Based on what parameters is safe to discontinuate inhaled corticosteroids in children with asthma?

OBJECTIVE: Remission of childhood asthma has not been widely studied. Patients in clinical remission continue to have some degree of bronchial hyperresponsiveness (BHR). The aim of this study was to investigate whether clinical parameters and lung function test are good parameters for discontinuation of inhaled corticosteroids (ICS) in asthmatic children, including patients with persistent BHR, as measured by the methacholine challenge test (MCT). METHODS: One year after discontinuation of inhaled corticosteroids (ICS), MCT was performed in a group of 40 asthmatic children to confirm or exclude BHR. In all patients, ICS treatment was discontinued based on the same parameters: symptoms, spirometry, daily PEF, and negative bronchodilator test. After achieving complete asthma control for at least 6 to 12 months, ICS treatment was stepped down and discontinued. Clinical course and spirometry were followed up after ICS discontinuation. RESULTS: Positive MCT was found in 50% of the patients. There was no statistically significant difference between the positive and negative MCT groups in age at initiation and discontinuation of ICS therapy, duration of ICS therapy, duration of stepping down period, FEV1, and PEF at the time of withdrawal of ICS and one year later. ICS treatment had to be restarted in two patients from the positive MCT group, due to recurrence of asthma symptoms. CONCLUSION: Clinical parameters, normal spirometry, daily PEF values, and a negative bronchodilator test are good parameters for discontinuing ICS treatment in asthmatic children, even in patients with persistent BHR. Children should continue to be monitored, as symptoms may recur.

PARENTAL AWARENESS OF THE DANGERS OF FOREIGN BODY INHALATION IN CHILDREN.

Background: The presence of a foreign body in the airways is a life-threatening condition and thus a medical emergency that requires timely diagnosis and treatment. If not recognized, it can lead to a number of serious complications. It is of the utmost importance to raise public awareness and educate parents and other caregivers on all aspects of this topic. Methods: This observational cross-sectional study aimed to investigate parental awareness of the dangers of foreign body aspiration. To determine the current level of knowledge of the parents, a 14- question questionnaire was designed and filled out by parents of children under 5 years of age referred for their regular check- ups. Results: The results show that majority of parents know that inhaling a foreign body is a potentially life-threatening condition and recognize which objects have a potential to cause foreign body aspiration. 36.9% of respondents said they knew what the symptoms of foreign body aspiration were, however only 15.6% offered a complete answer. 59.6% of the respondents could not specify the right course of action in case FBA occurred. 2% responded accurately. No statistically significant correlation was found between the number of children in the family nor the age and the sex of the parents and the level of knowledge about the aspiration of foreign bodies. Conclusion: This study indicates that parents are insufficiently informed on recognizing foreign body aspiration symtoms as well as providing first aid. Media-assisted campaigns and the internet are potential sources of easily accessible educational material.

Features of the Skin Microbiota in Common Inflammatory Skin Diseases.

Many relatively common chronic inflammatory skin diseases manifest on the face (seborrheic dermatitis, rosacea, acne, perioral/periorificial dermatitis, periocular dermatitis, etc.), thereby significantly impairing patient appearance and quality of life. Given the yet unexplained pathogenesis and numerous factors involved, these diseases often present therapeutic challenges. The term "microbiome" comprises the totality of microorganisms (microbiota), their genomes, and environmental factors in a particular environment. Changes in human skin microbiota composition and/or functionality are believed to trigger immune dysregulation, and consequently an inflammatory response, thereby playing a potentially significant role in the clinical manifestations and treatment of these diseases. Although cultivation methods have traditionally been used in studies of bacterial microbiome species, a large number of bacterial strains cannot be grown in the laboratory. Since standard culture-dependent methods detect fewer than 1% of all bacterial species, a metagenomic approach could be used to detect bacteria that cannot be cultivated. The skin microbiome exhibits spatial distribution associated with the microenvironment (sebaceous, moist, and dry areas). However, although disturbance of the skin microbiome can lead to a number of pathological conditions and diseases, it is still not clear whether skin diseases result from change in the microbiome or cause such a change. Thus far, the skin microbiome has been studied in atopic dermatitis, seborrheic dermatitis, psoriasis, acne, and rosacea. Studies on the possible association between changes in the microbiome and their association with skin diseases have improved the understanding of disease development, diagnostics, and therapeutics. The identification of the bacterial markers associated with particular inflammatory skin diseases would significantly accelerate the diagnostics and reduce treatment costs. Microbiota research and determination could facilitate the identification of potential causes of skin diseases that cannot be detected by simpler methods, thereby contributing to the design and development of more effective therapies.

