Non-asthmatic patients show increased exhaled nitric oxide concentrations

OBJECTIVE: Evaluate whether exhaled nitric oxide may serve as a marker of intraoperative bronchospasm. INTRODUCTION: Intraoperative bronchospasm remains a challenging event during anesthesia. Previous studies in asthmatic patients suggest that exhaled nitric oxide may represent a noninvasive measure of airway inflammation. METHODS: A total of 146,358 anesthesia information forms, which were received during the period from 1999 to 2004, were reviewed. Bronchospasm was registered on 863 forms. From those, three groups were identified: 9 non-asthmatic patients (Bronchospasm group), 12 asthmatics (Asthma group) and 10 subjects with no previous airway disease or symptoms (Control group). All subjects were submitted to exhaled nitric oxide measurements (parts/billion), spirometry and the induced sputum test. The data was compared by ANOVA followed by the Tukey test and Kruskal-Wallis followed by Dunn's test. RESULTS: The normal lung function test results for the Bronchospasm group were different from those of the asthma group (p <0.05). The median percentage of eosinophils in induced sputum was higher for the Asthma [2.46 (0.45-6.83)] compared with either the Bronchospasm [0.55 (0-1.26)] or the Control group [0.0 (0)] (p <0.05); exhaled nitric oxide followed a similar pattern for the Asthma [81.55 (57.6-86.85)], Bronchospasm [46.2 (42.0 -62.6] and Control group [18.7 (16.0-24.7)] (p< 0.05). CONCLUSIONS: Non-asthmatic patients with intraoperative bronchospasm detected during anesthesia and endotracheal intubation showed increased expired nitric oxide.

Sensitivity and specificity of self-reported symptoms for exercise-induced bronchospasm diagnosis in children

Exercise-induced bronchospasm [EIB] is a common condition in elite athletes. The purpose of this study was to evaluate the diagnostic value of self-reported EIB symptoms in children. In a cross sectional study in 2005, all soccer player boys of 3 football schools of Shahr Rey a town in the south of Tehran, enrolled in this study. All subjects were asked for the presence of four cardinal symptoms of EIB [cough, wheeze, shortness of breath, chest pain/discomfort] during and after exercise. Self reported symptom-based EIB was defined as having at least two out of four symptoms. Findings were compared to spirometric criteria as a gold standard test. A total of 371 boys were enrolled in this study. The mean age of children was 11.67 +/- 1.53 years [range 7-16 years]. According to spirometric findings, 74 [19.9%] subjects had EIB. The sensitivity and specificity of self-reported symptoms for EIB diagnosis were 13.0% and 89.9%, respectively. Self-reported symptoms of EIB in children can be useful for epidemiological study. Our results in Iran are comparable with studies in other countries and point to a relatively high prevalence of EIB among athlete children

Malformaciones adenomatoidea quística congénita en un niño escolar / Cystic adenomatoid malformations in scholar boy

La malformación adenomatoidea congénita (MAQC) es una anomalia producida por alteraciones de los bronquios terminales. En la histologia se aprecian zonas adenomatosas cerradas y zonas quísticas dilatadas. En los recien nacidos existe una dificultad respiratoria progresiva, lo que no ocurre en pacientes mayores de un año donde se aprecian infecciones respiratorias recurrentes. El diagnóstico antenatal es ideal y I.R.M. se constituye como e método más efectivo del mismo, La radiografia, el ultrasonido y la T.A.C. continuan siendo armas importantes en el diagnóstico. El tratamiento siempre es quirurgico con la resección del parénquima afectado. Se describe a un paciente de 5 años 11 meses de edad, con introducción temprana de alimentos alergénicos, abuelo paterno asmático, abuela y tia paternas alérgicas, ambos padres con rinitis alérgica y asma. Desde los 3 años el niño presenta cuadros de broncoespasmo de predominio nocturno. a los 4 años sufre traumatismo torácico derecho con neumotórax y hemotórax que requiere colocación de sello de agua, posterior a lo cual muestra incremento del broncoespasmo y de infecciones recurrentes de vias aéres superiores e inferiores. A los 5 años acude a consulta especializada y se sospecha de malformaciones congénitas, en las radiografías se aprecian zonas quisticas apicales izquierdas que comprimen el parénquima basal, estos hallazgos se confirman con T.A.C y Gammagrafia. Se realiza tratamiento con cromoglicato y resección del lóbulo superior izquierdo. El examen patológico de la pieza operatoria confirma el diagnóstico de Malformacion adenomatoidea quística congénita tipo II.(au)

Fatores associados com asma aguda grave na infancia - aspectos epidemiologicos e clinicos / Factors related to severe acute asthma in childhood - epidemiologic and clinical aspects

Objetivo: Estudar fatores epidemiológicos e clínicos relacionados com asma aguda em crianças admitidas em UTIP. Tipo de estudo: Observacional, prospectivo, epidemiológico. Pacientes e métodos: Crianças hopitalizadas por asma grave na UTIP-HSL-PUCRS. Foi aplicado um questionário aos familiares destes pacientes, registrando-se história clínica e fatores precipitantes do broncoespasmo. Observou-se a evoluçäo clínica de cada paciente. Resultados: 31 crianças foram admitidas em 42 ocasiöes para o tratamento de asma grave (7,3 por cento das admissöes). A proporçäo masculino:feminino foi 1,2:1,0 e a idade média foi de 25 meses. As infecçöes de vias aéreas superiores foram os principais fatores relacionados ao desencadeamento das crises (74 por cento). A história familiar de asma , atopia ou tabagismo foi obsevada em 97 por cento dos casos. ...