Children

Editorial

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3 pages, 188 KiB

Open AccessEditorial

Lung Function in Childhood: Designing the Future Trajectories

by Michele Ghezzi and Ahmad Kantar

Children 2023, 10(6), 1036; https://doi.org/10.3390/children10061036 - 9 Jun 2023

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Abstract

Lung development is a highly regulated process that may be disrupted by both genetic and environmental factors beginning at an early age [...] Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

Research

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14 pages, 966 KiB

Open AccessArticle

Efficacy of the Simeox^® Airway Clearance Technology in the Homecare Treatment of Children with Clinically Stable Cystic Fibrosis: A Randomized Controlled Trial

by Dorota Sands, Katarzyna Walicka-Serzysko, Justyna Milczewska, Magdalena Postek, Natalia Jeneralska, Aleksandra Cichocka, Ewa Siedlecka, Urszula Borawska-Kowalczyk and Laurent Morin

Children 2023, 10(2), 204; https://doi.org/10.3390/children10020204 - 23 Jan 2023

Cited by 3 | Viewed by 2721

Abstract

Background: Cystic fibrosis (CF) patients require regular airway clearance therapy (ACT). The aim of this study was to evaluate homecare therapeutic effects of a new ACT (Simeox^®) added to the optimal standard of care, including home chest physiotherapy, in the treatment [...] Read more.

Background: Cystic fibrosis (CF) patients require regular airway clearance therapy (ACT). The aim of this study was to evaluate homecare therapeutic effects of a new ACT (Simeox^®) added to the optimal standard of care, including home chest physiotherapy, in the treatment of clinically stable children. Methods: Forty pediatric CF patients (8–17 years old) with stable disease were randomized 1:1 in a single-center, prospective, open-label, cross-over trial into two groups: with or without Simeox^®. Lung function (impulse oscillometry, spirometry, body plethysmography, multi-breath nitrogen washout) results, health-related quality of life, and safety were assessed during the study after 1 month of therapy at home. Results: A significant decrease in proximal airway obstruction (as supported by improvement in airway resistance at 20 Hz (R20Hz) and maximum expiratory flow at 75% of FVC (MEF75)) compared to the control group was observed after 1 month of therapy with the device. Lung-clearance index was stable in the study group, while it worsened in the control group. In addition, the device group demonstrated a significant increase in the Cystic Fibrosis Questionnaire—Revised (CFQ-R) physical score. No side effects were identified during the study. Conclusions: Simeox^® may improve drainage of the airways in children with clinically stable CF and could be an option in chronic treatment of the disease. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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12 pages, 6712 KiB

Open AccessArticle

Allogeneic Mesenchymal Stromal Cells as a Global Pediatric Prospective Approach in the Treatment of Respiratory Failure Associated with Surfactant Protein C Dysfunction

by Gloria Pelizzo, Maria Antonietta Avanzini, Stefania Croce, Anna Mandelli, Elisa Lenta, Andrea Farolfi, Chiara Valsecchi, Salvatore Zirpoli, Giulia Lanfranchi, Eleonora Durante, Elena Zoia, Gianvincenzo Zuccotti and Valeria Calcaterra

Children 2023, 10(1), 162; https://doi.org/10.3390/children10010162 - 14 Jan 2023

Cited by 1 | Viewed by 1562

Abstract

Mesenchymal stromal cells (MSCs) have been proposed as a new therapeutic strategy to treat congenital and acquired respiratory system diseases. We describe a case report of an 18-month-old male patient with progressive chronic respiratory failure, associated with mutations of the surfactant protein C [...] Read more.

