Methacholine challenge test by wheezing and oxygen saturation in preschool children with asthma

Methacholine challenge test (MCT) performed with spirometry is a commonly used test to evaluate bronchial hyperreactivity (BHR) in children. However, preschoolers do not usually collaborate. OBJECTIVES: To assess the usefulness of MCT through clinical evaluation (wheezing auscultation and decreased pulse arterial oxygen saturation [SpO2]) in recurrent wheezing preschoolers with asthma, in comparison to healthy controls. METHODS: We performed the MCT (modified Cockroft method) on healthy and on asthmatic preschoolers. The end point was determined by the presence of wheezing in the chest and/or tracheal auscultation (PCw) and/or a decrease in SpO2 of ≥5 from the baseline value (PCSpO2). Maximal methacholine concentration was 8 mg/ml. RESULTS: The study population comprised 65 children: 32 healthy and 33 asthmatic children. There were no differences in demographic characteristics between the groups. The median methacholine doses for PCw and for PCSpO2 were significantly lower among asthmatic than healthy children: 0.5 mg/ml (0.25-0.5 mg/ml) vs. 2 mg/ml (1-4 mg/ml), respectively, p < 0.001; and 0.25 mg/ml (0.25-0.5 mg/ml) and 2 mg/ml (0.5-4 mg/ml), respectively, p < 0.001. The best cut-off point of PCw was observed at a methacholine concentration of 0.5 mg/ml (AUC = 0.72 [95% CI = 0.66-0.77]), its sensitivity was 91%, specificity 43%, PPV 16% and NPV 98%. For PCSpO2 the best cut-off point was a methacholine concentration of 1 mg/ml (AUC = 0.85 [95% CI 0.81-0.89]), with sensitivity of 80%, specificity 74%, PPV 49%, and NPV 92%. There were no adverse reactions. CONCLUSION: MCT using clinical parameters such as wheezing auscultation and SpO2 measurement could be a useful and safe test to confirm BHR among preschoolers

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Methacholine challenge test by wheezing and oxygen saturation in preschool children with asthma.

UNLABELLED: Methacholine challenge test (MCT) performed with spirometry is a commonly used test to evaluate bronchial hyperreactivity (BHR) in children. However, preschoolers do not usually collaborate. OBJECTIVES: To assess the usefulness of MCT through clinical evaluation (wheezing auscultation and decreased pulse arterial oxygen saturation [SpO2]) in recurrent wheezing preschoolers with asthma, in comparison to healthy controls. METHODS: We performed the MCT (modified Cockroft method) on healthy and on asthmatic preschoolers. The end point was determined by the presence of wheezing in the chest and/or tracheal auscultation (PCw) and/or a decrease in SpO2 of ≥5 from the baseline value (PCSpO2). Maximal methacholine concentration was 8 mg/ml. RESULTS: The study population comprised 65 children: 32 healthy and 33 asthmatic children. There were no differences in demographic characteristics between the groups. The median methacholine doses for PCw and for PCSpO2 were significantly lower among asthmatic than healthy children: 0.5 mg/ml (0.25-0.5 mg/ml) vs. 2 mg/ml (1-4 mg/ml), respectively, p<0.001; and 0.25 mg/ml (0.25-0.5 mg/ml) and 2 mg/ml (0.5-4 mg/ml), respectively, p<0.001. The best cut-off point of PCw was observed at a methacholine concentration of 0.5 mg/ml (AUC=0.72 [95% CI=0.66-0.77]), its sensitivity was 91%, specificity 43%, PPV 16% and NPV 98%. For PCSpO2 the best cut-off point was a methacholine concentration of 1 mg/ml (AUC=0.85 [95% CI 0.81-0.89]), with sensitivity of 80%, specificity 74%, PPV 49%, and NPV 92%. There were no adverse reactions. CONCLUSION: MCT using clinical parameters such as wheezing auscultation and SpO2 measurement could be a useful and safe test to confirm BHR among preschoolers.

Simplified stepwise management of primary spontaneous pneumothorax: a pilot study.

