Establishment and validation of a model for predicting recurrent wheezing in children with bronchiolitis / 中国医师进修杂志

Objective:To analyze the risk factors of recurrent wheezing in children with bronchiolitis and to construct a predictive model.Methods:Prospective research methods was used. One hundred and eighty children with bronchiolitis who were treated in Hefei Eighth People's Hospital from February 2017 to February 2019 were selected as the study subjects, and the included children were separated into a modeling group (126 cases) and a validation group (54 cases) according to 7∶3. The children were followed up for 3 years, and then the modeling group was divided into wheezing group (48 cases) and no wheezing group (78 cases) according to whether the children had recurrent wheezing. The Hosmer-Lemeshow fitting curve and receiver operating characteristic (ROC) curve were drawn to evaluate the validity and accuracy of the constructed prediction model.Results:Multivariate Logistic regression analysis showed that artificial feeding ( OR = 8.838, 95% CI 2.601 to 30.027), family history of allergies ( OR = 6.709, 95% CI 1.825 to 24.665), underlying diseases ( OR = 8.114, 95% CI 1.638 to 40.184), and higher IgE level ( OR = 1.020, 95% CI 1.012 to 1.029) were the independent risk factors for recurrent wheezing in children with bronchiolitis ( P<0.05). The area under the curve of the modeling group was 0.917 (95% CI 0.855 to 0.959), and the sensitivity and specificity were 83.33% and 85.90%, respectively; the area under the curve of the validation group was 0.911 (95% CI 0.847 to 0.954), and the sensitivity and specificity were 89.58% and 79.49%, respectively. Conclusions:Artificial feeding, family history of allergies, underlying diseases, and higher IgE level are the independent risk factors for recurrent wheezing in children with bronchiolitis. The constructed prediction model has good accuracy and validity, and can be used as an effective tool for clinical prediction of recurrent wheezing in children with bronchiolitis.

Clinical evaluation of Jiawei Zhixiao Decoction on acute attack of bronchial asthma / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of Jiawei Zhixiao Decoction and western medicine comprehensive therapy in acute attack of bronchial asthma of heat asthma syndrome.Methods:Randomized controlled trial. A total of 80 patients with acute exacerbation of bronchial asthma and TCM pattern heat asthma, who treated in the respiratory department of our hospital from January 2021 to December 2021, were selected. Accordlty to random number table method the patients were divided into the treatment group and control group, with 40 in each group. The patients in the control group were given comprehensive treatment of Western Medicine (bronchodilator and glucocorticoid, etc.). On the basis of comprehensive treatment of Western medicine, the treatment group was combined with Jiawei Zhixiao Decoction. All patients received a 14-day treatment. Before and after treatment, the TCM symptom scores were recorded, FEV1 and forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC) were measured by pulmonary function meter, and peak expiratory flow (PEF) was measured by peak expiratory flow meter. Serum TNF-α and IL-8 levels were detected by ELISA, and procalcitonin (PCT) was detected by electrochemiluminescence. The disease grade, clinical efficacy and adverse reactions were also recorded.Results:The total effective rate was 95.0% (38/40) in the treatment group and 80.0% (32/40) in the control group, the difference between the two groups was statistically significant ( χ2=4.11, P=0.043). After treatment, the TCM symptom score of the treatment group was significantly lower than that of the control group ( t=7.91, P<0.01). FEV1 [(2.83±0.37) L vs. (2.38±0.32) L, t=6.77], FEV1/FVC [(85.37±9.36) % vs. (75.50±10.24) %, t=4.50], PEF [(4.84±0.82) L vs. (3.92±0.43) L, t=6.28] was significantly higher than that of control group ( P<0.01). Serum IL-8 [(80.59±10.28) ng/L vs. (87.15±8.25) ng/L, t=3.15], TNF-α [(43.18±4.08) ng/L vs. (51.78±7.58) ng/L, t=6.32], PCT [(0.84±0.35) μg/L vs. (0.41±0.12) μg/L, t=7.35] were significantly lower than those in control group ( P<0.01). The improvement of asthma grade was significantly better than that of control group ( Z=17.86, P<0.05). During the observation period, there were no serious adverse reactions in both groups, and the safety was high. Conclusion:Application of Jiawei Zhixiao Decoction and western medicine comprehensive therapy in acute attack of bronchial asthma of heat asthma syndrome can effectively improve the TCM symptoms and lung function, attenuate the inflammation response, and alleviate the severity of asthma.

Sibilancia recurrente en pediatría

Introducción: los episodios de obstrucción bronquial a temprana edad constituyen un problema frecuente en pediatría. Se realizó un estudio descriptivo, longitudinal, retrospectivo. Objetivo: caracterizar el comportamiento de la sibilancia recurrente en los niños menores de 5 años pertenecientes al municipio Bayamo, del Hospital Provincial Pediátrico Docente "General Milanés "en el año 2019. Métodos: la muestra fue de 63 pacientes y se estudiaron las variables edad, sexo, lactancia materna, ingresos previos, procedencia, género de vida y posibles factores de riesgo. El análisis estadístico se realizó a través de las estimaciones de las frecuencias absolutas y relativas. Resultados: predominaron los niños de 1 a 5 años con 52 casos (82.6%) y el sexo masculino, 29 de ellos pertenecieron a este grupo etáreo ( 80.6%); los ingresos previos de menos de 3 días en 37 casos (66.1%) y 56 casos no recibieron lactancia materna exclusiva, 37 de ellos representó el 66.1%; 44 casos tuvieron un género de vida malo ( 69.8%) y de los 43 casos que procedían de la zona urbana 28 pertenecían a ese género de vida(65.1%); los antecedentes patológicos familiares de alergia o asma y la atopia fueron los más significativos con 63 y 52 casos(100 y 82.5%) respectivamente. Conclusiones: se comprobó que la edad de 1 a 5 años, el sexo masculino, los ingresos de menos de tres días, sin lactancia materna , el género de vida malo, la procedencia urbana fueron los que predominaron en el estudio, así como los antecedentes patológicos familiares y la atopia como factores de riesgo que exacerbaron la enfermedad.