Mesenchymal stromal cells (MSCs) have been proposed as a new therapeutic strategy to treat congenital and acquired respiratory system diseases. We describe a case report of an 18-month-old male patient with progressive chronic respiratory failure, associated with mutations of the surfactant protein C gene (SFTPC) due to c.289G > T variant p.Gly97Ser (rs927644577) and c.176A > G variant (p.His59Arg), submitted to repeated intravenous infusions of allogeneic bone marrow (BM) MSCs. The clinical condition of the patient was monitored. Immunologic studies before and during MSC treatment were performed. No adverse events related to the MSC infusions were recorded. Throughout the MSC treatment period, the patient showed a growth recovery. Starting the second infusion, the patient experienced an improvement in his respiratory condition, with progressive adaptation to mechanical ventilation. After the third infusion, five hours/die of spontaneous breathing was shown, and after infusion IV, spontaneous ventilation for 24/24 h was recorded. A gradual decrease of lymphocytes and cell subpopulations was observed. No variations in the in vitro T cell response to PHA were determined by MSC treatment as well as for the in vitro B cell response. A decrease in IFN-γ, TNF-α, and IL-10 levels was also detected. Even though we cannot exclude an improvement of pulmonary function due to the physiological maturation, the well-known action of MSCs in the repair of lung tissue, together with the sequence of events observed in our patient, may support the therapeutic role of MSCs in this clinical condition. However, further investigations are necessary to confirm the result and long-term follow-up will be mandatory to confirm the benefits on the pulmonary condition. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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13 pages, 1443 KiB

Open AccessArticle

Skin Barrier Function and Infant Tidal Flow-Volume Loops—A Population-Based Observational Study

by Martin Färdig, Hrefna Katrín Gudmundsdóttir, Angela Hoyer, Karen Eline Stensby Bains, Catarina Almqvist, Christine Monceyron Jonassen, Eva Maria Rehbinder, Håvard O. Skjerven, Anne Cathrine Staff, Riyas Vettukattil, Cilla Söderhäll, Karin C. Lødrup Carlsen and Björn Nordlund

Children 2023, 10(1), 88; https://doi.org/10.3390/children10010088 - 31 Dec 2022

Cited by 2 | Viewed by 1773

Abstract

Background: The relationship between the skin barrier- and lung function in infancy is largely unexplored. We aimed to explore if reduced skin barrier function by high transepidermal water loss (TEWL), or manifestations of eczema or Filaggrin (FLG) mutations, were associated with [...] Read more.

Background: The relationship between the skin barrier- and lung function in infancy is largely unexplored. We aimed to explore if reduced skin barrier function by high transepidermal water loss (TEWL), or manifestations of eczema or Filaggrin (FLG) mutations, were associated with lower lung function in three-month-old infants. Methods: From the population-based PreventADALL cohort, 899 infants with lung function measurements and information on either TEWL, eczema at three months of age and/or FLG mutations were included. Lower lung function by tidal flow-volume loops was defined as a ratio of time to peak tidal expiratory flow to expiratory time (t_PTEF/t_E) <0.25 and a t_PTEF <0.17 s (<25th percentile). A high TEWL >8.83 g/m²/h (>75th percentile) denoted reduced skin barrier function, and DNA was genotyped for FLG mutations (R501X, 2282del4 and R2447X). Results: Neither a high TEWL, nor eczema or FLG mutations, were associated with a lower t_PTEF/t_E. While a high TEWL was associated with a lower t_PTEF; adjusted OR (95% CI) 1.61 (1.08, 2.42), the presence of eczema or FLG mutations were not. Conclusions: Overall, a high TEWL, eczema or FLG mutations were not associated with lower lung function in healthy three-month-old infants. However, an inverse association between high TEWL and t_PTEF was observed, indicating a possible link between the skin barrier- and lung function in early infancy. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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11 pages, 574 KiB

Open AccessArticle

Risk Factors for Non-Adherence to Inhaled Corticosteroids in Preschool Children with Asthma

by Louise Mandrup Bach, Sune Rubak, Adam Holm-Weber, Julie Prahl, Mette Hermansen, Kirsten Skamstrup Hansen and Bo Chawes

Children 2023, 10(1), 43; https://doi.org/10.3390/children10010043 - 25 Dec 2022

Cited by 1 | Viewed by 1407

Abstract

Non-adherence to asthma controllers increases morbidity among school-aged children. This study aimed to determine non-adherence risk factors in preschool children with asthma. We investigated 172 children <6 years diagnosed with asthma in 2018 and analyzed baseline characteristics and loss of control events extracted [...] Read more.

