Esposizione a fumo di tabacco e malattie respiratorie infantili

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Environmental Effects on Fractional Exhaled Nitric Oxide in Allergic Children

Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation in asthma and respiratory allergy. Environmental factors, especially indoor and outdoor air quality, may play an important role in triggering acute exacerbations of respiratory symptoms. The authors have reviewed the literature reporting effects of outdoor and indoor pollutants on FeNO in children. Although the findings are not consistent, urban and industrial pollution—mainly particles (PM2.5 and PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2)—as well as formaldehyde and electric baseboard heating have been shown to increase FeNO, whilst ozone (O3) tends to decrease it. Among children exposed to Environmental Tobacco Smoke (ETS) with a genetic polymorphisms in nitric oxide synthase genes (NOS), a higher nicotine exposure was associated with lower FeNO levels. Finally, although more studies are needed in order to better investigate the effect of gene and environment interactions which may affect the interpretation of FeNO values in the management of children with asthma, clinicians are recommended to consider environmental exposures when taking medical histories for asthma and respiratory allergy. Further research is also needed to assess the effects of remedial interventions aimed at reducing/abating environmental exposures in asthmatic/allergic patients

A comprehensive environmental exposure indicator and respiratory health in asthmatic children: a case study

The primary goal of asthma management is to achieve and maintain asthma control, which can be influenced by environmental factors. This longitudinal study aimed to construct a comprehensive environmental indicator to predict asthma control in children with asthma in Palermo, Italy. The study included 179 asthmatic children aged 5–16 years. The Normalized Difference Vegetation Index (NDVI) was used to measure green cover, and the Coordination of Information on the Environment (CORINE) framework was used to assess land use based on each home address. A land use regression (LUR) model centered on the home address estimated NO2 exposure for each child using GIS. An environmental indicator, including environmental and personal exposure, was formulated using an additive value model approach. A logistic regression mixed model assessed the association between the environmental indicator and uncontrolled asthma. A probability map of uncontrolled asthma was constructed. In conclusion, a comprehensive environmental indicator proved effective in identifying areas at higher and lower risk of uncontrolled asthm

Medical assistive robots

Medical assistive robots (MARs) are innovative tools providing extensive support and assistance to users in different medical scenarios, enhancing patients’ health and care. Social MARs have been implemented in respiratory medicine to help manage chronic respiratory conditions, such as asthma, COPD and cystic fibrosis. To integrate MARs into routine clinical practice, more studies are needed to strengthen the evidence on the feasibility, acceptability and efficacy of MARs in chronic respiratory conditions in the long term

Beclomethasone dipropionate hydrofluoroalkane for the treatment of allergic rhinitis

Allergic rhinitis (AR) is a common respiratory disease, and its prevalence is increasing all over the world, both in adults and in children. Patients experience symptoms that may negatively impact on physical, social and psychological well-being. Hence, if left untreated, allergic rhinitis may significantly affect quality of life. Under current guidelines, intranasal corticosteroids are considered the most effective drugs and they are recommended as first-line therapy. Among the several corticosteroid intranasal sprays available, beclomethasone dipropionate is one of the most prescribed. Recently, new intranasal hydrofluoroalkane-propelled formulations with little or no impact on the ozone layer have been developed for the treatment of AR. The use of these devices might improve patients' adherence to treatment, avoiding some of the most common side effects associated with aqueous formulations. This review provides the most recent evidence for the efficacy and safety of beclomethasone dipropionate hydrofluoroalkane nasal aerosol in the treatment of allergic rhinitis

New insights in respiratory impedance in young children after repair of congenital diaphragmatic hernia: a cross-sectional study

Lung function impairment is common in Congenital Diaphragmatic Hernia (CDH) survivors. The aim of this study was to evaluate, in children who underwent CDH surgical repair, mid and long-term consequences on respiratory impedance, investigating the impact of CDH on both resistance and reactance parameters, as well as bronchodilator response.Forced Oscillation Technique (FOT) parameters were collected from 12 patients (2-11 years). Resistance and reactance values at 8 Hz (Rrs8, Xrs8) and the area under the reactance curve (AX) were measured pre and post-salbutamol. Quantitative variables were compared using Mann-Whitney U test. Differences of categorical variables were evaluated using Fisher exact test. Statistically significant differences between measured and predicted values for Rrs8 (p = 0.04), Xrs8 (p = 0.02) and AX (p = 0.01) were found. When stratifying for age, significant difference between measured and predicted values was observed only in children < 5 years (n = 6) (Rrs8 p = 0.03, Xrs8 p = 0.001, AX p = 0.007). With respect to children 5 years (n = 6), the younger ones showed higher z-scores in Rrs8 (p = 0.015), Xrs8 (p = 0.002) and AX (p = 0.002) values. Since the z-score difference was greater than 0.5, it was considered a difference clinically relevant. No differences in bronchodilator response were recorded.In children with CDH an impairment of respiratory impedance measured by FOT is observed only in children aged less than 5 years