In primary spontaneous pneumothorax (PSP) requiring intervention, removal of air from the pleural space can be achieved by manual needle aspiration or by pleural drainage after insertion of a chest tube. This study aimed to evaluate the efficacy and safety of a serial-steps approach with a single system (small-calibre catheter/Heimlich valve) in a homogeneous population of patients with a first episode of PSP. All patients had an 8.5 F distally multiperforated polyurethane pigtail catheter inserted via the anterior route, at the bedside without any guidance, using the Seldinger technique. A one-way Heimlich valve was connected to the catheter, allowing the air to flow spontaneously outwards for 24-48 h. Thereafter, if the lung failed to re-expand wall suction was applied. Patients with an air leak persisting for >4 days were referred for surgery. Primary end-points were success rates at 24 h and 1 week, and 1 yr recurrence-free survival. In total, 41 consecutive patients entered the study. They were typically thin, young, smoking males. No procedure-related complications were observed. The need for pain relief medication was minimal. Within the first 24 h, most of the patients were able to walk around and half of them were able to take a shower with their catheter in place. The 24-h and 1-week success rates were 61 and 85%, respectively, and the actuarial 1-yr recurrence rate was 24%. Four patients underwent surgical pleurodesis because of a persistent air leak. The length of stay when excluding the four surgical cases was 2.3+/-1.3 days. When 24-h and 1-week success rates and recurrence at 12 months were taken as end-points, the method described here is as effective as simple manual needle aspiration or a conventional chest tube thoracotomy. These results support further studies assessing this "one system, serial-steps approach" in an outpatient management algorithm.

[Pediatric lung resection. A case series and evaluation of postoperative lung function]. / Resección pulmonar en pediatría. Serie clínica y evaluación de la función pulmonar postoperatoria.

The most common causes of pulmonary lobectomy in children are congenital lung malformations (CLM) and bronchiectasias. Our aim was to present the causes and clinical course and lung function of lobectomized patients. Between 1990 and July 1999 27 lobectomies were performed on patients whose ages ranged from newborn to 14 years. Lobectomies were performed to correct CLM in 124 cases and for acquired pulmonary disease (APD) in 13. Among CLM cases, half (n = 7) had cystic adenomatoid malformation. Among the APD patients, 10 had bronchiectasias, with etiological confirmation in 6 cases (3 secondary to serious adenovirus infection). Mean hospital stay was 4.6 days among those who experienced no postoperative complications. Symptoms resolved after surgery for most symptomatic patients. Lung function tests could be carried out with 8 patients over 6 years old whose operations had taken place 7 to 78 months earlier (x = 35 months) and whose age at the time of surgery was a mean 7 years 6 months (range 60 to 144 months). Spirometry showed normal forced vital capacity for 7 of 8 patients (87 to 143% of theoretical value). Arterial oxygen saturation measured during and after a 6-minute walking test was normal for 7 of 8 patients. Chest films showed reduced lung volume on the affected side in 5 of 8 patients. In summary, lobectomy is a procedure with few complications. It requires a short hospital stay and has good postoperative prognosis. Function and x-ray studies show adequate lung growth and development, with normal lung function in those who could be so examined because they were old enough to cooperate.

Resección pulmonar en pediatría. Serie clínica y evaluación de la función pulmonar postoperatoria / Pediatric lung resection. A case series and evaluation of postoperative lung function