Non-adherence to asthma controllers increases morbidity among school-aged children. This study aimed to determine non-adherence risk factors in preschool children with asthma. We investigated 172 children <6 years diagnosed with asthma in 2018 and analyzed baseline characteristics and loss of control events extracted from the medical records for four years following diagnosis. At end of follow-up, 79 children had a prescription of inhaled corticosteroids (ICS) and were included in the analyses. Adherence was assessed in a two-year period through pharmacy claims using percentage of days covered (PDC) analyzed dichotomously with non-adherence defined as PDC < 80% and using adherence ratio (AR) defined as days with medical supply divided by days without. Of the 79 children, 59 (74.7%) were classified as non-adherent. In analyses adjusted for sex, age and exacerbations prior to inclusion, adherence was positively associated with having had a loss of control event requiring a step-up in asthma controller (_aAR:2.34 [1.10;4.98], p = 0.03), oral corticosteroids (_aAR:2.45 [1.13;5.34], p = 0.026) or redeeming a short-acting b2-agonist prescription (_aAR:2.91 [1.26;6.74], p = 0.015). Further, atopic comorbidity was associated with increased adherence (_aAR:1.18 [1.01;1.37], p = 0.039), whereas having a first degree relative with asthma was associated with worse adherence (_aAR:0.44 [0.23;0.84], p = 0.015). This study found poor adherence to ICS among three quarters of preschool children with asthma. Increasing adherence was associated with atopic comorbidity and loss of control events, whereas lower adherence was associated with atopic predisposition. These findings should be considered to improve adherence in preschool children with asthma. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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7 pages, 241 KiB

Open AccessArticle

Clinical Course of Children with Chronic Suppurative Lung Disease or Bronchiectasis Infected with Pseudomonas aeruginosa

by Elpiniki Kartsiouni, Stylianos Chatzipanagiotou, Angeliki Galani, Dafni Moriki, Olympia Sardeli, Spyridon Prountzos, Efthymia Alexopoulou, Ioanna Loukou, Kostas N. Priftis and Konstantinos Douros

Children 2022, 9(12), 1822; https://doi.org/10.3390/children9121822 - 25 Nov 2022

Cited by 2 | Viewed by 1769

Abstract

Children with chronic wet cough and without cystic fibrosis (non-CF) may suffer from chronic suppurative lung disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one of the offending microbes in these children. The present study aimed to describe the clinical course of [...] Read more.

Children with chronic wet cough and without cystic fibrosis (non-CF) may suffer from chronic suppurative lung disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one of the offending microbes in these children. The present study aimed to describe the clinical course of children with the above two conditions who were infected with Pa. Data of 54 children with CSLD/bronchiectasis who were diagnosed and attended in our department were retrospectively analysed through a Cox proportional hazard model, with age, presence of bronchiectasis, use of inhaled colistin, azithromycin, inhaled hypertonic saline as the covariates. In 42 of the 54 patients, there was no identifiable cause or underlying chronic disorder. Microbiological clearance was defined as the absence of daily wet cough for four months along with four negative cultures taken during the last four consecutive follow-up visits. Multivariate analysis was performed with a Cox proportional hazard model with time to microbiological clearance as the outcome. Results are described as Hazard Ratios (HR) with 95% Confidence Intervals (95%CI). Nebulised antibiotics and the presence of bronchiectasis were statistically significant predictors of remission (HR: 3.99; 95%CI: 1.12–14.14; p = 0.032, and HR: 0.24; 95%CI: 0.08–0.71; p = 0.010). In conclusion, the rate of microbiological clearance increases with the use of inhaled colistin and decreases when there is established bronchiectasis. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

10 pages, 783 KiB

Open AccessArticle

Association between History of Prolonged Exclusive Breast-Feeding and the Lung Function Indices in Childhood

by Evanthia P. Perikleous, Sotirios Fouzas, Magdalena Michailidou, Anna Patsourou, Dimos Tsalkidis, Paschalis Steiropoulos, Evangelia Nena, Athanasios Chatzimichael and Emmanouil Paraskakis

Children 2022, 9(11), 1708; https://doi.org/10.3390/children9111708 - 8 Nov 2022

Cited by 3 | Viewed by 1222

Abstract

Although the propitious effects of breastfeeding on children’s health are indisputable, the impact of exclusive breastfeeding on the lung function later in life remains controversial. Our objective was to explore the possible associations between breastfeeding and the lung function of children who were [...] Read more.

