PubMed Health⌕ Search

Biomedical subjects

F Brémont

Publications and source records attributed to F Brémont.

At least 19 recordsLinked to original sources
PubMed2004

[Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology].

INTRODUCTION: Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS: In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS: Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS: This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.

Bronchoscopes↗
PubMed2004

[From asthma attack to fatal asthma in children].

Mortality by asthma has decreased, but the number of children being hospitalized is stable: 10% of the asthmatic children are hospitalized within the year, or will be at least once before their tenth year. Some factors are associated with occurrence of a severe asthma attack: poor lung function, bronchial hyperreactivity or poor asthma control, a food allergy, a decreased perception of airway obstruction prior hospitalisation, denial of illness, psychological and social difficulties. The prevention of most asthma exacerbations is possible. The treatment must be adapted to severity of asthma: inhaled steroids, even low doses, have been proven efficient. The follow-up must be regular: planned consultations, repeated lung function testing. Educational programs show an increased quality of life, therapeutic adherence or reduction of hospitalization. The patient and care giver must be able to recognize the signs of severity of asthma exacerbation; an exacerbation is considered severe if it begins suddenly, if its progression or symptoms are unusual, and therefore requires a prompt adapted treatment. An action plan and accessible emergency care are essential.

Administration, Inhalation↗
PubMed2004

Traffic related air pollution and incidence of childhood asthma: results of the Vesta case-control study.

STUDY OBJECTIVE: The Vesta project aims to assess the role of traffic related air pollution in the occurrence of childhood asthma. DESIGN AND SETTING: Case-control study conducted in five French metropolitan areas between 1998 and 2000. A set of 217 pairs of matched 4 to 14 years old cases and controls were investigated. An index of lifelong exposure to traffic exhausts was constructed, using retrospective information on traffic density close to all home and school addresses since birth; this index was also calculated for the 0-3 years age period to investigate the effect of early exposures. MAIN RESULTS: Adjusted on environmental tobacco smoke, personal and parental allergy, and several confounders, lifelong exposure was not associated with asthma. In contrast, associations before age of 3 were significant: odds ratios for tertiles 2 and 3 of the exposure index, relative to tertile 1, exhibited a positive trend (1.48 (95%CI = 0.7 to 3.0) and 2.28 (1.1 to 4.6)), with greater odds ratios among subjects with positive skin prick tests. CONCLUSIONS: These results suggest that traffic related pollutants might have contributed to the asthma epidemic that has taken place during the past decades among children.

Age Factors↗
PubMed2002

Exhaled NH3 and excreted Nh4+ in children in unpolluted or urban environments.

Exhaled ammonia (NH3ex) was measured by chemiluminescence in a group of healthy children (n = 20) and in two groups of asthmatic children, one (Group 1) residing in a National Park in the mountains (n = 68) and other (Group 2) in an urban area (n = 52). We also determined urinary ammonia, nitrates, urea, sodium and potassium normalized to osmolarity. Unlike exhaled nitric oxide (NOex), NH3ex was not specific to asthma as the children in Group 2 and the controls exhaled more ammonia that did the children in Group 1 (14.3 +/- 10.2 and 14.8 +/- 10.3 vs. 5.6 +/- 4.7 ppb; P < .001, respectively). In the urban environment, all children, including the healthy controls, excreted more ammonia (P < .001) and potassium (P < .001) but less urea (P < .02) than did the children residing in the National Park. These manifestations of moderate metabolic acidosis would favor excretion of ammonia at the expense of urea. In the children residing in the National Park, positive correlations were observed between NH3ex and urinary ammonia, and nitrates, age and morphological parameters. The relationship with the morphological parameters is a reflection of the normal physiological formation of NH3ex. In the children residing in the urban area, the other endogenous source of NH3ex was attributed to a slight disturbance in acid-base balance. In conclusion, the measurement of NH3ex appeared of limited interest, although the higher urinary urea/NH4+ ratio in Group 1 (P < .0001), especially in the treated children, appeared to be linked to the lack of atmospheric pollutants in the National Park. Further experimentation is in progress to confirm these findings.

Air Pollutants↗
PubMed2002

[Lung abscess due to Mycoplasma pneumoniae in an adolescent].