Introduction: episodes of bronchial obstruction at an early age are a frequent problem in pediatrics. A descriptive, longitudinal, retrospective study was conducted. Objective: to characterize the behavior of recurrent wheezing in children under 5 years of age belonging to the Bayamo municipality, of the "General Milanés" Teaching Pediatric Provincial Hospital in 2019. Methods: the sample consisted of 63 patients and the variables age, sex, breastfeeding, previous income, origin, gender of life and possible risk factors were studied. Statistical analysis was performed through estimates of absolute and relative frequencies. Results: there was a predominance of children aged 1 to 5 years with 52 cases (82.6%) and males, 29 of them belonged to this age group (80.6%); previous admissions of less than 3 days in 37 cases (66.1%) and 56 cases did not receive exclusive breastfeeding, 37 of them accounted for 66.1%; 44 cases had a bad lifestyle (69.8%) and of the 43 cases that came from the urban area, 28 belonged to that kind of life (65.1%); Family pathological history of allergy or asthma and atopy were the most significant wit. Conclusions: it was found that age from 1 to 5 years, male sex, income of less than three days, without breastfeeding, poor lifestyle, urban origin were those that predominated in the study, as well as family pathological history and atopy as risk factors that exacerbated the disease.

Introdução: episódios de obstrução brônquica em idade precoce são um problema frequente em pediatria. Trata-se de um estudo descritivo, longitudinal e retrospectivo. Objetivo: caracterizar o comportamento da sibilância recorrente em crianças menores de 5 anos pertencentes ao município de Bayamo, do Hospital Provincial Pediátrico Universitário "General Milanés", em 2019. Métodos: a amostra foi composta por 63 pacientes e estudadas as variáveis idade, sexo, aleitamento materno, renda prévia, procedência, sexo de vida e possíveis fatores de risco. A análise estatística foi realizada por meio de estimativas de frequências absolutas e relativas. Resultados: houve predomínio de crianças de 1 a 5 anos com 52 casos (82,6%) e do sexo masculino, sendo que 29 deles pertenciam a essa faixa etária (80,6%); internações anteriores inferiores a 3 dias em 37 casos (66,1%) e 56 casos não receberam aleitamento materno exclusivo, sendo que 37 deles corresponderam a 66,1%; 44 casos tinham estilo de vida ruim (69,8%) e dos 43 casos provenientes da zona urbana, 28 pertenciam a esse tipo de vida (65,1%); História anatomopatológica familiar de alergia ou asma e atopia foram as mais significativas, com 63 e 52 casos (100 e 82,5%), respectivamente. Conclusões: verificou-se que idade de 1 a 5 anos, sexo masculino, renda inferior a três dias, ausência de aleitamento materno, estilo de vida ruim, origem urbana foram os que predominaram no estudo, assim como história patológica familiar e atopia como fatores de risco que exacerbaram a doença.

Cardiac asthma or bronchial asthma: a case report

Wheezing is often found in patients with asthma bronchialebut wheezing may also be found in paroxysmal nocturnal dyspnea and pulmonary edema (cardiac asthma). Cardiac asthma has been used to explain wheezing and airflow obstruction due to heart failure (HF). The respiratory symptoms such as wheezing, shortness of breath and cough. These symptoms normally occur at night and are common in elderly.Both asthma bronchiale and cardiac asthma are important to diagnose because treatments for asthma bronchiale and HF are different. Here we presented a case report of a 59-years old female diagnosed with cardiac asthma due to heart failure.Cardiac asthma defined as congestive heart failure (CHF) associated with wheezing represents one third of CHF in elderly patients. It is often confused with asthma and exercise-induced bronchospasm. These diseases have different therapies. Cardiac asthma using diuretics and asthma using bronchodilator therapy. CHF can lead to pulmonary congestion and pulmonary edema (PE), and this is classically thought to be the primary cause of cardiac asthma. Current management of cardiac asthma focuses on controlling the underlying HF and PE.

Clinico-Epidemioogical and Radiological Profile of Broncholitis at Sher-E-Bangla Medical College Hospital in Barishal, Bangladesh

Background: Bronchiolitis, caused mostly by Respiratory syncytial virus (RSV) virus is the leading cause of lower respiratory tract infection in infants. The disease is mostly presents with cough runny nose, fever, breathing difficulties and respiratory failure This infection usually affects children up to age of 24 months, with younger infants often more severely affected and is the most prevalent cause of hospitalization in infants under the age of 12 months. The treatment is supportive; therefore, epidemiology, clinical, laboratory, and radiologic findings can help to ensure appropriate diagnosis and proper treatment.Methods:This descriptive cross-sectional observation study was conducted at Paediatrics department of Sher-E-Bangla Medical College & Hospital (SBMCH), Barishal, Bangladesh between October 2018 to March 2019To find out the clinico-epidemiological and radiological profile of Bronchiolitis. Children below 24 months of age diagnosed as bronchiolitis were studied.Results:200 children were evaluated, including 150 boys and 50 girls; Infants below 6 months accounted for the highest proportion (60%). All the bronchiolitis patients had cough or cold with respiratory distress. Other symptoms were fever (98.0%), restlessness (63.0%), poor feeding (60%) and fast breathing. On examination lower chest indrawing and rhonchi were found in all cases. Hyperinflation was the most prevalent radiological finding (60%) and more than half (55%) patients had lymphocytosis on CBC.Conclusion:Most children present with typical clinical and radiological feature of bronchiolitis which can help the clinicians to clinically identify this disease more efficiently.