Although the propitious effects of breastfeeding on children’s health are indisputable, the impact of exclusive breastfeeding on the lung function later in life remains controversial. Our objective was to explore the possible associations between breastfeeding and the lung function of children who were exclusively breastfed for an extensive period of time. This was a cross-sectional study of children who were exclusively breastfed for more than 12 months. Demographics and anthropometric data were collected; the body mass index (BMI), % body fat, and % central obesity were calculated; and all the participants underwent standard spirometry with reversibility testing. The relationship between breastfeeding duration and spirometric parameters was assessed by Spearman’s correlation and multivariable regression, after adjustment for other confounders. Forty-six children (21 boys), aged 9.2 ± 2.4 years, with a reported breastfeeding duration of 27.5 ± 12.5 months (range 12–60 months) were included; 13% were overweight (none were obese) and 21.7% had central obesity. The average FEV1 was 104.7 ± 10.4% and the average FEF25-75 was 107.9 ± 13.3%. The duration of exclusive breastfeeding was positively correlated with FEF25-75% (r = 0.422, p = 0.003). Multivariable linear regression analysis confirmed the above finding (beta coefficient 0.478, p = 0.002), independently of age, overweight, and central obesity. No correlation was noted between the duration of breastfeeding and other spirometric parameters. In addition to its favorable impact on the metabolic profile, prolonged exclusive breastfeeding seems to exert a propitious effect on the function of smaller airways throughout childhood. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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12 pages, 302 KiB

Open AccessArticle

Perceived Stress in the Primary Caregivers of Adolescents with Asthma: A Cross-Sectional Study

by Selene Valero-Moreno, Inmaculada Montoya-Castilla, Konstanze Schoeps, Silvia Postigo-Zegarra and Marián Pérez-Marín

Children 2022, 9(11), 1614; https://doi.org/10.3390/children9111614 - 25 Oct 2022

Cited by 1 | Viewed by 1680

Abstract

This study aims to determine the impact of the disease on the perceived stress levels of caregivers of adolescents with asthma. A total of 140 primary caregivers, whose mean age was 45.43 years (SD = 5.03), of whom 85% were mothers, were assessed [...] Read more.

This study aims to determine the impact of the disease on the perceived stress levels of caregivers of adolescents with asthma. A total of 140 primary caregivers, whose mean age was 45.43 years (SD = 5.03), of whom 85% were mothers, were assessed using the perceived stress questionnaire (PIP), and medical indicators related to asthma were recorded. Mean comparisons, correlations, and qualitative comparative analysis (QCA) models were used. The results indicated moderate levels of perceived stress in caregivers, no kinship differences were found, and age was negatively associated with perceived stress. QCA models suggested that perceived stress could be explained by a higher frequency of visits, poorer adherence, more frequent daily medication doses, and higher severity of asthma. In conclusion, the development of psychological interventions addressing the subjective overload of the family caregiver may benefit them, increasing their well-being, and in turn help to manage the emotional difficulties of adolescents. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

11 pages, 771 KiB

Open AccessArticle

Cytokines Profile and Lung Function in Children with Obesity and Asthma: A Case Control Study

by Laura Maffeis, Carlo V. Agostoni, Denise Pires Marafon, Leonardo Terranova, Claudia Giavoli, Gregorio P. Milani, Mara Lelii, Barbara Madini, Paola Marchisio and M. Francesca Patria

Children 2022, 9(10), 1462; https://doi.org/10.3390/children9101462 - 24 Sep 2022

Cited by 5 | Viewed by 2436

Abstract

The existence of common inflammatory biomarkers linking obesity and asthma in children has been hypothesized. Nevertheless, laboratory and clinical characteristics of children with obesity and asthma are still poorly defined. The primary aim of the present study is to investigate the lung function [...] Read more.

The existence of common inflammatory biomarkers linking obesity and asthma in children has been hypothesized. Nevertheless, laboratory and clinical characteristics of children with obesity and asthma are still poorly defined. The primary aim of the present study is to investigate the lung function and the cytokine profile, in children with obesity and asthma. In this prospective, cross-sectional pilot study, pulmonary function tests, biochemical parameters, and serum cytokines levels were compared in three groups of 28 children each, matched for age and sex. Obese children showed normal forced spirometry values except an increased distal airway resistance in subjects with obesity and no asthma. Both groups including obese children showed higher leptin and IL-10 levels and lower adiponectin and TNF-alpha levels compared to children with no obesity and asthma. IL-33 and TGF-beta1 levels were higher in children with obesity and asthma vs. children with normal weight and asthma. Finally, IL-6 was undetectable in approximately 70% of obese children with no asthma, in 57% obese asthmatic children and in 100% of children with normal-weight and asthma. Children with obesity and asthma show the most striking cytokine profile, suggesting a pro-inflammatory role of fat mass in asthma development. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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10 pages, 554 KiB

