986 results found
Saglani S, Robinson P, Fontanella S, et al., 2021, Recurrent severe preschool wheeze: From pre-specified diagnostic labels to underlying endotypes, American Journal of Respiratory and Critical Care Medicine, ISSN: 1073-449X
Ullmann N, Allegorico A, Bush A, et al., 2021, Effects of the COVID-19 pandemic and lockdown on symptom control in preschool children with recurrent wheezing, Pediatric Pulmonology, ISSN: 1099-0496
INTRODUCTION: Preschool wheezers are at high risk of recurrent attacks triggered by respiratory viruses, sometimes exacerbated by exposure to allergens and pollution. Because of the COVID-19 infection, the lockdown was introduced, but the effects on preschool wheezers are unknown. We hypothesized that there would be an improvement in outcomes during the lockdown, and these would be lost when the lockdown was eased. MATERIALS AND METHODS: Patients underwent medical visits before and after the COVID-19 lockdown. We recorded the childhood Asthma Control Test (cACT) and a clinical questionnaire. Data on symptoms, the need for medications and the use of healthcare resources were recorded. We compared these data with retrospective reports from the preceding year and prospectively acquired questionnaires after lockdown. RESULTS: We studied 85 preschool wheezers, mean age 4.9 years. During the lockdown, cACT score was significantly higher (median 25 vs. 23); families reported a dramatic drop in wheezing episodes (51 vs. none), significant reductions in the day and nighttime symptoms, including episodes of shortness of breath (p < .0001); the use of salbutamol and oral corticosteroids (OCS) dropped significantly (p < .0001) and 79 (95%) patients needed no OCS bursts during the lockdown. Finally, patients had significantly fewer extra medical examinations, as well as fewer Emergency Room visits (p < .0001). All were improved compared with the same time period from the previous year, but outcomes worsened significantly again after lockdown (cACT median: 22). CONCLUSIONS: During the national lockdown, children with persistent preschool wheeze showed a significant clinical improvement with reduction of respiratory symptoms, medication use for exacerbations, and use of healthcare resources. This trend reversed when lockdown restrictions were eased.
Bush A, Pabary R, Allinson J, et al., 2021, They SHALL grow old: a UK rare disease clinical network for adult congenital thoracic malformations., Arch Dis Child
Lucchetti D, Santini G, Perelli L, et al., 2021, Detection and characterization of extracellular vesicles in exhaled breath condensate and sputum of COPD and severe asthma patients., Eur Respir J
Pifferi M, Bush A, Mulé G, et al., 2021, Longitudinal Lung Volume Changes by Ultrastructure and Genotype in Primary Ciliary Dyskinesia., Ann Am Thorac Soc
RATIONALE: Genotype-phenotype relationships are emerging in primary ciliary dyskinesia (PCD), but little is known about lung volume changes over time. OBJECTIVES: To investigate evolution of static lung volumes with ultrastructural defects, gene mutations, BMI, and specific infections in PCD. METHODS: Prospective, longitudinal, single-center study in children and adults evaluated twice yearly for up to 10 years. Linear mixed effects models were used to assess associations between ciliary morphology, genetic mutations, and clinical features. RESULTS: 122 patients had 1096 visits. At enrollment, almost all spirometric and, especially in adults, plethysmographic parameters were significantly worse in absent inner dynein arms, central apparatus defects, and microtubular disorganization (IDA/CA/MTD) compared with Normal Electron Microscopy (EM) patients. Mean trend increase with time for residual volume (RV) was significantly higher in IDA/CA/MTD compared to outer dynein arms (ODA) defect and Normal EM groups. Mean trend of RV/total lung capacity (TLC) in IDA/CA/MTD was significantly worse than in all other groups. The steepest rise in lung volumes was in CCDC39/CCDC40, while hyperinflation increased less in DNAH5 and DNAH11 groups. RV/TLC showed a significantly steeper rise in patients with Pseudomonas aeruginosa compared to other infections, or without infection. CONCLUSIONS: Patients with IDA/CA/MTD defects or CCDC39/CCDC40 mutations had the greatest increase in hyperinflation, while those with ODA defect and Normal EM or DNAH11 and DNAH5 mutations had less severe changes. We have robustly confirmed the worse prognosis for some genetic and ultrastructural defects, which association hitherto rested solely on spirometry.
Devaney R, Simpson T, Bush A, et al., 2021, Fructose 1,6-bisphosphatase deficiency as a cause of childhood interstitial lung disease, PEDIATRIC PULMONOLOGY, ISSN: 8755-6863
Schmidt A, Kenia P, Morgan C, et al., 2021, Hereditary pulmonary alveolar proteinosis as collateral damage from a large chromosomal deletion, PEDIATRIC PULMONOLOGY, ISSN: 8755-6863
Meghji J, Mortimer K, Agusti A, et al., 2021, Improving lung health in low-income and middle-income countries: from challenges to solutions, LANCET, Vol: 397, Pages: 928-940, ISSN: 0140-6736
Bousquet J, Anto JM, Czarlewski W, et al., 2021, Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19, Allergy, Vol: 76, Pages: 735-750, ISSN: 0105-4538
Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT1 R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT1 R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.
