The use of inhaled corticosteroid in preschool wheezers: what's the point today?

Among the preschool children who wheeze two different groups can be identify: children who have a viral infection and those who respond to multiple triggers, such as exercise or allergens

Predictive power of Oxygen Desaturation Index (ODI) and Apnea-Hypopnea Index (AHI) in detecting long-term neurocognitive and psychosocial outcomes of sleep-disordered breathing in children: a questionnaire-based study

Pediatric obstructive sleep apnea can negatively affect children's neurocognitive function and development, hindering academic and adaptive goals. Questionnaires are suitable for assessing neuropsychological symptoms in children with sleep-disordered breathing. The study aimed to evaluate the effectiveness of using the Oxygen Desaturation Index compared to the Obstructive Apnea-Hypopnea Index in predicting long-term consequences of sleep-disordered breathing in children. We conducted a retrospective analysis of respiratory polysomnography recordings from preschool and school-age children (mean age: 5.8 ± 2.8 years) and followed them up after an average of 3.1 ± 0.8 years from the home-based polysomnography. We administered three validated questionnaires to the parents/caregivers of the children by phone. Our results showed that children with an Oxygen Desaturation Index (ODI) greater than one event per hour exhibited symptoms in four domains (physical, school-related, Quality of Life [QoL], and attention deficit hyperactivity disorder [ADHD]) at follow-up, compared to only two symptoms (physical and school-related) found in children with an Obstructive Apnea-Hypopnea Index greater than one event per hour at the time of diagnosis. Our study also found a significant correlation between the minimum SpO2 (%) recorded at diagnosis and several outcomes, including Pediatric Sleep Questionnaire (PSQ) scores, physical, social, and school-related outcomes, and ADHD index at follow-up. These results suggest that the Oxygen Desaturation Index could serve as a valuable predictor of long-term symptoms in children with sleep-disordered breathing, which could inform treatment decisions. Additionally, measuring minimum SpO2 levels may help assess the risk of developing long-term symptoms and monitor treatment outcomes

Mental health and cognitive development in symptomatic children and adolescents scoring high on habitual snoring: role of obesity and allergy

Background: Obstructive sleep apnea can have a negative impact on children’s and adolescents’ neurocognitive abilities and hinder their academic and adaptive progress in academic, social, and/or behavioral dimensions. In this retrospective cross-sectional study, we investigated the influence of body weight conditions and allergy status on long-term mental health, cognitive development, and quality of life in children and adolescents who snored. Methods: The study sample included 47 subjects (age range 4.1 to 15.3 years) who exhibited high levels of snoring and underwent home-based polysomnography between 2015 and 2019. Follow-up assessments (3 years on average between baseline and follow-up) entailed phone interviews with the subject’s parents/caregivers who completed three validated questionnaires investigating sleep, quality of life, and parental ratings. Results: We found a correlation between age at diagnosis and being retrospectively overweight and high levels of snoring. In addition to a higher risk of developing emotional symptoms (8.2% increase in retrospective overweight status for each unit increase in the emotional score at follow-up) and oppositional behavior (9% increase in retrospective overweight status for each unit of oppositional T points at follow-up), we also noted reduced long-term social symptoms (11% decrease in retrospective overweight status for each unit increase in the social score at follow-up) and cognitive symptoms (10.6% decrease in retrospective overweight status for each unit increase in the cognitive score at follow-up), as well as a 6.1% increase in retrospective allergy status for each unit increase in academic performance at follow-up. Conclusions: Snoring can have negative impacts on mental health and cognitive development in the long term. Early detection and intervention for neuropsychological disorders is important in children and adolescents who score high on snoring. In the long term, the effects of snoring on neuropsychological disorders may vary based on previous body weight and allergy status

Correlation between gastroesophageal reflux and respiratory sounds in children.

