Lung function and cardiopulmonary response to exercise in children with thalassemia major

There is no consensus about the exact nature of the pulmonary dysfunction in children with thalassemia major [TM]. Pulmonary vascular involvement by microthrombosis was suggested as a cause of pulmonary hypertension and/or abnormal pulmonary function test [PFT]. The aim of this work was to, [1] determine the predominant abnormality of PFT in children with TM, [2] detect the potential pulmonary hypertension [PH] and/or other forms of cardiac dysfunction, and [3] investigate whether exercise tolerance would be predominantly affected by cardiac, and or pulmonary abnormalities.Twenty five children with TM aged 8-15 year were investigated by echocardiography, lung function, carbon monoxide diffusion and coefficient by single breath method [DLcoSB], and exercise testing a few days after transfusions. All have had regular transfusions and chelation with deferoxamine and none had chronic pulmonary disease symptoms. Twelve healthy children underwent the same investigations as control group. The results proved that three TM children [12%] had severe restrictive lung disease, 9 [36%] had moderate restrictive and 3 [12%] had mild restrictive abnormality during lung function. DLcoSB was below cent predicted value in 48% of TM children, 91.6% of them had restrictive lung function. DLcoSB was normal in control group. Echocardiographic abnormalities were left ventricular dysfunction [LVD] in 11 TM children, 4 of them had PH. Two of the patient with PH had right ventricular dysfunction [RVD]. Significant decrease in exercise capacity was seen in all children with TM but none of the control group. Severe exercise impairment due to ventilatory limitation was observed in 4 [16%], moderately severe exercise impairment due to cardiac limitation was observed in 13 TM children [56%], and 7 TM children [28%] had mild exercise impairment due to cardiac limitation. 14 TM children [54%] had mild to moderate cardiac limitation to exercise without echocardiographic abnormalities

Conclusion: Restrictive lung disease is the predominant abnormality of PF in children with TM. LVD, and PH are common finding in children with TM. Moderate to severe exercise impairment due to abnormal cardiac response was the most frequent observation in TM children with or without echocardiographic abnormalities, while ventilatory limitation to exercise was less frequent. The early detection of cardiac abnormalities and lung limitation may have important therapeutic and prognostic implications in children with TM. Further studies would be warranted to establish the long term reproducibility of indices derived from exercise testing as tool to detect early cardiac dysfunction in the course of this disease in children

Pulmonary function abnormalities in children with henoch-schönlein purpura

Henoch-Schönlein purpura [HSP] is a widespread necrotizing vasculitis affecting small vessels, characterized by nonthrombocytopenic purpura. Pulmonary involvement is a rare fatal complication with diffuse alveolar hemorrhage. The objective of this study was to evaluate possible early lung function abnormalities and to establish any relationship with the clinical activity of the disease. Fifteen children with HSP and without clinical or radiological evidence of lung involvement undem/ent pulmonary function study at the onset of the disease. A sample subjects matched by age, height, and weight was chosen as a control. After a mean of 11 months [range 10-12] lung function tests were repeated in 10 of the previously studied children. During the acute phase of the disease the transfer factor for carbon monoxide, measured singIe-breath [DLcoSB] method, was found to be significantly lower in children with HSP than control subjects. There was no significant relationship between pulmonary function tests with symptoms and signs at onset, nor was there any correlation between variables and serum immunoglobulin A [IgA] concentration. In all but two patients, clinical recovery was observed within 6 weeks from the onset of the disease. In one case relapses of purpuric skin lesions were observed during the tirst 3 months of follow-up. The second case had relapses of purpuric skin lesions and microscopical hematuria during the 12 months following the onset of the disease with characteristic IgA mesangial deposition on renal biopsy. Although the overall mean value of DLcoSB improved from baseline to the second investigation, in both patients the recurrences of clinical signs were associated with a slight impairment of DLcoSB at the second evaluation

Conclusion: These data suggest an early subclinical lung impairment in children with HenochSchénlein purpura during the active phase of the disease. The presence of isolated pulmonary function abnormalities was not associated with the subsequent development of lung disease

Prevalence rate of bronchial asthma in school children aged 6-14 years in Alexandria

Bronchial asthma [BA] is a leading cause of chronic illness in childhood. It is considered the most prevalent chronic condition in children responsible for a significant proportion of both acute and chronic illness and also school absenteeism. The aim of the present work was to determine the prevalence of BA in school children aged 6-14 years in Alexandria, and to reveal some epidemiological features. A representative sample of children [2336] of the target population was surveyed by using stratified random sampling technique. Data were collected using pre-designed questionnaire to be fulfilled by the parents of the child. All asthmatic children detected were included in the study and subjected to thorough history, and clinical examination, x-ray chest, pulmonary function test and samples of them were subjected to bronchial challenge testing. The prevalence rate of asthmatic children aged 6-14 years in Alexandria was 18% in scholastic year 2001-2002. The prevalence rate for males and females were 9.6% and 8.4% respectively, which was not statistically significant [P=0.936]. There was a decrease of asthma incidence and severity with increasing age but this was not statistically significant [P=0.707]. Also, socioeconomic status did not influence the prevalence rate of asthma in the present work. Most children have their asthma exacerbations during cold weather [P=0.047]. The prevalence of asthma was not influenced be the district. Although severe persistent asthma increased in low socioeconomic districts [Borg EI-Arab, and El-Gomrok] but this was not statistically significant

Conclusion: The prevalence rate of BA among school children aged 6-14 years in Alexandria has increased dramatically during the last 25 years to reach 18% in the scholastic year 2001-2002. Asthma exacerbations increased significantly during cold weather. Although severe persistent asthma increased in EI-Gomrok and Borg AI-Arab districts, but this was not statistically significant. Sixty percent of cases of asthmatic children in this study were cases of persistent asthma which are in need for maintenance therapy. Twenty eight percent of cases are under diagnosed due to lack of knowledge about this disease. Asthma in not influenced by sex or age but affect both sex and all age