Horseshoe lung associated with diaphragmatic herniation of the liver.

Horseshoe lung is a rare congenital pulmonary anomaly in which the caudal and basal segments of the left and right lungs are joined together behind the pericardium at the height of cardiac apex. Most patients with horseshoe lung have many other cardiovascular anomalies typical of the scimitar syndrome or the hypogenetic right lung syndrome. We report on a patient with horseshoe lung not associated with scimitar syndrome, but presented with a focal diaphragmatic herniation of the liver, such as never reported before in case of horseshoe lung without associated scimitar syndrome.

Necrotizing pneumonia in infants.

Community-acquired bacterial pneumonias generally have a good prognosis, given a good response to the antibiotic treatment applied, and complications such as pleural effusion, empyema, abscess and necrotizing pneumonia with pneumatocele formation (cavitary necrosis) are rare. Although cavitary necrosis is manifested as a severe disease, most children show complete recovery even without surgical treatment and have normal chest radiographs at long term. A case is presented of an immunocompetent infant that developed necrotizing pneumonia with pneumatocele formation during treatment of bacterial pneumonia. Conservative treatment led to complete regression of necrotic cavities and resulted in normal chest radiography finding 2.5 months of the occurrence of pneumatoceles.

Spontaneous pneumomediastinum in a healthy adolescent.

Spontaneous pneumomediastinum is a rare clinical entity defined as the presence of free air in the mediastinal structures without an apparent cause such as trauma. Spontaneous pneumomediastinum is rare in children and most frequently occurs in young male patients. It usually develops after alveolar rupture and air penetration into the pulmonary interstice, followed by air penetration towards the hila and into the mediastinum. Alveolar ruptures may be caused by various pathological and physiological processes, in children most frequently by asthma. Clinical diagnosis is based on the symptom triad including chest pain, dyspnea and subcutaneous emphysema. The diagnosis is confirmed by radiography. On differential diagnosis, esophageal perforation should be considered first, and if suspected, contrast esophagogram should be performed. Spontaneous pneumomediastinum usually resolves spontaneously in several days of treatment, which includes identification of the underlying cause (if possible), rest, analgesics and clinical monitoring. Complications involving spontaneous pneumomediastinum, such as tension pneumomediastinum and tension pneumothorax, are quite rare. A case is presented of pneumomediastinum in a 17-year-old male adolescent with no relevant history but with a clinical picture of intense retrosternal pain and subcutaneous emphysema of the neck and supraclavicular region. Thorough examinations including chest x-ray, chest computed tomography, bronchoscopy and esophagoscopy failed to identify the cause of pneumomediastinum. After eight days of conservative treatment, the pneumomediastinum symptoms completely disappeared and x-ray showed resolution of pneumomediastinum.

An individualized approach in the education of asthmatic children.

Asthma is the most prevalent chronic disorder of childhood. In a large number of cases, it can be well managed. In addition to accurate diagnosis, appropriate therapy and control of environmental factors, a good educational program is required, which has not yet received due attention. Prompted by the fact that a large number of asthmatic children and their parents lack sufficient knowledge about asthma, six years ago we launched an individual educational program for all asthmatic children over seven years of age and their parents. We monitored a group of 58 asthmatics, the first to have completed our individual educational program, during the year before and the year after they had received individual education. The prerequisites for inclusion in the study were that the child was over seven years of age, diagnosed with chronic asthma according to the GINA guidelines and had been monitored for one year prior to receiving individual education. We compared the number of asthma exacerbations, hospitalizations due to asthma, days with asthmatic symptoms, the mean value of the forced expiratory volume in 1 second (FEV 1), and the mean dose of inhaled corticosteroids (ICS) taken during the year before and the year after receiving individual education. Study results showed the number of asthma exacerbations (p < 0.0001), hospitalizations due to asthma (p = 0.0236) and days with asthmatic symptoms (p < 0.0001) to have significantly reduced, along with a significant increase in FEV 1 (p < 0.0001) and lower mean ICS dose (p < 0.0001) upon completion of individual educational program. It is concluded that the addition of individual education in the treatment of asthmatic children enables better control of the disease (lower number of hospitalizations and asthma exacerbations, increased FEV 1) with a lower mean ICS dose. The knowledge about asthma acquired by the children and their parents, self-management, compliance with the written asthma management plan, control of environmental factors, along with good cooperation of the patients and parents in the management of asthma certainly contributed to this favorable observation.