UNLABELLED: Pulmonary abscess is an uncommon complication of pneumonia in children. Pyogenes, in particular Staphylococcus aureus or Streptococcus pneumoniae are the principal responsible bacteria. Mycoplasma pneumoniae is rarely the cause. CASE REPORT: A 14-year-old child was hospitalized with right thoracic pain. The patient was non-febrile and had a recent history of moderate infection. He was receiving antibiotic (macrolide) and non-steroidal anti-inflammatory therapy. CT scan confirmed a mid-lobe abscess in the right lung. Interruption of therapy resulted in fever and increase in C-reactive level with hyperleucocytosis, suggesting that the abscess was caused by a bacterial infection. The child's general condition and the radiographic picture improved with combined antibiotic therapy with amoxycillin and clavulanic acid, aminoglycosides and macrolides. The suspected diagnostic of M. pneumoniae was confirmed by increased IgM antibodies for M. pneumoniae. Recovery was complete two months later without sequelae. COMMENT: Pulmonary abscess is a rare complication of M. pneumoniae infection in children. This complication should be considered when the general condition does not improve despite appropriate early treatment of a pneumonia, as in the case of our patient.

Adolescent↗
PubMed2002

Five epidemiological studies on transport and asthma: objectives, design and descriptive results.

A case-control study was conducted in five French metropolitan areas in order to assess the role of traffic-related air pollution in the occurrence of childhood asthma. This paper presents the study design and describes the distribution of key exposure variables. A set of 217 pairs of matched 4- to 14-year-old cases and controls were investigated (matching criteria: city, age, and gender). Current and past environmental smoke exposures, indoor allergens or air pollution sources, and personal and family atopy were assessed by standard questionnaires. When possible, direct measurements were done to check the validity of this information, on current data: skin prick tests, urine cotinine, house dust mites densities, personal exposures to, and home indoor concentrations of NO(x) and PM(2.5). Cumulative exposure to traffic-related pollutants was estimated through two indices: "traffic density" refers to a time-weighted average of the traffic density-to-road distance ratio for all home and school addresses of each child's life; "air pollution" index combines lifelong time-activity patterns and ambient air concentration estimates of NO(x), using an air dispersion model of traffic exhausts. Average current PM(2.5) personal exposure is 23.8 microg/m3 (SD=17.4), and average indoor concentrations=22.5 microg/m3 (18.2); corresponding values for NO(2) are 31.4 (13.9) and 36.1 (21.4) microg/m3. Average lifelong calculated exposures to traffic-related NO(x) emissions are 62.6 microg/m3 (43.1). The five cities show important contrasts of exposure to traffic pollutants. These data will allow comparison of lifelong exposures to indicators of traffic exhausts between cases and controls, including during early ages, while controlling for a host of known enhancers or precipitators of airway chronic inflammation and for possible confounders.

Adolescent↗
PubMed2001

Cytological characterization of apatitic calcium phosphate structures in bronchial epithelial tissue cultured from a child with cystic fibrosis (deltaF508).

Patients with cystic fibrosis homozygous for the AF508 mutation have marked disturbances in ion exchanges in a variety of tissues. Alterations in intra- or extracellular levels of Ca2+ and calcifications have been observed in numerous tissues from such patients, although the nature and origin of such calcifications have yet to be elucidated. In this study, we investigated the formation of calcifications in the respiratory tract of a AF508 homozygous child and attempted to establish their origin. Samples of bronchial epithelium from this patient were subjected to cytophysiological analysis ex vivo and in vitro. The defect of targeting of the cystic fibrosis transmembrane conductance regulator (CFTR) to the apical plasma membrane of epithelial cells was verified. Cytochemical and ultrastructural analysis revealed the presence of crystalline aggregates in fine needles in the respiratory tract. Cytochemical analysis, X-ray spectrometry, and electron diffraction showed that these aggregates corresponded to crystals of calcium phosphate in an apatite-like structure. Ultrastructural study of primary cultures of bronchial epithelium showed the presence of calcium phosphate crystals in granules from Golgi apparatus and in mitochondria. These observations indicated that modifications of ionic exchanges due to a defect in targeting of CFTR AF508 to the apical plasma membrane led to the formation of crystals of calcium phosphate in the cytoplasm of pulmonary cells. These crystals could enhance inflammation of the lung in patients with cystic fibrosis.

Apatites↗
PubMed2001

Exhaled NO in asthmatic children in unpolluted and urban environments.