Hogg C, Bush A, 2021, Pro-Con Debate CON: Primary Ciliary Dyskinesia diagnosis: Genes are all you need!, PAEDIATRIC RESPIRATORY REVIEWS, Vol: 37, Pages: 34-36, ISSN: 1526-0542
Bush A, Levy M, Fleming L, 2021, Steroid-filled rant: or another fashion accessory?, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 106, Pages: 211-+, ISSN: 0003-9888
Makhecha S, Jamalzadeh A, Irving S, et al., 2021, Paediatric severe asthma biologics service: from hospital to home., Arch Dis Child
Children with severe asthma may be treated with biologic agents normally requiring 2-4 weekly injections in hospital. In March 2020, due to COVID-19, we needed to minimise hospital visits. We assessed whether biologics could be given safely at home. The multidisciplinary team identified children to be considered for home administration. This was virtually observed using a video link, and home spirometry was also performed. Feedback was obtained from carers and young people. Of 23 patients receiving biologics, 16 (70%) families agreed to homecare administration, 14 administered by parents/patients and 2 by a local nursing team. Video calls for omalizumab were observed on 56 occasions, mepolizumab on 19 occasions over 4 months (April-July). Medication was administered inaccurately on 2/75 occasions without any adverse events. Virtually observed home biologic administration in severe asthmatic children, supported by video calls and home spirometry, is feasible, safe and is positively perceived by children and their families.
Nagakumar P, Chadwick C-L, Bush A, et al., 2021, Collateral impact of COVID-19: why should children continue to suffer?, EUROPEAN JOURNAL OF PEDIATRICS, ISSN: 0340-6199
Chang AB, Fortescue R, Grimwood K, et al., 2021, Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis., Eur Respir J
There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 "Patient, Intervention, Comparison, Outcome" [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.
Gidaris DK, Stabouli S, Bush A, 2021, Beware the inhaled steroids or corticophobia?, Swiss Med Wkly, Vol: 151
Inhaled corticosteroids have been the cornerstone of atopic, allergic asthma management for more than half a century. They have side effects (as does every medication), but they have transformed the control of asthma and saved many lives since their introduction. The current review revisits local and systemic side effects of inhaled corticosteroids and explores the prevalence and nature of parental fears (“corticophobia”) in different parts of the world. The empathetic physician treating asthma should bear in mind the impact of parental concerns on the management of this potentially life-threatening disease and try to dispel myths at every opportunity by emphasising the well-established benefits and excellent safety profile of inhaled corticosteroids.
Nagakumar P, Bush A, Gupta A, 2021, Childhood acute respiratory illnesses: will normal inadequate services be resumed?, Arch Dis Child
Bloom C, Franklin C, Bush A, et al., 2020, Burden of preschool wheeze and progression to asthma in the UK: population-based cohort 2007 to 2017, Journal of Allergy and Clinical Immunology, ISSN: 0091-6749
BackgroundWheeze is one of the most common symptoms of preschool children (age 1 to 5 years), yet we have little understanding of the burden in the UK.ObjectivesDetermine prevalence and pattern of physician-confirmed preschool wheeze, related healthcare utilisation, and factors associated with progression to school-age asthma.MethodsWe used nationally representative primary and secondary care electronic medical records between 2007-2017 to identify preschool children with wheeze. Factors associated with asthma progression were identified in a nested cohort of children with follow-up from 1-2 years of age, until at least 8 years of age.ResultsFrom 1,021,624 preschool children, 69,261 were identified with wheeze. Prevalence of preschool wheeze was 7.7% in 2017. Wheeze events were lowest in August and highest in late-autumn/early-winter. During median follow-up of 2.0 years (IQR 1.2-4.0), 15.8% attended an emergency department, and 13.9% had a hospital admission, for a respiratory disorder. The nested cohort with prolonged follow-up identified 15,085 children; 35.5% progressed to asthma between 5-8 years old. Of children with preschool wheeze, without an asthma diagnosis, 34.9% were prescribed inhaled corticosteroids, and 15.6% oral corticosteroids. The factors most strongly associated with progression to asthma were wheeze frequency and severity, atopy, prematurity, maternal asthma severity and first reported wheeze event occurring in September.ConclusionsPreschool wheeze causes considerable healthcare burden, a large number of children are prescribed asthma medication and have unplanned secondary care visits. Multiple factors influence progression to asthma, including first wheeze event occurring in September.