Effects of Huaiqihuang Granules on airway inflammation in bronchiolitis / 中国基层医药

Objective:To investigate the effects of Huaiqihuang Granule on airway inflammation and wheezing reattack in bronchiolitis. Methods:A total of 120 patients with bronchiolitis presenting airway inflammation and wheezing reattack who received treatment in Zaozhuang Municipal Hospital and Yicheng Hospital of Traditional Chinese Medicine between January 2018 and October 2019 were included in this study. These patients randomly underwent either conventional treatment (control group, n = 60) or conventional treatment + Huaiqihuang Granule treatment (experimental group, n = 60). They received pulmonary function examinations and laboratory tests for evaluating serum and urinary inflammatory factors at admission and 2 months after discharge. They were followed up by telephone 3 months and 1 year after onset. Results:The ratio of time to reach the peak tidal expiratory flow over total expiratory time (TPTEF/TE) and the volume to peak tidal expiratory flow to total expiratory volume (VPTEF/VE) were significantly higher in the experimental group compared with those in the control group ( t = 3.13, 3.60, all P < 0.01). The ratio of tidal peak flow to tidal expiratory flow when 25% of tidal volume remains in the lungs (PF/TEF25) and functional residual capacity/kg (FRCp/kg) significantly decreased in the experimental group compared with those in the control group ( t = 3.88, 3.74, all P < 0.01). Interleukin-4 level and the ratio of interleukin-4/γ-interferon levels were significantly lower in the experimental group than in the control group ( t = 5.70, 8.93, all P < 0.01). Gamma-interferon level was significantly higher in the experimental group than in the control group ( t = 3.85, P < 0.01). There was no significant difference in urinary leukotriene E4 level post-treatment between the two groups ( t = 1.18, P > 0.05). The number of patients who had a wheezing attack again within 3 months post-treatment and the number of patients who had ≥3 wheezing attacks were significantly lower in the experimental group compared with those in the control group ( χ2 = 5.18, 6.98, P < 0.01 or 0.05). Conclusion:Huaiqihuang granule can effectively regulate the balance of the Th 1/Th 2 ratio, inhibit airway inflammation in bronchiolitis, improve pulmonary function, and reduce the number of wheezing reattacks.

Risk factors for wheezing in children with adenovirus pneumonia / 国际儿科学杂志

Objective:To investigate the risk factors for wheezing in the children with HAdV pneumonia.Methods:Ninety-seven cases of children aged 2 to 5 years with HAdV pneumonia were selected from Pediatric Department of Shengjing Hospital of China Medical University from January 2019 to December 2019.Meanwhile, 100 children of the same age without adenovirus pneumonia were recruited as the control group.According to whether wheezing or not, the children with HAdV pneumonia were divided into wheezing group and non-wheezing group.The general characteristics, clinical characteristics and laboratory examination data of HAdV pneumonia group and non-HAdV pneumonia group were statistically analyzed, and the risk factors of wheezing after HAdV pneumonia were analyzed by multivariate logistic regression.Results:Compared with the non-HAdV group, fever duration, serious cases, cases of wheezing in HAdV group were significant different( P<0.05). In laboratory examination, the white blood cell(WBC)count in HAdV group was significantly higher than those in control group( P<0.05). Whereas, hospitalization time, C-reactive protein(CRP), alanine aminotransferase(ALT), creatinine(Cr), creatine kinase(CK), CKMB, and lactic dehydrogenase(LDH)levels in HAdV group were not statistically significant compared with those of the children in non-HAdV pneumonia group( P>0.05). Wheezing occurred in 52.6%(51/97)of children with HAdV pneumonia.Compared with the non-wheezing group, history of wheezing, cases with atopy, serious cases, eosinophils(EO)count, and cases with small airway changes in wheezing group were significantly different( P<0.05). Whereas, atopic family history, hospitalization time, fever duration, lymphocyte(LY)count, WBC count, CRP level, the cases with co-infection and consolidation in lung images in wheezing group were not statistically significant compared with those of the children in non-wheezing group( P>0.05). Multivariate logistic regression analysis showed that the risk of wheezing in children with severe HAdV pneumonia was 2.949 times as much as those without severe HAdV pneumonia.The risk of wheezing in children with HAdV pneumonia with atopic constitution was 3.930 times as much as those without atopiy. Conclusion:The incidence of wheezing in children with HAdV pneumonia is higher than those in children of non-HAdV pneumonia.Severe cases and atopy are the independent risk factors for wheezing in the children with HAdV pneumonia.

The bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in the 1993 birth cohort, Pelotas, Brazil / Associação bidirecional entre sibilância e obesidade durante a adolescência e início da vida adulta na coorte de nascimentos de 1993, Pelotas, Brasil

ABSTRACT Objective: To analyze the bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in a cohort in southern Brazil. Methods: This prospective longitudinal study used data from the 1993 birth cohort in Pelotas, Brazil. The following outcome variables were measured at 22 years of age: self-reported wheezing during the last 12 months and obesity (BMI ≥ 30 kg/m2). The following exposure variables were measured at ages 11, 15, and 18: self-reported wheezing (no wheezing or symptom presentation in 1, 2, or 3 follow-ups) and obesity (non-obese or obese in 1, 2, or 3 follow-ups). Crude and adjusted logistical regression stratified by sex were used in the analyses. The reference category was defined as participants who presented no wheezing or obesity. Results: A total of 3,461 participants had data on wheezing and 3,383 on BMI. At 22 years of age, the prevalence of wheezing was 10.1% (95%CI: 9.1; 11.2), and obesity, 16.2% (95%CI: 15.0; 17.6). In females, the presence of wheezing in two follow-ups revealed a 2.22-fold (95%CI: 1.36; 3.61) greater chance of developing obesity at 22 years of age. Meanwhile, the presence of obesity in two follow-ups resulted in a 2.03-fold (95%IC: 1.05; 3.92) greater chance of wheezing at 22 years of age. No associations were found between wheezing and obesity in males. Conclusions: The obtained data suggest a possible positive bidirectional association between wheezing and obesity, with greater odds ratios in the wheezing to obesity direction in females and in the category of occurrence of exposure in two follow-ups.

