E-NOSE: AN INNOVATIVE TECHNOLOGY TO EVALUATE DIFFERENT RESPIRATORY PATTERNS IN PEDIATRIC POPULATION

Il naso elettronico (e-Nose) rappresenta una metodica innovativa biomimetica che permette di simulare il sistema olfattivo umano nel verificare la qualit\ue0 degli odori attraverso l\u2019utilizzo di un sistema di nano-sensori in combinazione con specifici algoritmi di rielaborazione. Le strumentazioni utilizzate sono apparecchi elettronici caratterizzati da architetture complesse. Il naso elettronico \ue8 in grado di rilevare i composti organici volatili (VOCs) derivanti dagli idrocarburi come ad esempio formaldeide, metanolo, etanolo, solfato di idrogeno, benzene, acetaldeide, acetone, toluene, fenoli che vengono prodotti durante i processi metabolici, infiammatori e nello stress ossidativo. In linea generale tale strumento non permette di identificare un singolo VOC ma definisce le caratteristiche di un gruppo di VOCs attraverso la definizione di un profilo specifico. L\u2019esposizione del campione da analizzare ai 32 sensori dello strumento provoca una modificazione delle resistenze basali modificandone la conduttivit\ue0 elettrica. Diverse sono le applicazioni di questa tecnologia nell\u2019ambito medico in campo pneumologico per la caratterizzazione di diverse patologie (sarcoidosi, COPD, asma, patologie ostruttive del sonno) cos\uec come dimostrato da diversi studi su pazienti adulti. In letteratura solo pochi studi sono stati condotti su soggetti pediatrici, in particolare in pazienti sottoposti a ventilazione meccanica, pertanto non sono disponibili dati su pazienti in respiro spontaneo e non \ue8 ancora disponibile una standardizzazione della metodica in questa fascia di et\ue0. L\u2019aria esalata, contiene pi\uf9 di 200 sostanze organiche volatili (VOCs) presenti in tracce, molte delle quali derivanti dal metabolismo di sostanze endogene ed altre provenienti da contaminazioni esterne (composti xenobiotici). L\u2019analisi dell\u2019aria espirata, rappresenta un nuovo approccio per la valutazione di alterazioni metaboliche legate a diverse malattie, es. tumore polmonare, asma, fibrosi cistica. Lo scopo del nostro studio \ue8 quindi quello valutare innanzitutto la fattibilit\ue0 della metodica in ambito pediatrico e definirne eventuali limiti nella raccolta dei campioni. Successivamente valutare se possono esistere differenti pattern 8 respiratori riconducibili a una differente composizione di VOCs sulla base della patologia respiratoria del paziente. Questo studio ha gettato le basi per ulteriori approfondimenti nell\u2019ambito della standardizzazione della raccolta del campione di esalato in soggetti e lo studio delle principali patologie pediatriche.Electronic nose (e-Nose) is an innovative biomimetic method that simulate the human olfactory system to identify the quality of odors, through a nano-sensor system in combination with specific processing algorithms. The instruments used are electronic devices characterized by complex architectures. The electronic nose can detect volatile organic compounds (VOCs) derives from hydrocarbons such as formaldehyde, methanol, ethanol, hydrogen sulphate, benzene, acetaldehyde, acetone, toluene, phenols produced during metabolic, inflammatory and oxidative stress. In general, this tool does not allow to identify a single VOC but defines the characteristics of a group of VOCs defining a specific profile. The sample to analyzed is exposed to the 32 nano-sensors resulting in the modification of the basal resistances and its electrical conductivity. There are several applications of this technology in the medical field in particular pneumology for the characterization of various disease (sarcoidosis, COPD, asthma, obstructive sleep disorders) as demonstrated by several studies on adult patients. In the literature, only a few studies have been conducted on pediatric subjects, particularly in patients undergoing mechanical ventilation, therefore data on spontaneous breathing is not available and standardization of the method in this age group is not yet available. The exhaled air contains more than 200 volatile organic substances (VOCs), many of which derive from the metabolism of endogenous substances and others from external contaminants (xenobiotic compounds). Exhaled air analysis is a new approach to evaluating metabolic disorders related to various diseases, eg. lung cancer, asthma, cystic fibrosis. The purpose of our study is assessing the feasibility of the method on pediatric patients and to define any limits in the collection of the samples. Then evaluate if there are different respiratory pattern due to a different composition of VOCs based on the respiratory pathology of the patient. 6 This study has laid the ground for further refinement in the standardization of exhaled sample collection in pediatric subjects and the evaluation of pediatric disease