Las causas más frecuentes de lobectomía pulmonar en niños son las malformaciones pulmonares congénitas (MPC) y las bronquiectasias. Nuestro objetivo es presentar la casuística y la evolución clínica y funcional respiratoria de pacientes lobectomizados. Entre 1990 y julio de 1999 se realizaron 27 lobectomías, entre recién nacidos y pacientes de 14 años. En 14 casos fue por MPC y en 13 por enfermedad pulmonar adquirida (EPA). Dentro de las MPC la mitad (n = 7) correspondieron a una malformación adenomatoidea quística. Del grupo de EPA 10 fueron bronquiectasias, con confirmación etiológica en 6 casos (3 secundarias a infección grave por adenovirus). De los pacientes que no presentaron complicación postoperatoria, el promedio de estancia hospitalaria fue de 4, 6 días. Las complicaciones fueron la aparición de filtración aérea en 3 casos, requiriendo sólo un tratamiento quirúrgico. En la mayoría de los pacientes sintomáticos hubo resolución de los síntomas posterior a la cirugía. Se logró realizar un estudio funcional respiratorio a 8 pacientes mayores de 6 años, cuya intervención quirúrgica se había realizado entre 7 y 78 meses previos (media de 35 meses) y cuya edad en el momento de la cirugía fue, como promedio de 7 años y 6 meses (rango: 60-144 meses). La espirometría demostró una capacidad vital forzada normal en 7 de 8 pacientes (87-143 por ciento del valor teórico). La medición de la saturación arterial de oxígeno durante y posterior a una caminata de 6 min fue normal en 7 de 8 pacientes. La radiografía de tórax demostró una disminución del volumen pulmonar en el lado intervenido en 5 de 8 pacientes. En resumen, la lobectomía es un procedimiento con escasas complicaciones, requiere un período corto de hospitalización y presenta un buen pronóstico postoperatorio. Los estudios funcional y radiológico demuestran un adecuado crecimiento y desarrollo pulmonar, con una evaluación de la función pulmonar normal en aquellos pacientes que se pudieron estudiar por tener una edad suficiente para poder colaborar en el examen (AU)

[Clinical experience in home care of children with tracheostomy]. / Experiencia clínica en el manejo domiciliario de niños traqueostomizados.

BACKGROUND: Home care of tracheostomized children is considered a safe and low-cost alternative. AIM: To report the experience with tracheostomized children at the Pediatric Respiratory Unit of the Catholic University Hospital. PATIENTS AND METHODS: The records of 16 children (9 male) with tracheostomy (TQ) in home care between 1992 and 1998 were reviewed. RESULTS: The average age at the moment of TQ was 9 months (range 1-30 months) and the postoperative hospital management period was 5 months (range 1-11 months). The average age at discharge was 13 months (range 3 to 30 months). Surgical indication were upper airway obstruction (congenital or acquired subglottic stenosis in three, upper airway malformations in one, vocal cord palsy in one and tracheobronchomalacia in one) and chronic assisted ventilation (severe tracheobronchomalacia in four, pulmonary hypoplasia in two, myopathy in one, central nervous injury in one and bronchopulmonary dysplasia in one). Overall rate complications were 2 per 100 tracheostomy months during home care and 8 per 100 tracheostomy months during hospital care. No tracheostomy-related deaths were observed. A parenteral education program to teach about tracheostomy management and cardiopulmonary resuscitation was carried out. CONCLUSIONS: Tracheostomized children can be safely managed at home.

[Primary ciliary dyskinesia. Experience in 6 patients]. / Disquinesia ciliar primaria. Experiencia en 6 pacientes.

BACKGROUND: Primary ciliary dyskinesia is characterized by a congenital alteration of the ciliary ultrastructure and function. As a consequence, their respiratory tract sweeping action is lost and recurrent respiratory infections ensue. AIM: To analyze a clinical series of patients with primary ciliary dyskinesia, their clinical and laboratory features. PATIENTS AND METHODS: A retrospective review of patients with primary ciliary dyskinesia seen a University Hospital, between 1994 and 1998. Bronchial biopsies were obtained with 3.6 mm diameter Olympus fibrobronchoscope, using a cayman type forceps. Ultrastructural alterations of respiratory tract ciliated cells were recorded. RESULTS: Six patients (four male) aged 9 months to 13 years old were reviewed. Three patients had situs inversus. All had repeated bouts of obstructive bronchitis and pneumonia, five had sinusitis, four atelectasis, three recurrent otitis and three had bronchiectasis. Cystic fibrosis and immunological alterations were ruled out in five children. Ultrastructural analysis revealed absence of dynein arms in three cases, absence of the internal dynein arm in one, additional peripheral microtubules and absence of dynein arms in one case. CONCLUSIONS: Primary ciliary dyskinesia must be considered in the differential diagnosis of recurrent respiratory infections. Ultrastructural analysis of ciliary structure can be done in bronchial biopsies obtained through bronchoscopy.