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Obesity and obstructive sleep apnea in children and adolescents – a systematic review of literature
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Posters / Paediatric Respiratory Reviews 14S2 (2013) S55–S85
In the trachea, the mass of salbutamol was similar with Itinhaler and Tipshaler (5±2 mg vs 5.5±2 mg). In addition, deposition of fine particles of salbutamol was higher with Itinhaler compared to Tipshaler (73±11 mg vs 51±2 mg, p < 0.05). Concerning fluticasone, in the trachea, the mass of fluticasone was lower with Tipshaler compared to Itinhaler (4±0.3 mg vs 0.9±0.3 mg, p < 0.05). However, the fine particle dose was similar between the two inhalation chambers (27±2 mg vs 25±1 mg). In conclusion, material type and pMDI influence the valved holding chamber performances. P03-49 Dynamic changes of serum cytokines and prognosis of interstitial lung disease in children
secretions in the right bronchial tree. Immunodeficiency, infectious causes, malignancy, and Castleman’s disease were excluded. Thoracoscopic partial resection of the mass was performed and tissue biopsy revealed lymphoplasmocytic infiltrate and increased number of IgG4-positive plasma cells (16 IgG4-positive plasma cells/ HPF). A month later the size of the mediastinal mass increased to its initial dimensions with worsening of the respiratory symptoms. Glucocorticoids therapy was started (prednisone 2 mg/kg) with symptomatic improvement, reduction in the size of the mass and decrease of serum IgG4 levels after 6 weeks. Comments: IgG4-RD is a newly recognized systemic condition that rarely presents in children. A close follow up is necessary to access the durability of treatment response after steroid tapering.
Y.H. Kim, K.E. Lee, M.J. Kim, H.S. Kim, Y.A Park, H.S. Lee, Y.K. Han, K.W. Kim, M.H. Sohn, K.-E. Kim. Severance Hospital Pulmonology & Allergy, Seoul, South Korea
P05-165 Obesity and obstructive sleep apnea in children and adolescents – a systematic review of literature
Rationale: Interstitial lung disease (ILD) in children which shows mostly massive inflammation and fibrosis of lung parenchyma is associated with high morbidity and mortality. The aim of this study was to evaluate dynamic changes of serum cytokines which have been known to be related with inflammation and fibrosis of lung and identify meaningful changes that are predictive of outcome in children with ILD. Methods: We evaluated 16 children with ILD who were able to be collected their serum samples serially in hospital. IL-8, IL-13, IL-33, transforming growth factor beta 1 (TGF-b1), granulocyte macrophage-colony stimulating factor (GM-SCF), and vascular endothelial cell growth factor (VEGF) were assessed by ELISA. Results: Six of the 16 children survived. The mean age of all children was 2.55 years and 12 children were male. There was no significant difference of age, gender, clinical symptoms and treatments between survivors and non-survivors. No significant difference existed in any cytokine according to survival after an initial steroid pulse therapy. In dynamic changes of cytokines, TGF-b1 decreased abruptly in non-survivors while it maintained its increased level which was from 500 to 1500 pg/mL in survivors. The serial changes of VEGF also showed a similar tendency as in those of TGF-b1. TGF-b1 was positively correlated with PaO2 /FiO2 (r = 0.404, P = 0.004) and negatively with oxygenation index (r = −0.443, P = 0.005). Conclusions: Maintenance of increased TGF-b1 and VEGF in children with ILD can be considered as a good prognosis marker, especially in an acute stage. The role of TGF-b1 and VEGF in acute lung injury may be lighted as a healing and repairing marker more than as an excessive fibrosis marker in children with ILD.
