No effect of fluticasone propionate on linear growth in preschool children with asthma.

BACKGROUND: Eighty percent of asthmatic children develop asthma symptoms by the age of 5 years. Inhaled corticosteroids (ICS), depending on dosage, may cause linear growth reduction and adrenal gland suppression. There are few studies about linear growth of preschool children with asthma. The aim of the present study was to investigate whether there is any effect of fluticasone propionate (FP) on linear growth and adrenal gland function. METHODS: Twenty-eight children aged 18-52 months with persistent asthma receiving ICS FP 100-200 µg daily were studied for 1 year. Patients were divided into two groups according to clinical parameters: well (group 1) and poorly controlled (group 2). Height was measured every 3 months and expressed as height standard deviation score (SDS). Cumulative dose of FP expressed in mg was calculated for every patient. Early morning levels of serum adrenocorticotropic hormone (ACTH) and cortisol were assessed at the beginning and at the end of the study. RESULTS: Patients took FP for an average of 11 months in group 1 and 16 months in group 2, which was not statistically significantly different. At the end of the study height SDS difference was -0.0143 in group 1 and -0.2000 in group 2, which was not statistically significantly different (t= 0.6072, P= 0.5489). There was also no statistically significant difference for average cortisol (P= 0.4381) or ACTH (P= 0.5845) concentration at the end of the study. CONCLUSION: FP 100-200 µg daily had no effect on linear growth or on the hypothalamic-pituitary-adrenal gland axis but further follow up is necessary.

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.