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Biomedical subjects

Gregory J Redding

Publications and source records attributed to Gregory J Redding.

11 recordsLinked to original sources
PubMed2007

Vertical expandable prosthetic titanium rib for thoracic insufficiency syndrome: a new method to treat an old problem.

PURPOSE: The vertical expandable prosthetic titanium rib (VEPTR) thoracoplasty is a new technique devised for the treatment children with thoracic insufficiency syndrome. This study describes our initial experience with this device. METHODS: This is a retrospective chart review of all children undergoing VEPTR placement between October 2001 and December 2005. RESULTS: Twenty-two patients had 36 VEPTR devices placed. Two patients had Jeune syndrome, 19 had scoliosis, and 1 had a chest wall resection for tumor. Most had associated carbon dioxide retention, pulmonary restrictive disease, or respiratory failure. Eleven patients had multiple fused ribs requiring opening thoracostomy. All but the most recent patients have undergone sequential VEPTR expansion. All children had intraoperative spinal cord monitoring (somatosensory evoked potential). Four experienced intraoperative somatosensory evoked potential changes that resolved with decreased VEPTR expansion. Seven VEPTR devices required revision for erosion through the bone or dislodgment and 3 were removed. Five were outgrown and removed or replaced. One eroded soft tissue causing superficial infection that resolved with operative revision. Postoperative ventilation/perfusion scans improved most in younger children. Two of three children with carbon dioxide retention pre-VEPTR had carbon dioxide reduction post-VEPTR. CONCLUSIONS: Vertical expandable prosthetic titanium rib (VEPTR) is a new and safe method to treat children with thoracic insufficiency syndrome. The VEPTR may decrease carbon dioxide retention in some patients and may be most beneficial in younger children.

Adolescent↗
PubMed2006

Prevalence and impact of gastroesophageal reflux in adolescents with asthma: a population-based study.

We determined the prevalence of gastroesophageal reflux disease (GERD) symptoms and the associations between GERD symptoms and asthma morbidity in a population of adolescents with asthma. Two thousand, three hundred and ninety-seven students attending six middle schools in Seattle completed the International Study of Asthma and Allergy in Children (ISAAC) written and video survey that included additional questions pertaining to GERD symptoms and asthma morbidity. Based on their responses, children were categorized as having undiagnosed current asthma, physician-diagnosed current asthma, or no asthma symptoms. The prevalence of GERD symptoms occurring at least weekly or daily was determined for each group. The asthma morbidity outcomes were emergency department visits, physician visits, missed school days, and use of inhaled medications for respiratory symptoms within the past year. Associations between GERD symptoms and asthma morbidity outcomes were determined using logistic regression. The prevalence of GERD symptoms was significantly higher among students with current asthma (19.3%; 95% confidence interval (CI), 14.9-24.2) than students with no asthma symptoms (2.5%; 95% CI, 1.8-3.4). In children with current asthma (n = 296), symptoms of GERD that occurred at least weekly were strongly associated with emergency department visits (odds ratio (OR), 5.0; 95% CI, 2.6-9.6), physician visits (OR, 2.5; 95% CI, 1.3-4.6), missed school (OR, 2.0; 95% CI, 1.1-3.7), and inhaled medication use (OR, 2.5; 95% CI, 1.3-4.7). The associations between GERD symptoms and emergency department visits, physician visits, and inhaled medication use were stronger among children with asthma who reported daily GERD symptoms (n = 14) than among children reporting weekly GERD symptoms (n = 57). The prevalence of GERD symptoms was greater in adolescents with current asthma than in those without asthma. In addition, the presence of at least weekly GERD symptoms was strongly associated with greater asthma morbidity and the use of asthma medications.

Asthma↗
PubMed2006

Relationship between IgE and specific aeroallergen sensitivity in Alaskan native children.

BACKGROUND: The relationship between atopic disease and serum IgE levels varies among populations and geographic regions. The close association of atopy with IgE may not occur in subarctic populations as it does in developed countries in temperate climates. OBJECTIVE: To evaluate the relationship between total and specific IgE concentrations and clinical atopy in 5- to 8-year-old Alaskan native children. METHODS: Medical record reviews, interviews, physical examinations, serum IgE measurements, and radioallergosorbent testing (RAST) were performed. RESULTS: The IgE geometric mean was 122.1 IU/mL. Fifty-eight percent of patients had IgE levels greater than 70 IU/mL, and 17% had levels greater than 1,000 IU/mL; 14% had RAST values greater than 0.35 kU/L. Both IgE levels greater than 70 IU/mL and greater than 1,000 IU/mL were associated with RAST values greater than 0.35 IU/L (P = .004) and early wheezing (P = .005) but not with current wheezing, asthma, eczema, or a history of allergies. A RAST value greater than 3.51 kU/L was associated with eczema (P = .04) but not with allergies or wheezing. Children with current wheezing were more likely to have allergies (P = .03) but not eczema, an IgE level greater than 70 IU/mL, or a positive RAST value. Children hospitalized with respiratory syncytial virus (RSV) were not more likely than controls to have current wheezing. CONCLUSIONS: Elevated serum IgE concentrations, including levels greater than 1,000 IU/mL, are common among Alaskan native children; positive RAST reactions to aeroallergens are not. The IgE levels do not relate to wheezing, eczema, a history of allergies, or past hospitalization for RSV infection but likely reflect infections other than RSV and environmental factors in subarctic indigenous populations.