RESUMO Objetivo: Analisar a associação bidirecional entre sibilância e obesidade durante a adolescência e início da vida adulta em uma coorte no sul do Brasil. Métodos: Este estudo longitudinal prospectivo utilizou dados da coorte de nascimentos de 1993 em Pelotas, Brasil. As seguintes variáveis de desfecho foram medidas aos 22 anos de idade: sibilância autorreferida nos últimos 12 meses e obesidade (IMC ≥ 30 kg/m2). As seguintes variáveis de exposição foram medidas aos 11, 15 e 18 anos: sibilância autorreferida (sem sibilos ou presença do sintoma em 1, 2 ou 3 acompanhamentos) e obesidade (não obesos ou obesos em 1, 2 ou 3 acompanhamentos). Regressões logísticas simples e ajustada estratificadas por sexo foram utilizadas nas análises. A categoria de referência foi definida como participantes que não apresentavam sibilância ou obesidade. Resultados: Um total de 3.461 participantes tinham dados sobre sibilância e 3.383 sobre IMC. Aos 22 anos, a prevalência de sibilância foi de 10,1% (IC95%: 9,1; 11,2) e obesidade, 16,2% (IC95%: 15,0; 17,6). Em mulheres, a presença de sibilância em dois acompanhamentos apresentou 2,22 vezes (IC95%: 1,36; 3,61) maior chance de desenvolver obesidade aos 22 anos. Enquanto isso, a presença de obesidade em dois acompanhamentos resultou em 2,03 vezes (IC95%: 1,05; 3,92) maior chance de sibilância aos 22 anos. Não foram encontradas associações entre sibilância e obesidade em homens. Conclusões: Os dados obtidos sugerem uma possível associação bidirecional positiva entre sibilância e obesidade, com maiores razões de chance na direção sibilância para obesidade em mulheres e na categoria de ocorrência da exposição em dois acompanhamentos.

The effect of recombinant human interferon α1b treatment of infants hospitalized with lower respiratory tract infection on subsequent wheezing

Abstract Objective: To investigate the impact of recombinant human interferon α1b (rhIFNα1b) treatment in infants hospitalized with lower respiratory tract infections on subsequent wheezing. Methods: The clinical data of infants (n = 540) with viral pneumonia, wheezy bronchitis, or bronchiolitis hospitalized in 19 Chinese hospitals from June 2009 to June 2015 were retrospectively analyzed. The parameters relevant to wheezing episodes within the last year were collected by telephone and questionnaires. The rhIFNα1b treatment group (n = 253) and control group (n = 287) were compared in terms of wheezing episodes within the last year. Moreover, the wheezing group (95 cases) and non-wheezing group (445 cases) were compared. Results: Out of 540 cases, 95 (17.6%) experienced wheezing episodes, 13.8% (35/253) cases treated with rhIFNα1b, and 20.9% (60/287) cases without rhIFNα1b experienced wheezing episodes within the last year. The rhIFNα1b treatment significantly improved wheezing episodes within the last year, compared with the control peers (p = 0.031). Single-factor regression showed statistically significant differences between the wheezing and non-wheezing groups in terms of age, rhIFNα1b use, childhood and family history of allergy, housing situation, and feeding history (p < 0.05). Binary logistic regression showed a childhood history of allergy (OR = 2.14, p = 0.004), no rhIFNα1b use (OR = 1.70, p = 0.028), and living in a crowded house (OR = 1.92, p = 0.012) might be risk factors of subsequent wheezing. Accordingly, breastfeeding (OR = 0.44, p = 0.008) and hospitalization age of 1-year-old (OR = 0.58, p = 0.024) were protective factors. Conclusions: Early use of rhIFNα1b in infants hospitalized with lower respiratory tract infections and breastfeeding could prevent subsequent wheezing. Living in a crowded house could promote subsequent wheezing.

Associated factors with recurrent wheezing in infants: is there difference between the sexes?

Abstract Objective: Identify associated factors for recurrent wheezing (RW) in male and female infants. Methods: Cross-sectional multicentric study using the standardized questionnaire from the Estudio Internacional sobre Sibilancias en Lactantes (EISL). The questionnaire was applied to parents of 9345 infants aged 12-15 months at the time of immunization/routine visits. Results: One thousand two hundred and sixty-one (13.5%) males and nine hundred sixty-three (10.3%) females have had RW (≥3 episodes), respectively (p10 colds episodes (OR = 3.46; IC 95% 2.35-5.07), air pollution (OR = 1.33; IC 95% 1.12-1.59), molds at home (OR = 1.23; IC 95% 1.03-1.47), Afro-descendants (OR = 1.42; IC 95% 1.20-1.69), bronchopneumonia (OR = 1.41; IC; 1.11-1.78), severe episodes of wheezing in the first year (OR = 1.56; IC 95% 1.29-1.89), treatment with bronchodilators (OR = 1.60; IC 95% 1.22-2,1) and treatment with oral corticosteroids (OR = 1,23; IC 95% 0.99-1,52). Associated factors for RW for females were passive smoking (OR = 1.24; IC 95% 1.01-1,51), parents diagnosed with asthma (OR = 1.32; IC 95% 1,08-1,62), parents with allergic rhinitis (OR = 1.26; IC 95% 1.04-1.53), daycare attendance (OR = 1.48; IC 95% 1.17-1,88), colds in the first 6 months of life (OR = 2.19; IC 95% 1.69-2.82), personal diagnosis of asthma (OR = 1.84; IC 95% 1.39-2.44), emergency room visits (OR = 1.78; IC 95% 1.44-2.21), nighttime symptoms (OR = 2.89; IC 95% 2.34-3.53) and updated immunization (OR = 0.62; IC 95% 0.41-0.96). Conclusion: There are differences in associated factors for RW between genders. Identification of these differences could be useful to the approach and management of RW between boys and girls.

