Exhaled nitric oxide distinguishes between subgroups of preschool children with respiratory symptoms.

BACKGROUND: Respiratory symptoms are common in early childhood. The clinical characterization of disease presentation and hence its likely disease progression has so far been proven difficult. OBJECTIVE: To investigate whether exhaled nitric oxide (NO) could be helpful to distinguish between subgroups of nonwheezy and wheezy young children less than 4 years of age. METHODS: Exhaled NO was measured in 391 children (age 3-47 months) with nonwheezy and wheezy respiratory symptoms. Children were divided into 3 groups: children with recurrent cough but no history of wheeze (group 1), with early recurrent wheeze and a loose index for the prediction of asthma at school age (group 2), and with frequent recurrent wheeze and a stringent index for the prediction of asthma at school age (group 3). RESULTS: Children from group 3 showed significantly higher median (interquartile range) fractional exhaled NO (FeNO) levels (11.7 [11.85]) than children from groups 1 (6.5 [5.5]; P < .001) and 2 (6.4 [6.5]; P < .001). No difference in FeNO levels was found between children from groups 1 and 2 (P = .91). CONCLUSION: Wheezy young children less than 4 years of age with a stringent index for the prediction of asthma at school age have elevated levels of FeNO compared with children with recurrent wheeze and a loose index for the prediction of asthma at school age or children with recurrent cough.

Effects of a multidisciplinary inpatient intervention on body composition, aerobic fitness, and quality of life in severely obese girls and boys.

PURPOSE: The last few decades have seen a major increase in the prevalence of juvenile obesity. Inpatient treatment programs are used mainly in children with severe obesity and related comorbidities. The aim of this study was to evaluate the gender differences of an 8-week multidisciplinary inpatient program on body weight, body composition, aerobic fitness, and quality of life of severely obese children and adolescents. METHODS: Body weight was measured daily, and body composition, aerobic fitness, and quality of life were measured at the beginning and the end of an 8-week multidisciplinary inpatient program in 130 severely obese patients (52 girls, 78 boys), median (25th, 75th percentile) age of 13.8 (12.1, 15.0) years, median body weight of 89.4 kg (77.1, 100.1), and a body mass index of 33.4 (30.1, 36.6) kg/m(2), which is well above the 98th percentile. The inpatient program was based on a multidisciplinary treatment and education program that focused on daily physical activity, a 1200-1600 kcal/day balanced nutrition regimen, and a behavior modification therapy. RESULTS: All results are expressed as medians (25th, 75th percentiles). At the end of the program all patients had lost a significant amount of body weight: 12.7 kg (10.8, 16.6), p < .001, girls 11.6 kg (9.7, 13.2), boys 13.7 kg (11.7, 17.3), p < .001, absolute body fat 8.0 kg (6.8, 10.0) p < 001, girls 7.0 kg (5.7, 8.1), boys 9.4 kg (7.6, 11.0) p < .001, % body fat per kg body weight: 4.9% (3.2, 6.6) p < .001, girls 3.7% (2.7, 4.9), boys 5.7% (4.0, 7.5) p < .001, and absolute fat free (or lean body) mass: 1.8 kg (0.64, 3.0) p < .001, girls 1.8 kg (0.87, 3.2), boys 1.7 kg (0.50, 2.9) p = .43. In addition, all measurements of aerobic fitness: VO(2)peak (mL/min.kg) and peak mechanical power (watts and watt/kg) and of quality of life increased significantly (p < .001, p < .001, p < .004 to p < .001). CONCLUSION: A multidisciplinary inpatient treatment program including moderate calorie restriction, daily physical activity, and behavior modification induced a major weight loss, a decrease in body fat, and an increse in aerobic fitness as well as the quality fo life of severely obese children and adolescents. Weight loss and the decrease in body fat (absolute and percent) were significantly more pronounced in boys than girls.

Facemasks and aerosol delivery in vivo.

It has been shown in vitro that even a small air leak in the facemask can drastically reduce the efficiency of drug delivery. In addition, it has been shown that drug deposition on the face does significantly add to overall drug loss and has the potential of local side effects. The aim of this study is therefore to verify these findings in vivo. Eight asymptomatic recurrently wheezy children, aged 18-36 months, inhaled a radiolabeled salbutamol formulation either from a pressurized metered-dose inhaler through a spacer with attached facemask or from a nebulizer with attached facemask. Drug deposition of radiolabeled salbutamol was assessed with a gamma camera and expressed as a percentage of the total dose. Lung deposition expressed as a percentage of the total dose (metered dose and nebulizer fill, respectively) was 0.2% and 0.3% in children who inhaled with a non-tightly fitted facemask. Lung deposition was 0.6% and 1.4% in screaming children with a tightly fitted facemask and between 4.8% and 8.2% in patients breathing normally. Overall mask deposition was between 0.8% and 5.2%. Overall face deposition was between 2.6% and 8.4%. The results from this pilot study support the results found in in vitro studies, where a facemask leak greatly reduces drug delivery to the patient.

Disease control in asthmatic children seen in private practice in Switzerland.

BACKGROUND: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice. METHODS: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2. RESULTS: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2. CONCLUSIONS: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.