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

Structured Light Plethysmography (SLP): Management and follow up of a paediatric patient with pneumonia

Structured Light Plethysmography (SLP) is a non-invasive method to study chest and abdominal movement during breathing and can identify abnormal contributions of the different regions of the chest. M.D hospitalized for pneumonia, underwent SLP and spirometry at admission (T0), after 48 hours (T1), and after one month (T2). SLP parameters showed expiratory flow limitation, information consistent with the spirometric parameters collected, and reduced motion in the area effected by pneumonia, with improvement and normalization at T1 and T2. This method gave useful information about the contribution to the respiratory movement of the lung area affected by pneumonia so we can speculate a possible use in the follow-up of children affected by pneumonia or other respiratory diseases, and who are not able to perform a spirometric test

Airways flat angioma misdiagnosed as difficult asthma in an adolescent

A 15 years-old boy came to our attention with a diagnosis of poorly controlled asthma. This case required thorough investigations: CT scan imaging revealed a flat angioma extending from the carina to the left main bronchus. Rigid bronchoscopy confirmed the presence of an angioma showing widespread mucosal diffusion involving most of the posterior tracheal wall and main bronchi, on the left side. We present this case report and these images to readers seeking for other experiences in the diagnosis of wide superficial bronchial angioma in pediatric age

Sleep-Disordered Breathing in Children with Recurrent Wheeze/Asthma: A Single Centre Study

The relationship between asthma and sleep-disordered breathing is bidirectional due to common risk factors that promote airway inflammation. Obstructive sleep-disordered breathing and recurrent wheeze/asthma are conditions that involve the upper and the lower respiratory system, respectively. The aim of the present study was to investigate the sleep disordered breathing in children with recurrent wheeze/asthma. This was a retrospective study concerning children older than 2 years who underwentbetween January 2014 and November 2016an in-laboratory overnight polygraphic study. We match the children between those who do or do not have recurrent wheeze/asthma disease. We examined the clinical records of 137 children. We excluded eight patients because of neurological and genetic conditions. Children with recurrent wheeze/asthma (N = 28) were younger (p = 0.002) and leaner (p = 0.013) compared to non-affected children (N = 98). Children with wheeze/asthma and unaffected ones had a similar obstructive apnea-hypopnea index (p = 0.733) and oxygen desaturation index (p = 0.535). The logistic regression analysis, in which the condition of wheeze/asthma (yes/no) was a dependent variable, while demographic (age, sex, body mass index (BMI) Z-score) and polygraphic results during sleep (obstructive apnea-hypopnea index, central apnea index, peripheral oxygen saturation (SpO(2)), and snoring) were covariates, showed that children with wheeze/asthma had higher central apnea index (Exp(B) = 2.212; Wald 6.845; p = 0.009). In conclusion, children with recurrent wheeze/asthma showed an increased number of central sleep apneas than unaffected children. This finding may suggest a dysfunction of the breathing control in the central nervous system during sleep. Systemic or central inflammation could be the cause

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

Can inhaled foreign body mimic asthma in an adolescent?