J.L. Mathew. Post Graduate Institute of Medical Education and Research Advanced Pediatrics Centre, Chandigarh, India
P04-215 IgG4-related disease – case report in a child S.M. Corujeira, J. Pimenta, C. Ferraz, L. Vaz. Centro Hospitalar S˜ ao Jo˜ ao Pediatrics, Porto, Portugal Introduction: Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized syndrome of unknown etiology. It can appear with multiple organ involvement, typically with tumor-like swelling and lymphoplasmocytic infiltrate enriched in IgG4-positive plasma cells. Case report: The authors describe the case of a 22-month-old female child with failure to thrive and recurrent respiratory tract infections since 8 months of age. Physical examination was normal except for pulmonary auscultation with bilateral crackles and wheezes. Laboratory tests revealed elevated erythrocyte sedimentation rate (32 mm), elevated serum IgG (1690 mg/dL) and IgG4 (805 mg/dL) with polyclonal hypergammaglobulinemia. Thoracic CT and MRI showed multiple mediastinal lymphadenopathy and a nodular posterior mediastinal mass (34×22 mm) in right paratracheal location with bronchial compression. Fine needle aspiration biopsy was compatible with reactive lymphadenopathy. Bronchofibroscopy examination revelead abundant purulent
Background: Emerging evidence of a link between childhood obesity and obstructive sleep apnea (OSA) necessitates a systematic review of literature. Objective: To undertake a systematic review of literature to explore the relationship between obesity and OSA in children and adolescents. Methods: Published literature was searched through EMBASE and Pubmed using a pre-defined search strategy. A three-stage screening process was employed to identify primary research studies (all designs except case reports and reviews) for inclusion. One author extracted relevant data and synthesized the review. Results: The bulk of evidence suggests that OSA is more frequent and/or more severe in children and adolescents who are overweight or obese. Meta-analysis showed odds ratio 1.34, 95% CI = 1.00– 1.80, I2 = 88%). Sensitivity analysis suggested an even stronger effect (OR = 2.44, 95% CI = 1.64–3.62, I2 = 0%). Some studies suggested that there is a higher frequency of obese children among those with OSA compared to those without. Obesity and OSA have several common clinical consequences including cardiovascular and metabolic effects especially insulin resistance and hyperlipidemia. In the presence of obesity, treatment of OSA with adenotonsillectomy results in less favourable results than in non-obese subjects. Meta-analysis for persistence of OSA in those who were obese showed OR = 3.12, 95% CI = 1.85–5.26, I2 = 54%. Surgical procedures for relieving morbid obesity are reported to relieve co-morbid OSA in some children. Despite these pointers, a clear cause and effect relationship between obesity and OSA could not be identified. Conclusion: There is a close relationship between obesity and OSA in children and adolescents, although a cause–effect relationship in either direction cannot be established. P06-64 Provider evaluation and treatment of ARC patients (<18 years): The Allergies, Immunotherapy, & RhinoconjunctivitiS (AIRS) provider survey D. Skoner1 , M. Blaiss2 , G. Ortiz3 , B. Leatherman4 , L. Bielory5 , N.E. Smith6 , F. Allen-Ramey6 . 1 West Penn Allegheny Health System Section of Allergy/Asthma/Immunology, Cranberry TWP, PA, USA; 2 Allergy & Asthma Care, Germantown, TN, USA; 3 Pediatric Pulmonary Services, El Paso, TX, USA; 4 Coastal ENT Associates, Gulfport, Mississippi, USA; 5 Rutgers University Center for Environmental Prediction, Springfield, NJ, USA; 6 Merck & Co, Inc Global Health Outcomes, Whitehouse Station, USA Rationale: Allergic Rhinoconjunctivitis (ARC) is common chronic disease in the US that can be effectively treated with specific immunotherapy (SIT). The AIRS provider survey assessed providers’ current approach to evaluation and treatment of ARC patients. Methods: A telephone survey was administered to 500 healthcare providers offering outpatient care to ≥1 ARC patient per
Posters / Paediatric Respiratory Reviews 14S2 (2013) S55–S85
In the trachea, the mass of salbutamol was similar with Itinhaler and Tipshaler (5±2 mg vs 5.5±2 mg). In addition, deposition of fine particles of salbutamol was higher with Itinhaler compared to Tipshaler (73±11 mg vs 51±2 mg, p < 0.05). Concerning fluticasone, in the trachea, the mass of fluticasone was lower with Tipshaler compared to Itinhaler (4±0.3 mg vs 0.9±0.3 mg, p < 0.05). However, the fine particle dose was similar between the two inhalation chambers (27±2 mg vs 25±1 mg). In conclusion, material type and pMDI influence the valved holding chamber performances. P03-49 Dynamic changes of serum cytokines and prognosis of interstitial lung disease in children
secretions in the right bronchial tree. Immunodeficiency, infectious causes, malignancy, and Castleman’s disease were excluded. Thoracoscopic partial resection of the mass was performed and tissue biopsy revealed lymphoplasmocytic infiltrate and increased number of IgG4-positive plasma cells (16 IgG4-positive plasma cells/ HPF). A month later the size of the mediastinal mass increased to its initial dimensions with worsening of the respiratory symptoms. Glucocorticoids therapy was started (prednisone 2 mg/kg) with symptomatic improvement, reduction in the size of the mass and decrease of serum IgG4 levels after 6 weeks. Comments: IgG4-RD is a newly recognized systemic condition that rarely presents in children. A close follow up is necessary to access the durability of treatment response after steroid tapering.
