Literature Review |

Top Ten List in Pediatric Lung Disease* FREE TO VIEW

LeRoy M. Graham
Author and Funding Information

*From Georgia Pediatric Pulmonology Associates PC, Department of Pediatrics, Morehouse School of Medicine, Atlanta, GA.

Correspondence to: LeRoy M. Graham, MD, FCCP, Georgia Pediatric Pulmonology Associates, PC. Suite 450, 1100 Lake Hearn Dr, Atlanta, GA 30342; e-mail: lgraham@gppa.net

Chest. 2004;125(3):1118-1120. doi:10.1378/chest.125.3.1118
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1. O’Brien L, Holbrook C, Klaus C, et al. Sleep and neurobehavioral characteristics of 5 to 7 year-old children with parentally reported symptoms of attention/deficit hyperactivity disorder. Pediatrics 2003; 111:554–563

In a study of 44 children designated as having significant symptoms of attention/deficit hyperactivity disorder based on parental reporting, there was no difference in the prevalence of obstructive sleep apnea when compared to control subjects. Remarkably, in a group without significant attention/deficit hyperactivity disorder symptoms but with mild behavioral hyperactivity, a significantly higher prevalence of obstructive sleep apnea was present (26% vs 5%, p < 0.02), suggesting sleep-disordered breathing may induce a mild behavioral hyperactive/inattentive phenotype.

2. Esper F, Boucher B, Kahn J, et al. Human metapneumovirus (hMPV) infection in the United States: clinical manifestations associated with a newly emerging respiratory infection in children. Pediatrics 2003; 111:1407–1410

The prevalence of human metapneumovirus was noted to be 6.4% in a cohort of symptomatic children who were younger than 5 years and had a negative result for respiratory syncytial virus, influenza A and B, parainfluenza viruses 1 to 3, and adenovirus by direct fluorescent antibody test in the first large study done in the United States. Fever, rhinorrhea, cough, and wheezing were all noted in > 50% of subjects. Hypoxia was noted in 31% of subjects.

3. Akinbami L, Schoendorf K. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics 2002; 110:315–322

In a review of data from the National Center for Health Statistics for the period from 1980 to 2000, childhood asthma prevalence increased from 3.6 to 6.2% from 1980 to 1996 with a peak prevalence of 7.5% in 1995. Prevalence among non-Hispanic blacks compared to non-Hispanic whites was 15% higher from 1980 to 1981 and 29% higher from 1995 to 1996. Black children were more than three times as likely to be hospitalized from 1997 to 1998 and more than four times more likely to die from asthma than white children throughout the study. While the increasing burden of childhood asthma may finally be leveling off, the disparities among black children compared to white children for asthma health-care utilization and mortality remain quite significant.

4. McConnell R, Berhane K, Gilliland F, et al. Asthma in exercising children exposed to ozone: a cohort study. Lancet 2002; 359:386–391

A cohort of 3,535 children, 9 to 16 years old, with no previous history of doctor-diagnosed asthma were administered baseline and annual questionnaires regarding the new diagnosis of asthma, asthma symptoms, and participation in team sports. In this study conducted in southern California, children in the six high-ozone communities who played three or more sports in the past year had a 3.3 increased relative risk (95% confidence interval [CI], 1.9 to 5.8) for the development of asthma compared with those playing no sports. Across all communities, there was a 1.8 relative risk (95% CI, 1.2 to 2.8) of asthma in children who had played three or more team sports in the past year.

5. Van Eerdewegh P, Little R, Dupuis J, et al. Association of the ADAM33 gene with asthma and bronchial hyperresponsiveness (BHR). Nature 2002; 418:426–430

Four hundred sixty white sibling-pair families with current asthma were studied to identify novel genetic polymorphisms associated with bronchial hyperresponsiveness (BHR) in asthma. Positional cloning revealed a novel region of interest on chromosome 20p13. Specifically, polymorphisms in the ADAM33 gene were linked to asthma and BHR. The ADAM proteins are a family of matrix metalloproteinases with diverse posttranslational cellular functions that include cytokine-mediated inflammation and cell signaling, proliferation, and death. Allelic variation in ADAM 33 may underlie lower airway dysfunction in asthma including BHR and airway remodeling.