Caracterización clinicoepidemiológica de niños con sibilancia recurrente / Clinical epidemiological characterization of children with recurrent wheezing

Introducción: Las sibilancias recurrentes en lactantes y preescolares son motivo frecuente de consulta en pediatría. Objetivo: Caracterizar a niños con sibilancia recurrente desde los puntos de vista clínico y epidemiológico. Métodos: Se realizó una investigación observacional, longitudinal y prospectiva de 140 niños con sibilancia recurrente, atendidos en el Servicio de Respiratorio del Hospital Infantil Docente Sur Dr. Antonio María Béguez César de Santiago de Cuba, desde de enero de 2016 hasta diciembre de 2018. Resultados: Predominaron el sexo masculino (57,1 %), los pacientes de procedencia urbana (62,1 %) y el área de salud 28 de septiembre como la de mayor incidencia (42,7 %). El promedio de edad fue de 1 año y 5 meses, aproximadamente. Los niños incluidos en el intervalo de 6 a 11 meses y 29 días fueron los más afectados (28,6 %). Entre los municipios, Guamá aportó el mayor número de casos (33,9 %). No existió asociación estadística entre el índice predictivo de asma y el sexo; sin embargo, resultó mayor entre los varones (19,3 %). Conclusiones: Las características clínicas y epidemiológicas de los pacientes con sibilancia recurrente de esta casuística no difieren del contexto epidemiológico mundial, siendo una entidad de observación frecuente en los servicios de pediatría.

Introduction: The recurrent wheezing in infants and preschool children are frequent reason of visit in pediatrics. Objective: To characterize children with recurrent wheezing from the clinical and epidemiologic points of view. Methods: An observational, longitudinal and prospective investigation of 140 children with recurrent wheezing, assisted in the Respiratory Service of Dr. Antonio María Béguez Cesar Southern Teaching Children Hospital was carried out in Santiago de Cuba, from January, 2016 to December, 2018. Results: There was a prevalence of the male sex (57.1 %), the patients of urban origin (62.1 %) and 28 de Septiembre health area as that of more incidence (42.7 %). The average age was of 1 year and 5 months, approximately. The children included in the interval from 6 to 11 months and 29 days were the most affected (28.6 %). Among the municipalities, Guamá contributed the higher number of cases (33.9 %). There was no statistical association between the prediction index of asthma and the sex; however, it was higher among males (19.3 %). Conclusions: The clinical and epidemiologic characteristics of the patients with recurrent wheezing of this case material don't differ from the world epidemiologic context, being an entity of frequent observation in the pediatrics services.

Bronquiolitis por rinovirus en menores de 1 año y riesgo de sibilancias recurrentes y asma

RESUMEN Introducción: La Bronquiolitis se ha asociado a sibilancias recurrentes. Objetivo: analizar la incidencia de sibilancias recurrentes, hospitalizaciones y atopia/asma en pacientes con antecedentes de hospitalización por bronquiolitis por RV antes de los 12 meses de edad. Materiales y Métodos: estudio de cohorte retrospectiva. Ingresaron pacientes de 2 a 4 años con sibilancias recurrentes y antecedentes de hospitalización por bronquiolitis antes de los 12 meses de edad, con retorno viral positivo por estudio molecular. Fueron estudiados los datos demográficos, hospitalizaciones, atopia personal y familiar, asma y exposición al humo. Los datos fueron analizados en SPSS utilizando estadísticas descriptivas e inferenciales. Los resultados se expresaron en RR con IC 95%. El protocolo fue aprobado por el comité de ética institucional. Resultados: Ingresaron 120 pacientes. No hubo diferencias en la incidencia de sibilancias recurrentes en el grupo expuesto y el control50,9% vs 49% respectivamente p=0,85. Las hospitalizaciones por sibilancias y la presencia de atopia fueron más frecuentes en el grupo Rinovirus, RR=1,7 (IC 95% 1,2 -2,9) p=0,03 y RR 1,6 (IC 95% 1,2 -2,2) p= 0,005 respectivamente. Conclusiones: la incidencia de sibilancias recurrentes fue similar en ambas cohortes. Las hospitalizaciones por sibilancias y la atopia/asma fue mayor en el grupo Rinovirus.

ABSTRACT Introduction: Bronchiolitis has been associated with recurrent wheezing. Objective: to analyze the incidence of recurrent wheezing, hospitalizations and atopy / asthma in patients with a history of hospitalization for rhinovirus (RV) bronchiolitis before 12 months of age. Materials and Methods: this was a retrospective cohort study. We included patients aged 2 to 4 years with recurrent wheezing and a history of hospitalization for bronchiolitis before 12 months of age, with a positive viral testing by molecular study. Demographic data, hospitalizations, personal and family history of atopy, asthma and exposure to smoke were studied. The data were analyzed in SPSS using descriptive and inferential statistics. The results were expressed in RR with 95% CI. The protocol was approved by the institutional ethics committee. Results: 120 patients were included. There were no differences in the incidence of recurrent wheezing in the exposed and control groups, 50.9% vs 49%, respectively, p = 0.85. Hospitalizations for wheezing and the presence of atopy were more frequent in the Rhinovirus group, RR = 1.7 (95% CI 1.2 -2.9) p = 0.03 and RR 1.6 (95% CI 1, 2 -2.2) p = 0.005 respectively. Conclusions: the incidence of recurrent wheezing was similar in both cohorts. Hospitalizations for wheezing and atopy / asthma were higher in the Rhinovirus group.