Bhatt JM, Ramphul M, Bush A, 2020, An update on controversies in e-cigarettes, PAEDIATRIC RESPIRATORY REVIEWS, Vol: 36, Pages: 75-86, ISSN: 1526-0542
Gupta A, Bush A, Nagakumar P, 2020, Asthma in children during the COVID-19 pandemic: lessons from lockdown and future directions for management, LANCET RESPIRATORY MEDICINE, Vol: 8, Pages: 1070-1071, ISSN: 2213-2600
Davies G, Thia LP, Stocks J, et al., 2020, Minimal change in structural, functional and inflammatory markers of lung disease in newborn screened infants with cystic fibrosis at one year, JOURNAL OF CYSTIC FIBROSIS, Vol: 19, Pages: 896-901, ISSN: 1569-1993
Nair N, Hurley M, Gates S, et al., 2020, Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 105, Pages: 1114-1116, ISSN: 0003-9888
Abdel-Aziz MI, Brinkman P, Vijverberg SJH, et al., 2020, eNose breath prints as a surrogate biomarker for classifying patients with asthma by atopy, Journal of Allergy and Clinical Immunology, Vol: 146, Pages: 1045-1055, ISSN: 0091-6749
BACKGROUND: Electronic noses (eNoses) are emerging point-of-care tools that may help in the subphenotyping of chronic respiratory diseases such as asthma. OBJECTIVE: We aimed to investigate whether eNoses can classify atopy in pediatric and adult patients with asthma. METHODS: Participants with asthma and/or wheezing from 4 independent cohorts were included; BreathCloud participants (n = 429), Unbiased Biomarkers in Prediction of Respiratory Disease Outcomes adults (n = 96), Unbiased Biomarkers in Prediction of Respiratory Disease Outcomes pediatric participants (n = 100), and Pharmacogenetics of Asthma Medication in Children: Medication with Anti-Inflammatory Effects 2 participants (n = 30). Atopy was defined as a positive skin prick test result (≥3 mm) and/or a positive specific IgE level (≥0.35 kU/L) for common allergens. Exhaled breath profiles were measured by using either an integrated eNose platform or the SpiroNose. Data were divided into 2 training and 2 validation sets according to the technology used. Supervised data analysis involved the use of 3 different machine learning algorithms to classify patients with atopic versus nonatopic asthma with reporting of areas under the receiver operating characteristic curves as a measure of model performance. In addition, an unsupervised approach was performed by using a bayesian network to reveal data-driven relationships between eNose volatile organic compound profiles and asthma characteristics. RESULTS: Breath profiles of 655 participants (n = 601 adults and school-aged children with asthma and 54 preschool children with wheezing [68.2% of whom were atopic]) were included in this study. Machine learning models utilizing volatile organic compound profiles discriminated between atopic and nonatopic participants with areas under the receiver operating characteristic curves of at least 0.84 and 0.72 in the training and validation sets, respectively. The unsupervised approach revealed t
Woodhull S, Bush A, Tang AL, et al., 2020, Massive paediatric pulmonary haemorrhage in Dieulafoy's disease: Roles of CT angiography, embolisation and bronchoscopy., Paediatr Respir Rev, Vol: 36, Pages: 100-105
Acute, major pulmonary haemorrhage in children, is rare, may be life-threatening and at times presents atypically. Dieulafoy's disease of the bronchus presenting with recurrent or massive hemoptysis was first described in adults. Prior to reviewing the literature, we report an illustrative case of bronchial Dieulafoy's disease (BDD) in a child presenting unusually with massive apparent hematemesis. The source of bleeding is a bronchial artery that fails to taper as it terminates within the bronchial submucosa. A high index of suspicion is required to identify such lesions via radiological imaging and the role of bronchial artery embolisation is highlighted with video images of angiography included.
Perikleous E, Tsalkidis A, Bush A, et al., 2020, Coronavirus global pandemic: An overview of current findings among pediatric patients, PEDIATRIC PULMONOLOGY, Vol: 55, Pages: 3252-3267, ISSN: 8755-6863
Davies G, Stanojevic S, Raywood E, et al., 2020, An observational study of the lung clearance index throughout childhood in cystic fibrosis: early years matter, EUROPEAN RESPIRATORY JOURNAL, Vol: 56, ISSN: 0903-1936
Bush A, Saglani S, 2020, Preschool wheeze: Challenges and research prospects reply to: Dr Jartti and Colleagues; in response to our manuscript entitled: Medical algorithm: Diagnosis and treatment of preschool asthma, ALLERGY, Vol: 75, Pages: 2718-2718, ISSN: 0105-4538
Bush A, Saglani S, 2020, Medical algorithm: diagnosis and treatment of preschool asthma, Allergy, Vol: 75, Pages: 2711-2712, ISSN: 0105-4538
Edmondson C, Westrupp N, Wallenburg J, et al., 2020, MONITORING LUNG FUNCTION OF YOUNG PEOPLE WITH CF AT HOME: IS IT RELIABLE? RESULTS FROM THE CLIMB-CF STUDY, Publisher: WILEY, Pages: S290-S290, ISSN: 8755-6863
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