ABSTRACT
BACKGROUND: Pediatric home care has improved therapeutic options for children with chronic disease. Home intravenous (IV) antibiotic treatment against Pseudomonas aeruginosa (PsA) in cystic fibrosis (CF) patients has offered increased flexibility to these patients and family life. A prospective clinical study was conducted to compare safety, efficacy, and cost benefits of home versus hospital IV antibiotic treatment among CF children and adolescents. METHOD: The clinical outcome, quality of life, and cost benefits of home versus hospital antibiotic treatment were assessed. The clinical outcome was evaluated with Forced Expiratory Volume in one second (FEV1) and weight gain before and one month after antibiotic treatment, while the Quality of life was evaluated using the DISABKIDS questionnaire. Cost analysis was performed to calculate cost benefits from home IV treatment. RESULTS: Thirty-five stable patients with CF (mean age: 12.6 ± 7 years, 56 % male, mean FEV1: 83.5 ± 26 %), colonized with PsA, were treated with IV antibiotics for two weeks either in the hospital (15 patients), or at home (20 patients) under supervision by a home care nurse. Lung function (FEV1) and weight improved significantly in both groups (ΔFEV1% =7.7 ± 6.1, p <0.001; ΔWeight =1.2 ± 0.8, p <0.001). Hospital treatment did not show a better clinical outcome, compared to home treatment (ΔFEV1, p =0.606; ΔWeight, p =0.608). Both improvements in the quality of life and economical savings were substantial (p <0.001) regarding patients treated at home. Also, patients treated at home did not report any significant side effects or complications. CONCLUSIONS: Home IV antibiotic therapy monitored by a home care nurse, is a safe, efficient, and cost-saving therapeutic option in CF. Hippokratia 2016, 20(4): 279-283.
ABSTRACT
BACKGROUND: Progressive lung disease is the main cause of clinical deterioration and mortality in cystic fibrosis (CF) patients. Being able to assess the effectiveness of interventions is very significant. OBJECTIVES: To assess the response to intravenous (IV) treatment among CF patients, using forced expired volume in 1(st) second (FEV1) and Lung Clearance Index (LCI) as outcome measures and to compare the effect of IV treatment on lung function and LCI between CF children being treated on a regular basis, or in case of a pulmonary exacerbation. SUBJECTS AND METHODS: Thirty-two CF patients (15 males) with mean age 9.90 (range: 2-23) years, performed spirometry and multiple breath washout (MBW) before and one month after IV antibiotic treatment. Nineteen patients received a course of elective treatment (group A) and 13 received IV antibiotic regimens for an acute exacerbation (group B). RESULTS: Statistically significant differences after treatment were seen in LCI (p≤0.001), and Forced Expiratory Flow (FEF) z-scores (p<0.05). FEV1 did not change significantly after drug intervention. Dividing patients into two groups, only LCI showed significant change (p<0.05), when treatment was administered on a regular basis. Patients being treated for an acute pulmonary exacerbation showed significant improvement in most of the lung function parameters: LCI (p=0.0001), FEV1% (p=0.05), FEV1 z-score (p=0.033) and FEF25-75 (p=0.046). The mean LCI difference was significantly greater in group B compared to group A (p=0.001). CONCLUSION: LCI is more sensitive marker than FEV1 to assess the effect of IV antibiotic treatment among CF children. IV antibiotics are more effective on lung function parameters, when they are administered for an acute exacerbation, than when they are given on a regular basis. Hippokratia 2015, 19 (1): 47-52.
ABSTRACT
BACKGROUND AND AIM: Flexible fiberoptic bronchoscopy (FFB) is one of the most important procedures in paediatric pulmonology. To the best of our knowledge there is no review - audit summarising the experience with FFB in children in Greece. We therefore analysed retrospectively all FFBs performed by the paediatric pulmonology team in our hospital in order to analyse indications for bronchoscopy in our population, explore diagnostic yield for each indication and highlight potential complications. Material - Methods: Three hundred and sixteen (316) diagnostic FFBs performed in 305 children during a six years period were retrospectively analysed. RESULTS: Seventy five (75) % of bronchoscopies had a meaningful outcome. Diagnostic yield for individual indications ranged from 41% to 91%. Stridor was the most rewarding indication (91%). Fever was the most common side effect (7%). The rest of complications were in small numbers and easily reversible. CONCLUSIONS: Bronchoscopy is a safe procedure and in our diverse population the overall diagnostic yield was 75%.
ABSTRACT
BACKGROUND: Acute exacerbations of respiratory diseases are a common cause of hospitalization among infants and children. AIM: To assess the epidemiological characteristics of asthma, bronchiolitis and croup among hospitalized children in Thessaloniki, from 1990 to 2003 included. METHODS: Data from the patient registry with discharge diagnosis "asthma", "bronchiolitis" and "croup" were analyzed retrospectively, in five Paediatric Departments of Thessaloniki. Age and sex of the patients, as well as the month of admission were taken into consideration. RESULTS: A total of 8762 admissions of children (aged 3 months-14 years) with the diagnosis of asthma, "bronchiolitis" and "croup", were identified. Sex distribution was 65.86% males (64.86% bronchiolitis, 65.26% asthma and 70.31% croup). Asthma admissions decreased by 53.65%, croup admissions decreased by 4.73%, while bronchiolitis admissions increased by 25.03%, during the study period. A clear seasonal variation was found in all the three diseases, with the lowest incidence during summer months. Moreover there were two peaks for asthma (one during spring and a second during autumn), one peak for bronchiolitis (during winter early spring) and one peak for croup (during autumn). CONCLUSIONS: Paediatric asthma and croup admissions have declined during the last 14 years, in contrast with bronchiolitis admissions, which showed an increased tendency. More frequent use of inhaled steroids and induction of asthma education programs may have contributed to decreasing asthma admission rates.