Risk factors of post-bronchiolitis wheezing in infants / 国际儿科学杂志

Objective:To explore the risk factors of recurrent wheezing in infants after bronchiolitis, and to study the influence of different risk factors on recurrent wheezing, so as to provide strategies for clinical treatment and prevention.Methods:Four hundred and ninety-two patients with bronchiolitis in Department of Respiratory Pediatrics, Shengjing Hospital of China Medical University from January 2016 to December 2018 were selected and divided into wheezing group(147 cases)and non wheezing group(345 cases)according to the recurrence of wheezing after bronchiolitis.The data of the selected cases were collected, the risk factors were analyzed and the incidence of recurrent wheezing in patients with different risk factors for bronchiolitis was calculated.Results:In this study, 492 children with bronchiolitis were included, 147 cases(29.9%)had recurrent wheezing.There were significant differences in breastfeeding, artificial feeding, history of eczema, positive allergens reported by parents, family history of asthma, parents suffering from allergic disease, smoke exposure and severe illness between wheezing group and non wheezing group( P<0.05). Logistic regression analysis showed that the risk factors of wheezing after bronchiolitis were severe illness, positive allergens reported by parents, parents suffering from allergic disease, smoke exposure( P<0.05). Patients with one of these risk factors for bronchiolitis had a 16.7%~48.3% chance of recurrent wheezing.Patients with two of these risk factors for bronchiolitis had a 33.3%~100% chance of recurrent wheezing.Patients with three of these risk factors for bronchiolitis had a 50%~100% chance of recurrent wheezing.Patients with bronchiolitis with all four risk factors had a recurrent wheezing rate of 100%. Conclusion:The recurrent wheezing rate of infants with bronchiolitis was at a high level.The risk factors of wheezing after bronchiolitis were severe illness, positive allergen reported by parents, parents suffering from allergic disease and smoke exposure.The more risk factors, the higher probability of wheezing after bronchiolitis.

Progress on the mechanism of human adenovirus infection induced asthmatic disease in children / 国际儿科学杂志

Human adenovirus(HAdV)is one of the most common pathogens in children with community-acquired pneumonia.Due to the heterogeneity of the lesion site of adenovirus pneumonia and the easy involvement of small airways, it is often associated with a wheezing attack, which can also lead to an acute attack of asthma, or even an independent risk factor for bronchial asthma.Childhood adenovirus infection can often lead to latent infection and long-term carrying, and some children can be left with different degrees of pulmonary sequelae.In recent years, the number of children with wheezing after HAdV infection has increased gradually.As an important pathogen leading to asthmatic diseases in children, HAdV has been paid more and more attention in clinical practice, and it is particularly important to explore its pathogenesis.

Avaliação do controle da asma em universitários no sul do Brasil / Evaluation of asthma control in university students in southern Brazil

RESUMO: Objetivo: Mensurar o nível de controle da asma em estudantes com relato de chiado no peito no último ano através do Asthma Control Test (ACT). Método: Estudo transversal descritivo realizado com ingressantes na Universidade Federal de Pelotas (UFPel) em 2017, incluindo 1.865 universitários com 18 anos ou mais. Resultados: Cerca de 19% dos universitários apresentaram chiado no peito nos 12 meses que antecederam a entrevista. Destes, 14% apresentaram asma não controlada (ACT ≤18 pontos). A maior prevalência de asma não controlada foi observada no sexo feminino, em indivíduos com 24 anos ou mais, com a cor da pele parda, em um quarto dos universitários pertencentes às classes D e E, e naqueles que não fumam e não consomem bebida alcoólica. Conclusão: Apesar de a população estudada ser composta por universitários, observou-se uma prevalência expressiva de asma não controlada.

ABSTRACT: Objective:To measure the level of asthma control in students who have reported wheezing in the last year throughthe Asthma Control Test (ACT). Method:A cross-sectional study was carried out with students for the University Federal of Pelotas (UFPel) in 2017, including 1865 university students aged 18 years or over. Results: About 19% of the interviewees reported wheezing in the last year. Of these, 14% had uncontrolled asthma (ACT ≤ 18 points).The highest prevalence of uncontrolled asthma was observed among females, in individuals aged 24 years or older, with brown skin color, in one quarter of university students in class D and E, and who did not smoke and did not consume alcohol. Conclusion: Although the population studied was composed by university students, a considerable percentage of them had uncontrolled asthma.

Factores de riesgo de Bronquiolitis en pacientes menores de 2 años

Resumen Introducción: Se estima que a nivel mundial, cada año alrededor del 10% de los lactantes tienen bronquiolitis. Se produce un pico entre los 2 y los 6 meses de edad. Objetivo: Determinar los factores de riesgo de bronquiolitis en menores de dos años que consultaron al servicio de Pediatría del Instituto de Medicina Tropical entre el 2018 y 2019. Método: Estudio de tipo descriptivo, transversal en el que se incluyeron pacientes menores de 2 años internados en el Servicio de Pediatría del Instituto de Medicina Tropical de enero de 2018 a febrero de 2019 con diagnóstico de bronquiolitis en el que se analizaron los factores de riesgo de la enfermedad. Resultados: Se estudió una población de 38 pacientes que presentaron bronquiolitis antes de los 2 años, 19 fueron niños (50%) La edad media al ingreso fue de 3,5 ± 2,8 meses (límites, 1-10 meses). No se han encontrado datos de tabaco en el embarazo. Se detectó VRS en el aspirado nasofaríngeo de 8 niños (21%), la detección viral fue negativa en 14 niños (37%) y no se realizó la determinación en 18 casos (47%). Los siguientes factores de riesgo se asociaron de forma independiente con la bronquiolitis: Asma de los padres, infección por VSR, sibilancia, cianosis y hacinamiento. Los factores de riesgo estudiado, exposición al tabaco, sexo, edad en el momento de la bronquiolitis o lactancia materna exclusiva, no se asociaron con el ingreso a UTI de los pacientes con bronquiolitis. Conclusión: Hemos encontrado factores de riesgo asociado relacionados al huésped como asma de los padres, y otros como sibilancia, cianosis, hacinamiento e infección por VRS.