irty-eight children (aged>24 months) with symptoms of gastroesophageal re ux and/or wheezing and cough were enrolled in this study. Patients underwent pH-impedance monitoring and recording of lung sounds (WHolter\uae). Results: e median number of cough events associated with weakly acid re ux in the group of patients with positive impedance monitoring was signi cantly higher than the median of cough associated with weakly acid and non-acid re ux in the group of patients with negative impedance monitoring (p = 0.003). e median number of events of wheezing 655% associated with an episode of acid re ux was signi cantly higher (p = 0.008) in the group of patients with positive 24-hr pH monitoring than those with negative 24-hr pH monitoring. Conclusion: In conclusion, we found a relationship between gastroesophageal re ux and respiratory symptoms: wheezing was associated mainly with acid re ux, whereas coughing was associated with weakly acid re ux

The measurement of exhaled nitric oxide in routine practice.

Exhaled nitric oxide (NO) is considered the most easily available clinical test to indirectly assess the level of eosinophilic airway inflammation in asthma, and to predict the efficacy of anti-inflammatory treatment with inhaled corticosteroids (ICS). It is possible to measure the level of exhaled NO using online or offline methods. The most widely used online method employs techniques that enable NO in exhaled air to be measured in a single exhalation, calculating the value at the end-expiratory plateau. Because of the correlation between the level of exhaled NO with the level of eosinophilic inflammation in the airway of asthmatic patients, it has been proposed as a clinical marker in the practice of respiratory and allergy physicians with differing targets. In particular it is considered to be highly effective in the diagnosis of allergic asthma, to be capable of identifying those patients with a higher response probability to inhaled corticosteroids, and to a lesser extent, to be of value in contributing to the management of the disease. The possibility of easily taking measurements of FeNO in an office setting even by relatively young children, and the availability of a portable device, opens a significant perspective for the routine use of FeNO evaluation in daily practice

Un respiro\u2026 bollente (la temperatura dell\u2019aria esalata)

L\u2019asma \ue8 una malattia infiammatoria delle vie aeree. Essendo il \u201ccalore\u201d uno dei segni cardinali della flogosi, numerosi studi hanno valutato se la temperatura dell\u2019aria esalata possa riflettere la risposta patologica delle vie aeree nell\u2019asma bronchiale. \uc8 ipotizzabile che una notevole quantit\ue0 di \u201ccalore\u201d venga prodotta durante lo svolgimento delle diverse fasi dell\u2019infiammazione e del rimodellamento delle vie aeree del soggetto con asma. L\u2019insieme dei risultati ottenuti dagli studi fino ad oggi disponibili suggeriscono che la valutazione della temperatura dell\u2019aria esalata possa rappresentare un indicatore composito di malattia in grado di riflettere non soltanto la componente infiammatoria ma anche quella relativa al rimodellamento delle vie aeree. Si pu\uf2 pertanto ipotizzare un ruolo pratico nella valutazione del controllo di malattia e nel monitoraggio della risposta alla terapi

Gli steroidi per via inalatoria nel trattamento del respiro sibilante in et\ue0 prescolare

L\u2019uso di corticosteroidi per via inalatoria (ICS) in bambini con wheezing in et\ue0 prescolare \ue8 ampiamente diffuso nella pratica pediatrica. L\u2019obiettivo principale \ue8 la riduzione degli episodi di riacutizzazione, nel miglioramento dei sintomi e della funzionalit\ue0 respiratoria. Gli ICS agiscono principalmente sui diversi meccanismi dell\u2019infiammazione, sui processi di rimodellamento e sull\u2019ipereattivit\ue0 bronchiale che si associa al fenotipo asmatico in quanto hanno come bersaglio l\u2019infiammazione eosinofila che a quest\u2019ultimo si associa. L\u2019efficacia nell\u2019impiego di tali farmaci nel bambino piccolo, che presenta wheezing ricorrente spesso associato a infezione virale, \ue8, al contrario, molto dibattuta. La principale sfida nel trattamento del respiro sibilante in et\ue0 prescolare resta la definizione del fenotipo in modo tale da poter attuare un trattamento farmacologico pi\uf9 idoneo a migliorare la clinica e la progressione di malattia del paziente