Open AccessArticle

Non-Cystic Fibrosis Bronchiectasis in Pediatric Age: A Case Series in a Metropolitan Area of Northern Italy

by Marcella Gallucci, Egidio Candela, Emanuela Di Palmo, Angela Miniaci and Andrea Pession

Children 2022, 9(9), 1420; https://doi.org/10.3390/children9091420 - 19 Sep 2022

Cited by 4 | Viewed by 2185

Abstract

Non-cystic fibrosis bronchiectasis is an emergent disease characterized by endobronchial suppuration, dilated airways with neutrophilic inflammation and chronic wet cough due to recurrent lower airway infections. A regular clinical follow-up and adequate management of exacerbations are essential to reduce symptoms and the worsening [...] Read more.

Non-cystic fibrosis bronchiectasis is an emergent disease characterized by endobronchial suppuration, dilated airways with neutrophilic inflammation and chronic wet cough due to recurrent lower airway infections. A regular clinical follow-up and adequate management of exacerbations are essential to reduce symptoms and the worsening of lung injury. We report a retrospective study comprising 15 children and adolescents with NCFB followed in our hospital center of pediatric pulmonology. We retrospectively analyzed the main comorbidities associated with the presence of NCFB, the radiological aspect associated with the different etiologies and the therapeutic approach used. We also emphasized the importance of an effective preventive strategy to reduce and prevent pulmonary exacerbations. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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Review

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9 pages, 333 KiB

Open AccessReview

Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue

by Valeria Caldarelli, Federica Porcaro, Paola Di Filippo, Marina Attanasi, Valentina Fainardi, Marcella Gallucci, Angelo Mazza, Nicola Ullmann and Stefania La Grutta

Children 2022, 9(11), 1700; https://doi.org/10.3390/children9111700 - 5 Nov 2022

Cited by 4 | Viewed by 1619

Abstract

Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence [...] Read more.

Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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Other

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11 pages, 285 KiB

Open AccessPerspective

Lung Function in Children with Primary Ciliary Dyskinesia

by Valentina Agnese Ferraro, Raimondo Junior Castaldo, Valentina Tonazzo, Stefania Zanconato and Silvia Carraro

Children 2023, 10(2), 290; https://doi.org/10.3390/children10020290 - 2 Feb 2023

Cited by 3 | Viewed by 1611

Abstract

Background: Primary ciliary dyskinesia (PCD) is characterized by impaired mucociliary clearance that results in accumulation of mucus and bacteria in the airways. Lower respiratory tract infections lead to airway remodeling and lung function impairment. The aim of our narrative review is to discuss [...] Read more.

Background: Primary ciliary dyskinesia (PCD) is characterized by impaired mucociliary clearance that results in accumulation of mucus and bacteria in the airways. Lower respiratory tract infections lead to airway remodeling and lung function impairment. The aim of our narrative review is to discuss available data on lung function in PCD children, focusing on risk factors for lung function impairment. Methods: Relevant published studies searching MEDLINE/Pubmed are included in this narrative review, using these terms: “primary ciliary dyskinesia” and “pulmonary function test” or “spirometry” or “lung function”. Filters were language (English) and age of study subjects (0–18 years). Results and Conclusions: The majority of recent published studies showed normal spirometric values in PCD children, even if some authors described a pulmonary impairment. Together with spirometry, Lung Clearance Index has been applied for detecting peripheral airway disease, and it might have a role in early mild lung disease assessment. Studies on lung function trajectories after PCD diagnosis showed a significant heterogeneity, with some patients maintaining reasonably good lung function, whereas others showing a decline. Further studies are needed to analyze lung function prospectively from childhood into adulthood, and to evaluate whether lung function trajectories are affected by PCD clinical phenotype, ultrastructural ciliary defect or genetic background. Full article

(This article belongs to the Special Issue Lung Function, Respiratory and Asthma Disease in Children)

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