Abstract Introduction: It is estimated that globally, each year around 10% of infants have bronchiolitis. A peak occurs between 2 and 6 months of age Objective: To determine the risk factors of bronchiolitis in children less than two years of age who admitted at the pediatric service of the Institute of Tropical Medicine between 2017 and 2019 Method: A descriptive, cross-sectional study in which patients under 2 years of age admitted to the Pediatric Service of the Institute of Tropical Medicine from January 2018 to February 2019 were included with a diagnosis of bronchiolitis in which the risk factors of the disease were analyzed. Results: We studied a population of 38 patients who presented bronchiolitis before 2 years, 19 were children (50%) The average age at admission was 3.5 ± 2.8 months (range, 1-10 months). No tobacco data were found in pregnancy. RSV was detected in the nasopharyngeal aspirate of 8 children (21%), viral detection was negative in 14 children (37%) and the determination was not made in 18 cases (47%). The following risk factors were independently associated with bronchiolitis: Asthma of the parents, RSV infection, wheezing, cyanosis and overcrowding. The risk factors studied exposure to tobacco, sex, age at the time of bronchiolitis or exclusive breastfeeding were not associated with admission to the ICU of patients with bronchiolitis. Conclusion: We have found associated risk factors related to the host such as asthma of the parents, and others such as wheezing, cyanosis, overcrowding and RSV infection.

Clinical profile of children aged 2 months to 60 months presenting with wheeze in a tertiary medical centre

Background: Wheezing is common throughout infancy and childhood except in the neonatal period where it is relatively rare. By 10 years of age, about 19% of children experience wheezing with an average onset at 3 years of age. This study was aimed to identify the diverse factors associated with wheezing in children aged 2 months to 60 months and to study clinical profile along with short term outcome of the same.Methods: It was a hospital based cross-sectional study carried out in the Department of Paediatrics, Regional Institute of Medical Sciences Hospital (RIMS), Imphal, Manipur. The Study population consisted of randomly selected 131 children aged 2 months to 60 months who were admitted in Paediatrics ward with the symptom of wheezing.Results: Authors found that age below 12 months, male sex, low socioeconomic conditions and artificial breastfeeding practices were important risk factors for wheeze.Conclusions: Wheezing is accountable for a high demand of medical consultations and emergency care services with relatively high rates of hospitalization. Along with ARI, it plays an important role in infant mortality. In Manipur, it is being observed that increasing number of children with wheezing are attended by paediatricians in ED, OPD and ward, thereby proving an added burden to the younger age group. Therefore proper health education and counselling of parents, promotion of exclusive breast feeding and improvement of socioeconomic status can play a vital role in preventing occurrence of wheeze among the children.

Estudio descriptivo transversal: Asma en niños de 2 a 5 años identificados con los criterios API en dos hospitales de la ciudad de Cuenca en el periodo Junio 2015 ­ Enero 2016 / Cross - sectional study: Asthma in children aged 2 to 5 years identified with Asthma Predictive index in two hospitals, Cuenca, Ecuador. June 2015 - January 2016

INTRODUCCIÓN: El asma es una enfermedad de curso crónico que afecta la calidad de vida de los pa-cientes que la padecen y es por lo general diagnosticada a partir de los seis años de edad; sin embargo se ha notado que ésta aparece desde antes de la edad escolar en forma de sibilancias recurrentes, pero por la dificultad diagnóstica en la edad de lactancia y preescolar se han desarrollado varios índices como herramientas diagnósticas. El objetivo de este estudio es caracterizar pacientes sibilantes de 2 a 5 años de edad de acuerdo a los criterios del Índice Predictivo de Asma (API). MATERIALES y MÉTODOS: Se realizó un estudio descriptivo transversal y de correlación con todos los pacientes de 2 a 5 años que acudieron a consulta externa de Pediatría del Hospital Monte Sinaí y Hospital Militar desde junio de 2015 hasta enero de 2016 con sibilancias recurrentes, como criterio de inclusión. Se aplicó cuestionarios que contenían los criterios mayores (diagnóstico médico de eccema, antecedentes de asma en padres o familiares) y menores (diagnóstico médico de rinitis alérgica, sibi-lancias no asociadas a resfríos, eosinofilia >4%) del Índice Predictivo de Asma de Castro-Rodríguez y también que contaba con las variables de edad, sexo, talla, peso e índice de masa corporal (IMC). RESULTADOS:Se obtuvo una población total de 105 niños con sibilancias recurrentes, donde el 92.4% de ellos fueron API positivos y 7.6% negativos. 60% de pacientes cumplieron con el criterio mayor diagnóstico médico de eccema, 36.2% cumplió el criterio mayor de antecedentes personales de asma en padres o familiares. Dentro de los criterios menores el más frecuente fue de sibilancias recurrentes no asociadas a resfrío con el 93.3%, seguidamente se encuentra el criterio diagnóstico médico de rinitis alérgica con el 85.7%, finalmente, la eosinofilia >4% se obtuvo en el 45.71%. Se encontró asociación estadística significativa entre edad y diagnóstico médico de eccema y entre edad y presencia de eo-sinofilia mayor del 4%. No se observó una asociación significativa entre el estado nutricional y ser API positivo o negativo. Se encontró asociación estadística significativa entre sexo y diagnóstico médico de rinitis alérgica y entre sexo y sibilancias no asociados a resfríos. CONCLUSIÓN: Los criterios API son una herramienta de fácil aplicación para caracterizar e identificar a niños sibilantes preescolares que tienen alto riesgo de desarrollar asma en la edad escolar. (au)

