ABSTRACT
BACKGROUND: Asthma seems to be the more prevalent underlying condition in patients hospitalized for H1N1-related flu. METHODS: A prospective survey was conducted during the early phase of H1N1 pandemic in France in asthmatic children before vaccination to assess whether severe exacerbations in childhood asthma are associated with influenza-like illness (ILI, the definition of H1N1-related flu in a pandemic). Eight pediatricians in primary care distributed in three localities (Paris, south suburb, and west suburb) conducted the survey (4 weeks/locality from week 36 to 47). At each visit, the pediatrician filled a questionnaire entering the information regarding asthma treatment, severe exacerbation (at least 3 days' use of systemic corticosteroids), and ILI (temperature ≥37.8°C, cough, and/or sore throat, in the absence of a known cause other than influenza) during the past 3 weeks. RESULTS: The survey included 1155 asthmatic children (mean age [SD]: 7.5 years [4.1]); almost all visits were scheduled (99%). A severe exacerbation was recorded in 121 children [10.5%; 95% confidence interval (CI): 8.7-12.2%], which was concomitant with ILI in 20 children (16.5%; 95% CI: 9.9-23.2%), whereas 1034 children did not exhibit any exacerbation. In these latter children, 40 ILI were observed (3.9%; 95% CI: 2.7-5.0%), which constituted a significantly lesser percentage as compared with children with both exacerbation and ILI (p < .0001). This result remained significant in each locality. Overall, 60/1155 (5.2%; 95% CI: 3.9-6.5%) asthmatic children had an ILI. CONCLUSIONS: Our survey shows that severe exacerbation and ILI are strongly associated during the H1N1 pandemic in asthmatic children.
Subject(s)
Asthma/complications , Asthma/epidemiology , Influenza A Virus, H1N1 Subtype , Influenza, Human/complications , Influenza, Human/epidemiology , Pandemics , Vaccination , Adrenal Cortex Hormones/therapeutic use , Asthma/drug therapy , Child , Child, Preschool , Female , Hospitalization/statistics & numerical data , Humans , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Longitudinal Studies , Male , Paris/epidemiology , Suburban Population/statistics & numerical data , Surveys and QuestionnairesSubject(s)
Antibodies, Monoclonal/administration & dosage , Antiviral Agents/administration & dosage , Bronchiolitis, Viral/prevention & control , Respiratory Syncytial Virus Infections/prevention & control , Respiratory Syncytial Virus Vaccines/administration & dosage , Respiratory Syncytial Virus, Human , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Antiviral Agents/adverse effects , Double-Blind Method , Gestational Age , Health Education , Heart Defects, Congenital/complications , Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/prevention & control , Multicenter Studies as Topic , Palivizumab , Parents/education , Randomized Controlled Trials as Topic , Risk Factors , Treatment OutcomeSubject(s)
Cystic Fibrosis , Anti-Bacterial Agents/therapeutic use , Child , Cystic Fibrosis/diagnosis , Cystic Fibrosis/epidemiology , Cystic Fibrosis/genetics , Cystic Fibrosis/therapy , Expectorants/therapeutic use , France/epidemiology , Humans , Infant, Newborn , Long-Term Care , Lung Transplantation , Middle Aged , Neonatal Screening/organization & administration , Respiratory Therapy , Survival RateSubject(s)
Cystic Fibrosis/diagnosis , Neonatal Screening/organization & administration , Algorithms , Cystic Fibrosis/epidemiology , Cystic Fibrosis/genetics , Decision Trees , France/epidemiology , Humans , Infant, Newborn , National Health Programs/organization & administration , Neonatal Screening/nursingABSTRACT
OBJECTIVE: . The aim of this study was to establish objective, simple criteria for bronchial wall thickening in children with difficult-to-treat asthma. SUBJECTS AND METHODS: . Bronchial sections were counted at five levels in both lungs and at three levels in the right lung on high-resolution CT and plotted against lung function. Findings from 27 children with persistent symptoms of asthma (mean age, 11.4 years; SD, +/-3.1 years) that were severe (group A, n = 15) or moderate (group B, n = 12) were compared with findings from 21 control subjects (mean age, 10.8 years; SD, +/-3.0 years) using the Student's t test, analysis of variance, and Dunn-Bonferroni test. RESULTS: . A bronchial wall thickening score based on the number of visible bronchi at three levels (three-level score) proved to be as valuable as and simpler to obtain than a score based on the number of bronchi at five levels (five-level score). The three-level scores for groups A and B were similar (mean +/- SD, 16.8 +/- 4.2 vs 18.4 +/- 3.4, respectively; p = not significant), but these scores were significantly higher than those for the control subjects (mean +/- SD, 8.2 +/- 3.4, respectively; p < 0.001). There was no correlation between the three-level score and forced expiratory volume in 1 sec or forced expiratory flow between 25% and 75% of forced vital capacity. In contrast with adults with severe asthma, our pediatric patients with difficult-to-treat asthma did not have CT evidence of mucoid impaction, emphysema, areas of hyperlucency, bronchiectasis, or sequellar line shadows. CONCLUSION: . Bronchial wall thickening visible on high-resolution CT may constitute an additional criterion of asthma severity in children. CT evidence of bronchial wall thickening might help to identify patients with a higher risk of airway remodeling.