BACKGROUND: NO production (NOex) in the airway epithelium is increased in asthmatic patients and is potently inhibited by anti-inflammatory treatments. The study was designed to compare the: (i) levels of NOex in two groups of asthmatic children residing in different environments (one in a national park in the mountains and the other in a large city) and (ii) the influence of glucocorticoids on levels of NOex between the children and those without treatment. METHODS: The measurements were performed during the same period in the two locations, 100 km apart. NOex was measured using a chemiluminescence analyzer in controls and two comparable groups of asthmatic children. The first group included 63 children (10+/-3 years) recruited from a specialized institution for asthmatic children, and the second group consisted of 46 asthmatic children (9+/-3 years) living in an urban area. A reference group of 17 healthy children residing in the same city was also studied. MEASUREMENTS AND RESULTS: The concentrations of NOex in children in the specialized institution were significantly lower (P<.001) than those in asthmatic children living in the city (5.1+/-2.4 vs. 13.8+/-9.3 ppb) and comparable to those in healthy controls (5.3+/-4.0 ppb). In the urban area, NOex levels increased when atmospheric pollution recorded on the previous day had increased. In contrast to that observed in the urban children, glucocorticoids had little influence on the levels of NOex in the children living in the specialized institution. CONCLUSIONS: Although these relationships need to be confirmed, our findings show that for the determination of NOex, specifying the quality of the environment, in particular, the purity of the air respired by asthmatic children, not only at the time of measurement but also over the previous days, is important.

Air Pollutants↗
PubMed2001

[The consequences of parental smoking in children: pediatricians must act].

Prenatal and childhood passive tobacco smoke exposure resulting from parental smoking may have severe side effects, such as low birth weight, prematurity, sudden infant death syndrome, upper and lower respiratory tract infections and asthma. By giving information to parents, and particularly by emphasizing the dangers of passive smoke exposure for their children, pediatricians have a critical role to play in their prevention. This may also be helpful for adolescents who are starting to smoke actively by trying to understand the needs that they express by this behavior, and encouraging them to go to a stop smoking counseling center.

Adolescent↗
PubMed2001

[Definition and nosological aspects of chronic cough in children].

Cough is a physiological reflex occurring when sensitive receptors located in upper airways and the larynx are activated. By definition a 'chronic cough' lasts at least 3 weeks. An analysis of clinical characteristics is essential for setting up the diagnosis and giving correct treatment. We can individualize three mainly clinical aspects: the young child of less than 3 years of age, the nocturnal cough and the productive cough. The 'variant of asthma' cough is a common problem among all ages that frequently goes unrecognized. Any patient with dry nocturnal coughing that lasts more than three weeks should have an empiric bronchodilator treatment. The prognosis is on the whole favourable.

Adolescent↗
PubMed2001

[Chronic cough in children: etiology and decision trees].

Recurrent or chronic cough can be the symptom of a worrying condition which must be diagnosed without delay (cystic fibrosis, asthma, bronchial foreign body, bronchiectasis). Investigation of recurrent or chronic cough is based on simple principles: careful history-taking concerning the characteristics of the cough, full clinical examination to look for any associated symptoms, and auxological assessment to detect any interruption in weight increase. Only when this initial evaluation has been carried out can complementary investigations be sought. Ordinary respiratory infections that are part of the building up of immunity are predominant in coughs of children aged under 6 years and are aggravated by deleterious factors such as passive exposure to tobacco, early introduction to communal life, and urban pollution. We describe the most frequent causes of cough and their frequency according to the age of the child.

Age Factors↗
PubMed2001

[Chronic cough and gastroesophageal reflux in children].

Gastroesophageal reflux (GER) is one of the three most common causes of chronic cough in children, along with postnasal drip syndrome and asthma. There may be no gastrointestinal symptoms up to 50-75% of the time. GER plays a causative role in chronic cough, asthma without allergy and posterior laryngitis. GER most commonly provokes coughing by stimulating an esophageal-bronchial reflex and by irritating the lower respiratory tract by microaspiration. Twenty-four-hour pH monitoring of the distal esophagus is the most accurate diagnostic method for children with suspected GER and it helps to establish a temporal correlation between cough and GER. The first step of the treatment is the association of postural and dietetic measures and medications (prokinetics and antacids). The length of the treatment is a minimum of 3 months up to the age of walking. Surgical treatment must be reserved for the failure of medical treatment. The benefits of minimally invasive surgery are evident in children with chronic cough, who have a faster recovery with fewer complication than after open surgery.

Adolescent↗
PubMed2001

[Etiology of chronic cough in children: analysis of 100 cases].

In order to understand the epidemiological aspects of chronic cough, we analysed 100 patients' files referred for chronic cough in five pediatric-pulmonology consultations. The patients had a chronic cough for more than 3 weeks. The distribution of causes was: asthma, 56%; upper airway disorders, 16%; psychogenic, 4%; whooping cough, 4%; Mycoplasma pneumoniae pulmonary infection, 3%; Chlamydia pneumoniae pulmonary infection, 1%; bronchiectasis, 1%. In 15% of cases two or more causes were associated; In most cases, the clinical characteristics of the cough are evident enough to establish a diagnosis with few secondary explorations. The prognosis is on the whole favourable.

Adolescent↗