Showing posts with label respiratory illness. Show all posts
Showing posts with label respiratory illness. Show all posts

Monday, March 2, 2015

Pneumonia Effects in Childhood on Adult Respiratory Status: The Lung and Winding Road

          We are certainly aware that young children predisposed to lower respiratory illnesses in infancy and toddlerhood are often the ones who go on in childhood to experience some problems with lung function and develop illnesses such as asthma.  But what happens when these same children become adults?  Do they continue to experience problems with lung function? 
      Chan et al. (doi: 10.1542/peds.2014-3060)  explore these questions by following a cohort of children diagnosed with and without lower respiratory illnesses in the first 3 years of life and then followed with spirometry at ages 11,16,22, and 26 years of age along with information on asthma and wheezing obtained at 8 different time intervals between ages 11 and 29.  If a child experienced early pneumonia, the risk of experiencing asthma into adult life and being predisposed to developing adult chronic obstructive pulmonary disease was greater than if pneumonia had not been present in infancy and toddlerhood. 
      Understanding how early infection might trigger this life-long challenge with impaired airway function makes for an interesting discussion.  So take a deep breath and learn more about this longitudinal cohort, and how the findings in this study might apply to your own young patients with lower respiratory illness as they get older.

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Tuesday, December 9, 2014

RSV: Risk of Death

By: Lewis First, MD, MS; Editor-in-Chief 

With respiratory syncytial virus (RSV) season upon us, we know that our youngest and tiniest patients can experience significant morbidity with this virus in their system, but how fatal is it?

Byington et al.  (doi:10.1542/peds.2014-2151) looked at this question by using two large national databases to examine the past decade’s worth of hospitalizations for RSV, and in turn, the mortality associated with these hospitalizations.

The good news is that RSV deaths are extremely uncommon, although as you might expect, are most associated with infants with complex chronic conditions, making it tougher for them to deal with this respiratory infection.

Just what conditions are associated with increased RSV mortality awaits your reading of this useful description of a huge number of RSV admissions to determine the low prevalence of mortality reported. Take a deep breath and read this study to learn more that may help you reassure most families and perhaps be even more vigilant and supportive in your care of your more complex infants who succumb to RSV.

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Thursday, October 30, 2014

For Treating Empyema, Which Is Better—Urokinase Drainage or Video-Assisted Thoracoscopy?

By: Lewis First, MD, MS; Editor-in-Chief 

Video-assisted thoracoscopy.
Image by Cancer Research UK  via Wikimedia Commons.
Every once in a while we have a patient who develops a parapneumonic effusion of pus (otherwise known as an empyema) as a complication of an acute bacterial pneumonia. When this happens, treatment might involve a chest tube and when that fails, the use of thoracoscopy.

Recently however, the addition of urokinase to enzymatically break apart the empyema has been suggested to make the chest-tube drainage method more effective—but is it as effective as video-assisted thoracoscopy (VATS)?

Marhuenda et al. (doi:10.1542/peds.2013-3935) approached this question by performing a prospective randomized multicenter clinical trial in children younger than 15 years old with empyema that required intervention.

The results indicate that urokinase plus drainage may be just as effective as VATS, but if you want to see for yourself, scope out this study and discuss it with your local pediatric surgeons to see if they agree the two treatments are similar. Be sure to share what you learn with us by leaving a comment here on the blog, sharing an eLetter on our journal’s website or visiting us on Facebook or Twitter.

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Tuesday, September 16, 2014

Acute Respiratory Tract Infections: Prevalence of Bacterial Etiology & Rates of Antibiotic Prescribing

Photo by Ajay Suresh via Flickr
By: Lewis First, MD, MS; Editor-in-Chief 

In this era of antimicrobial stewardship to prevent bacterial resistance, we are certainly cautious about empiric usage of antibiotics in a child with respiratory symptoms and signs, especially given the predominant viral etiology of these acute infections. Yet, are we actually being good stewards?

Kronman et al. (doi: 10.1542/ peds.2014-0605) ventured into answering this interesting question using a meta-analysis of prior studies on this question to determine acute respiratory tract infection (ARTI) rates for children, and a retrospective cohort as well, to determine antimicrobial prescribing rates. The study shares condition specific-prevalence rates and then antimicrobial prescriptions ordered. It will be no surprise that the use of antimicrobials exceeds the prevalence—but just how much is worth your attention.

So give this study your attention. You’ll find nothing to sneeze at when it comes to being an even better steward of antibiotic usage in your patients.

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Wednesday, May 28, 2014

Coughing Up Evidence (or Lack Thereof) to Treat Mycoplasma Pneumonia

By: Lewis First, MD, MS

When we suspect a child or teen has mycoplasma pneumonia, our tendency has been to start a macrolide or doxycycline to help treat the pulmonary symptoms. Yet how good is the evidence for us to do that?

Photo by Rottem et al. via Wikimedia Commons
Biondi et al. (doi: 10.1542/ peds. 2013-3729) have performed a systematic review looking at the effectiveness of treating mycoplasma in a pediatric population. The researchers summarized 17 studies and the results may surprise you. The evidence is not particularly strong to treat, but the studies themselves have limitations at the same time.

To help us make sense of the lack of sufficient evidence to treat (as suggested by this study) when combined with the fact that there still may be much merit to treating is a commentary by Colin et al. (doi: 10.1542/peds. 2014-0871) that tells us not to stop writing antibiotic prescriptions just yet—despite the conclusions reached by Biondi and colleagues.

So what do you do or what would you do differently after reading both the study and commentary? Continue to treat mycoplasma, not treat, or perhaps only treat in some circumstances? We welcome your response to this study and commentary by sharing your thoughts below or via Facebook or Twitter or even an eLetter to our journal.

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Tuesday, February 25, 2014

Can Polymerase Chain Reaction (PCR) Help Identify Etiologies for Acute Respiratory Illnesses?

We know there are many viral etiologies for respiratory symptoms in children—but we also know that children can be asymptomatic and still culture some of these viruses in their nasopharynx. So are some respiratory viruses seen only with symptoms, or can we find all viruses even in asymptomatic children?

PCR Test for H1N1 Photo by Greg Sykes, ATCC
via the Centers for Disease Control and Prevention
To answer that question, Rhedin et al. (doi: 10.1542/ peds.2013-3042) studied nasopharyngeal aspirates from more than 150 symptomatic children and about half as many healthy controls and used quantitative polymerase chain reaction analyses to detect specific viral nucleic acids in both groups. Interestingly enough, rhinovirus appeared in both cases and controls quite commonly but there were some respiratory viruses that seemed to predominate in the case population.

Just what those viruses are and whether PCR can be helpful in determining a causal etiology for viral symptoms can be gleaned from reviewing this early release study which will certainly put you more in the nose, I mean, in the know when it comes to recognizing what viruses to really worry about in symptomatic patients.

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