6. Kourmboulis A, Hurlet-Jensen A, Goldberg M. Prevalence and reversibility of lower airway obstruction (LAO) in children with sickle cell disease. J Pediatr 2001; 138:188–192

Sixty-three children and adolescents (35 African American and 28 Hispanic) were studied to determine the prevalence and reversibility of lower airway obstruction (LAO) in pediatric subjects with homozygous SS sickle cell disease. The prevalence of LAO and restrictive lung disease was 35% and 8%, respectively. A positive response to bronchodilator was noted in 30% of those with normal lung function, 78% of those with LAO, and 67% of those with restrictive lung disease.

7. Morris C, Morris S, Vichinsky E, et al. Arginine therapy: a new treatment for pulmonary hypertension in sickle cell disease (SCD). Am J Respir Crit Care Med 2003; 168:63–69

Oral arginine was administered for 5 days to 10 patients with sickle-cell disease and documented pulmonary hypertension, resulting in a 15.2% mean reduction in estimated pulmonary artery pressure (63.9 ± 13 to 54.2 ± 12 mm Hg, p < 0.002 [± SD]). Arginase activity was also measured and found to be increased twofold in patients with pulmonary hypertension, thereby possibly limiting arginine bioavailability. The high mortality of pulmonary hypertension in patients with sickle-cell disease, the current study, and the emergence of novel treatments for pulmonary hypertension highlight the need for multicenter, randomized treatment studies in this critical area.

8. Farrell P, Kosorok M, Splaingard M, et al. Early diagnosis of cystic fibrosis through neonatal screening prevents severe malnutrition and improves long-term growth: Wisconsin Cystic Fibrosis Neonatal Screening Study Group. Pediatrics 2001; 107:1–13

Immunoreactive trypsinogen analysis applied to dried newborn specimens for recognition of cystic fibrosis risk was coupled with DNA-based detection of the Delta508 mutation during a combined period of 1985 to 1994. Randomization of 650,341 newborns resulted in two cohorts: an early diagnosis, screened cohort, and a standard diagnosis or control group. Anthropometric indexes of nutritional status including length/height, weight, and head circumference were significantly higher in the screened group despite a higher proportion of patients with pancreatic insufficiency in this cohort. Excluding infants presenting with meconium ileus, diagnosis was made at a much earlier age in screened patients. Incorporation of other infants with cystic fibrosis born during the randomization period resulted in a maximum calculated incidence of 1:3,398 (95% CI, 3,402 to 4,611). Early diagnosis facilitated by newborn screen appears to prevent the severe malnutrition that frequently accompanies delayed diagnosis.

9. Equi A, Balfour-Lynn I, Bush A, et al. Long term azithromycin in children with cystic fibrosis: a randomized, placebo-controlled crossover trial. Lancet 2002; 360:978–984

Forty-one children, aged 8 to 18 years, with a median FEV1 of 61% (range, 33–80%) participated in a 15-month, randomized, double-blind, crossover trial of azithromycin or placebo for 6 months followed by 2 months of washout and treatment cross-over. Median relative difference in FEV1 between azithromycin and placebo was 5.4% (95% CI, 0.8 to 10.5). This trial has been extended in a large multicenter study with similar results.1 A trial of azithromycin appears justified in children with moderate disease who do not respond to conventional therapy.

10. Bisgaard H. A randomized trial of montelukast in respiratory syncytial virus post bronchiolitis. Am J Respir Crit Care Med 2003; 167:379–383

One hundred thirty-six infants hospitalized with respiratory syncytial virus bronchiolitis were randomized to a 28-day trial of either 5 mg of montelukast or placebo initiated within 7 days of the onset of symptoms. Infants treated with montelukast were symptom free 22% of days and nights, compared to 4% symptom-free days and nights in the placebo group (p = 0.015). Daytime cough was significantly reduced (p = 0.04) and exacerbations were significantly delayed (p < 0.05) in the montelukast-treated group.

Abbreviations: BHR = bronchial hyperesponsiveness; CI = con-fidence interval; LAO = lower airway obstruction

Saiman, L, Marshall, BC, Mayer-Hamblett, N, et al (2003) Azithromycin in patients with cystic fibrosis chronically infected withPseudomonas aeruginosa: a randomized controlled trial.JAMA290,1749-1756. [CrossRef] [PubMed]




Saiman, L, Marshall, BC, Mayer-Hamblett, N, et al (2003) Azithromycin in patients with cystic fibrosis chronically infected withPseudomonas aeruginosa: a randomized controlled trial.JAMA290,1749-1756. [CrossRef] [PubMed]
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