replace face-to-face follow-up and monitoring because there is no evidence that it is associated with improved health outcomes