Y.H. Kim, K.E. Lee, M.J. Kim, H.S. Kim, Y.A Park, H.S. Lee, Y.K. Han, K.W. Kim, M.H. Sohn, K.-E. Kim. Severance Hospital Pulmonology & Allergy, Seoul, South Korea
P05-165 Obesity and obstructive sleep apnea in children and adolescents – a systematic review of literature
Rationale: Interstitial lung disease (ILD) in children which shows mostly massive inflammation and fibrosis of lung parenchyma is associated with high morbidity and mortality. The aim of this study was to evaluate dynamic changes of serum cytokines which have been known to be related with inflammation and fibrosis of lung and identify meaningful changes that are predictive of outcome in children with ILD. Methods: We evaluated 16 children with ILD who were able to be collected their serum samples serially in hospital. IL-8, IL-13, IL-33, transforming growth factor beta 1 (TGF-b1), granulocyte macrophage-colony stimulating factor (GM-SCF), and vascular endothelial cell growth factor (VEGF) were assessed by ELISA. Results: Six of the 16 children survived. The mean age of all children was 2.55 years and 12 children were male. There was no significant difference of age, gender, clinical symptoms and treatments between survivors and non-survivors. No significant difference existed in any cytokine according to survival after an initial steroid pulse therapy. In dynamic changes of cytokines, TGF-b1 decreased abruptly in non-survivors while it maintained its increased level which was from 500 to 1500 pg/mL in survivors. The serial changes of VEGF also showed a similar tendency as in those of TGF-b1. TGF-b1 was positively correlated with PaO2 /FiO2 (r = 0.404, P = 0.004) and negatively with oxygenation index (r = −0.443, P = 0.005). Conclusions: Maintenance of increased TGF-b1 and VEGF in children with ILD can be considered as a good prognosis marker, especially in an acute stage. The role of TGF-b1 and VEGF in acute lung injury may be lighted as a healing and repairing marker more than as an excessive fibrosis marker in children with ILD.
J.L. Mathew. Post Graduate Institute of Medical Education and Research Advanced Pediatrics Centre, Chandigarh, India
P04-215 IgG4-related disease – case report in a child S.M. Corujeira, J. Pimenta, C. Ferraz, L. Vaz. Centro Hospitalar S˜ ao Jo˜ ao Pediatrics, Porto, Portugal Introduction: Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized syndrome of unknown etiology. It can appear with multiple organ involvement, typically with tumor-like swelling and lymphoplasmocytic infiltrate enriched in IgG4-positive plasma cells. Case report: The authors describe the case of a 22-month-old female child with failure to thrive and recurrent respiratory tract infections since 8 months of age. Physical examination was normal except for pulmonary auscultation with bilateral crackles and wheezes. Laboratory tests revealed elevated erythrocyte sedimentation rate (32 mm), elevated serum IgG (1690 mg/dL) and IgG4 (805 mg/dL) with polyclonal hypergammaglobulinemia. Thoracic CT and MRI showed multiple mediastinal lymphadenopathy and a nodular posterior mediastinal mass (34×22 mm) in right paratracheal location with bronchial compression. Fine needle aspiration biopsy was compatible with reactive lymphadenopathy. Bronchofibroscopy examination revelead abundant purulent
Background: Emerging evidence of a link between childhood obesity and obstructive sleep apnea (OSA) necessitates a systematic review of literature. Objective: To undertake a systematic review of literature to explore the relationship between obesity and OSA in children and adolescents. Methods: Published literature was searched through EMBASE and Pubmed using a pre-defined search strategy. A three-stage screening process was employed to identify primary research studies (all designs except case reports and reviews) for inclusion. One author extracted relevant data and synthesized the review. Results: The bulk of evidence suggests that OSA is more frequent and/or more severe in children and adolescents who are overweight or obese. Meta-analysis showed odds ratio 1.34, 95% CI = 1.00– 1.80, I2 = 88%). Sensitivity analysis suggested an even stronger effect (OR = 2.44, 95% CI = 1.64–3.62, I2 = 0%). Some studies suggested that there is a higher frequency of obese children among those with OSA compared to those without. Obesity and OSA have several common clinical consequences including cardiovascular and metabolic effects especially insulin resistance and hyperlipidemia. In the presence of obesity, treatment of OSA with adenotonsillectomy results in less favourable results than in non-obese subjects. Meta-analysis for persistence of OSA in those who were obese showed OR = 3.12, 95% CI = 1.85–5.26, I2 = 54%. Surgical procedures for relieving morbid obesity are reported to relieve co-morbid OSA in some children. Despite these pointers, a clear cause and effect relationship between obesity and OSA could not be identified. Conclusion: There is a close relationship between obesity and OSA in children and adolescents, although a cause–effect relationship in either direction cannot be established. P06-64 Provider evaluation and treatment of ARC patients (<18 years): The Allergies, Immunotherapy, & RhinoconjunctivitiS (AIRS) provider survey D. Skoner1 , M. Blaiss2 , G. Ortiz3 , B. Leatherman4 , L. Bielory5 , N.E. Smith6 , F. Allen-Ramey6 . 1 West Penn Allegheny Health System Section of Allergy/Asthma/Immunology, Cranberry TWP, PA, USA; 2 Allergy & Asthma Care, Germantown, TN, USA; 3 Pediatric Pulmonary Services, El Paso, TX, USA; 4 Coastal ENT Associates, Gulfport, Mississippi, USA; 5 Rutgers University Center for Environmental Prediction, Springfield, NJ, USA; 6 Merck & Co, Inc Global Health Outcomes, Whitehouse Station, USA Rationale: Allergic Rhinoconjunctivitis (ARC) is common chronic disease in the US that can be effectively treated with specific immunotherapy (SIT). The AIRS provider survey assessed providers’ current approach to evaluation and treatment of ARC patients. Methods: A telephone survey was administered to 500 healthcare providers offering outpatient care to ≥1 ARC patient per