BACKGROUND: Asthma is a chronic disease, which impacts in the patient's life quality, it is generally diagnosed from six years of age; however it has been reported that asthma manifests itself even in preschool age with recurrent wheezing, but due to difficult diagnosis at this age, several index have been developed as useful diagnostic tools. The main pur-pose of this research is to characterize sibilant patients from 2 to 5 years according to the API(Asthma Predictive Index) criteria. METHODS: A descriptive, cross-sectional and correlational study was carried out with all the patients from 2 to 5 years who attended to a medical appointment at Pediatrics department from Hospital Monte Sinaí and Hospital Militar from June 2015 to January 2016 with recurrent wheezing as the inclusion criteria. The Castro ­ Rodríguez Asthma Predictive Index questionnaires were applied, it contained major criteria (medical diagnosis of eczema, history of asthma in pa-rents and relatives) and minor criteria (medical diagnosis of allergic rhinitis, wheezing not associated with colds, eosi-nophilia> 4%). We also included the variables: age, sex, height, weight and body mass index. RESULTS: A total population of 105 children was obtained, 92.4% of them were API positive and 7.6% negative. 60% of the patients had medical diagnosis of eczema, 36.2% had familiar history of asthma. Recurrent wheezing not associated with colds was the most frequent minor criteria with 93.3%, 85.7% had medical diagnosis of allergic rhinitis, and 45.71% had eosinophilia > 4%. We found statistical significant association between age and eczema diagnosis, and between age and eosinophilia > 4%. There was not association between nutritional conditions and being API positive. There was statistical significant association between sex and allergic rhinitis, and between sex and not cold related wheezing. CONClUSION: The API index is an easy application tool to characterize and identify preschool sibilant children with high risk of developing asthma later in childhood. (au)

A azitromicina administrada para bronquiolite aguda pode ter um efeito de proteção na sibilância recorrente / Azithromycin administered for acute bronchiolitis may have a protective effect on subsequent wheezing

RESUMO Objetivo Uma proporção significativa de lactentes desenvolve sibilância recorrente após um evento de bronquiolite aguda (BA). Estudos recentes demonstraram proteção para sibilância recorrente e menor morbidade respiratória em lactentes tratados com azitromicina durante uma crise de sibilância. O objetivo do presente estudo foi testar a hipótese de que a administração de azitromicina durante um evento BA reduz sibilos e reinternações hospitalares subsequentes. Métodos Trata-se de uma análise secundária de um estudo randomizado, duplo-cego, controlado por placebo, incluindo dados não publicados de sibilância e hospitalizações durante os seis meses iniciais após a internação por bronquiolite aguda. O estudo foi realizado em um hospital universitário terciário. Os bebês (<12 meses de idade) hospitalizados com BA foram randomizados para receber azitromicina ou placebo, administrados por via oral, por sete dias. As famílias foram contatadas por telefone aos três e seis meses após o evento agudo inicial, e responderam a um questionário padronizado para identificar sibilos recorrentes e reinternações hospitalares. Resultados Cento e quatro pacientes foram incluídos (grupo Azitromicina, n=50; grupo Placebo, n=54). Considerando o total de pacientes contatados com sucesso três meses após a hospitalização (n=70), a taxa de recorrência de sibilância no grupo da azitromicina foi significativamente menor do que no grupo placebo (RR=0,48; CI=0,24-0.98; p=0,038). Conclusões A azitromicina reduziu significativamente o risco de sibilância subsequente entre zero e três meses após a admissão hospitalar por bronquiolite aguda.

ABSTRACT Objective A significant proportion of the infants developed recurrent wheezing after an acute bronchiolitis (AB) event. Recent studies have demonstrated protection for recurrent wheeze and lower respiratory morbidity in infants treated with azithromycin during an acute respiratory wheezing. The aim of the present study was to test the hypothesis that administration of azithromycin during an AB event reduces subsequent wheezing and hospital re-admissions. Methods This is a secondary analysis of a randomized, double-blinded, placebo-controlled trial, including unpublished data of wheezing and hospitalizations during the initial 6 months following admission for acute viral bronchiolitis. The study was performed in a tertiary University hospital. Infants (<12 months of age) hospitalized with AB were randomized to receive either azithromycin or placebo, administered orally, for 7 days. Families were contacted by telephone at 3 and 6 months after the initial acute event and answered to a standardized questionnaire in order to identify recurrent wheezing and hospital readmissions. Results One hundred and four patients were included (Azithromycin group, n= 50; placebo group, n=54). Considering the total of patients contacted 3 months after hospitalization (n=70), the recurrence rate of wheezing in the azithromycin group was significantly lower than in the placebo group (RR = 0.48; CI = 0.24-0.98; p = 0.038). Conclusion Azithromycin significantly reduces the risk of subsequent wheezing between 0 and 3 months after hospital admission due to acute bronchiolitis irrespective of the presence of respiratory syncytial virus.

Bronquiolitis Obliterante como secuela de infección por Adenovirus. Presentación de caso, Hospital Infantil Dr. Robert Reid Cabral / Bronchiolitis Obliterans as sequel of Adenovirus infection. Case report, Hospital Infantil Dr. Robert Reid Cabral

Los procesos pulmonares en menores de dos años son causados en su mayoría por agentes virales, los cuales, en gran parte, se resuelven sin complicaciones posteriores. Sin embargo, hay agentes causales que debemos tener presentes puesto que pueden dejar secuelas importantes a nivel pulmonar. A continuación, presentamos un caso de bronquiolitis obliterante como secuela de infección por adenovirus

Pulmonary processes in children under two years are mostly caused by viral agents, which are largely resolved without further complications, however there are causal agents that we must keep in mind that can leave important sequelae at the lungs. We present a case of Bronchiolitis Obliterans as sequel of Adenovirus infection