A 14 year old male was diagnosed with asthma but didn't improve with appropriate inhalation therapy. Rigid bronchoscopy revealed a food fragment, almost completely occluding the lower-left bronchus lumen. Based on the reported history, it had been likely there for several years

Relationship between plasma homocysteine and obstructive sleep apneas in children: a preliminary study

Introduction: Plasma homocysteine concentration is increased adult patients with obstructive sleep apneas, whilst it is still unknown if its plasma levels may also be enhanced in obstructive sleep apnea in childhood. We investigated the possible relationship between plasma homocysteine and obstructive sleep apnea in children. Methods: A total number of 199 children were studied between July 2016 and June 2017. All children underwent an overnight respiratory polygraph study. Laboratory data were retrospectively reviewed, inclusing plasma homocysteine, folate and vitamin B12. Statistical analysis was performed using SPSS Statistics 22.0\uae software. Results: Twenty children were finally included in our study. Linear regression analysis showed that plasma homocysteine was positively correlated with age (\u3b2=2.930; p=0.010), and inversely correlated with folate (\u3b2=-4.830; p<0.001), vitamin B12 (\u3b2=-3.844; p=0.002) and haemoglobin (\u3b2=-3.503; p=0.003). No significant correlation was found with platelet count (p=0.578) and apnea-hypopnea index (p=0.272). After age adjustment, homocysteine levels remained inversely correlated with folate, but no association was found with sleep respiratory parameters. Conclusion: This retrospective study suggests that serum homocysteine levels is not increased in children with obstructive sleep apnea, whilst, a folate-enriched diet seems advisable in children with obstructive sleep apnea to counteract oxidative stress. Further controlled studies are needed

Thoracoabdominal asynchrony correlates with peripheral vascular resistance changes in a cohort of obese children

Objective: The purpose of this study was to assess the relationship between the thoracoabdominal asynchrony (phase angle), as an index of inspiratory airflow resistance, pulse transit time arousal index (PTT Ar/I), as changes in peripheral vascular resistance and intrathoracic pressure, and obstructive apnea index (OA), Oxygen Desaturation Index (ODI), snoring (% estimated Total Sleep Time - eTST) and apnea-hypopnea index (AHI) in a cohort of exogenous obese children. Material and Methods: Body mass index (BMI) and BMI z-scores were calculated according to age and sex in 36 consecutive obese children. Nasal patency, tonsil size, Friedman palate position scoring were also recorded. An overnight sleep respiratory recording was performed using an polygraphic ambulatory device. Results: Subjects studies had normal to mild sleep respiratory involvement (assessed by respiratory polysomnographic scoring). Phase angle correlated significantly with PTT Ar/I, but not with AHI (n/hr), OA (n/hr), ODI (n/hr) and snoring (% eTST), even adjusting for nasal patency, tonsil hypertrophy, palate position and BMI (z-score). Conclusion: Thoracoabdominal asynchrony (phase angle) is correlated with peripheral vascular resistance changes (PTT Ar/I), suggesting a subclinical upper respiratory airflow anomaly with autonomic activation in obese subjects

Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality?

Objectives. The severity of sleep apneas largely depends on abnormal size of upper airway. Therefore, nasal examination is essential part of clinical evaluation of children with sleep-disordered breathing. Methods. We performed a retrospective survey involving children aged 4 years and older which underwent in-laboratory overnight cardiorespiratory polygraph study between January 2016 and May 2017. Nasal obstruction test was used to score severity. Results. Fifty-three children (62% males) with a median age of 6.1 (IQR 3.1) years were enrolled in this study. Linear regression analysis showed that nasal obstruction score was correlated with apnea-hypopnea index (\u3b2=0.345; p < 0.014) and oxygen desaturation index (\u3b2=0.328; p < 0.022), whilst no association was found with age, BMI z-score, snoring and phase angle. Correlation analysis also showed that nasal obstruction score was correlated with apnea-hypopnea index (r=0.364; p = 0.009) and oxygen desaturation index (r=0.350; p = 0.012) after adjustment for age and BMI z-score., but not with snoring time or phase angle degree. Conclusions. Nasal obstruction test may be a useful, time saving assessment which aid exploring sleep disordered breathing in children. However, this test should not be used alone because it is plagued by objective consideration and at risk of under or overestimation