Alaska↗
PubMed2005

The prevalence of ibuprofen-sensitive asthma in children: a randomized controlled bronchoprovocation challenge study.

OBJECTIVE: To determine the prevalence of ibuprofen-sensitive asthma in school-aged children with mild or moderate persistent asthma. STUDY DESIGN: A randomized, double-blind, placebo-controlled, crossover bronchoprovocation challenge study in children 6 to 18 years of age with mild or moderate persistent asthma. Patients received a single dose of ibuprofen or placebo, per randomization, and then returned 2 to 7 days later to repeat the procedures after taking that study drug not received at the first visit. At each visit, patients performed spirometry before and (1/2), 1, 2, and 4 hours after administration of study drug. We defined bronchospasm as a > or =20% decrease from baseline in the forced expired volume in the first second (FEV1) and ibuprofen sensitivity as bronchospasm following administration of ibuprofen but not placebo. RESULTS: Of the 127 patients screened, 100 (mean age, 11 years) completed the study. Two patients met criteria for ibuprofen-sensitive asthma, resulting in a prevalence of 2% (95% CI: 0.2%-7%). Neither patient was known to have had any exposure to ibuprofen before the study. CONCLUSION: The prevalence of ibuprofen-sensitive asthma was low but non-zero in this group of children with mild or moderate asthma. The possibility of ibuprofen-induced bronchospasm should be considered before administering ibuprofen to children with asthma.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Childhood asthma hospitalization risk after cesarean delivery in former term and premature infants.

BACKGROUND: Cesarean delivery modifies infant gut bacterial flora composition, which may result in hindered tolerance to allergenic substances, thereby increasing the risk of asthma in accordance with the hygiene hypothesis. Results of previous studies regarding an association between birth route and asthma are conflicting, and these studies have not evaluated some potential confounding effects, including prematurity and maternal asthma. OBJECTIVE: To determine whether cesarean delivery in full-term and premature infants increases the risk of subsequent childhood asthma hospitalization. METHODS: We conducted a case-control study using the Washington State Birth Events Record Database linked to statewide hospitalization data. The study included 2,028 children hospitalized for asthma (cases) and 8,292 age-matched controls. RESULTS: Cesarean delivery was modestly associated with an increased risk of asthma hospitalization (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04-1.39). However, when analyzed separately, there was an association between cesarean delivery and asthma hospitalization in premature infants (OR, 1.90; 95% CI, 1.09-3.02) but not in full-term infants (OR, 1.15; 95% CI, 0.97-1.34). CONCLUSIONS: Cesarean delivery was associated with subsequent asthma hospitalization only in premature infants. Because mothers with asthma are reported to have increased rates of cesarean delivery and premature delivery, other factors in addition to the hygiene hypothesis, including genetic and in utero influences associated with maternal asthma, may contribute to the increased risk of asthma in premature infants.

Adult↗
PubMed2005

Changes in asthma prevalence and impact on health and function in Seattle middle-school children: 1995 vs 2003.

BACKGROUND: The prevalence of asthma has increased during the past several decades but may have stabilized during the last 5 years. It is not known whether the functional and health impact of asthma has decreased during the past decade. OBJECTIVE: To evaluate changes during a recent 8-year period in the prevalence and health and functional impact of current asthma symptoms in young teenagers. METHODS: In 1995 and 2003, 2,330 and 2,397 middle-school students from Seattle, WA, respectively (median age, 13 years), completed written surveys and answered questions pertaining to 4 wheezing or asthma video scenarios. Children were categorized as having physician-diagnosed current asthma (wheeze in the past year and a physician diagnosis of asthma), undiagnosed current asthma symptoms (wheeze in the past year without a physician diagnosis), or no asthma. Outcome measures were the prevalence of asthma and undiagnosed asthma symptoms and the differences between years in respiratory-associated functional impairment (exercise limitation, missed school, disrupted sleep) and health impact (physician visits, wheeze-limited speech). RESULTS: The prevalence of physician-diagnosed current asthma increased from 1995 to 2003 (3.0% to 6.2%), whereas that for undiagnosed current asthma symptoms decreased (12.0% to 6.2%). The degree of functional and health impairment was similar between the 2 study periods for each subgroup and was highest in the children with physician-diagnosed current asthma. CONCLUSIONS: The prevalence of current asthma symptoms in middle-school children from Seattle decreased slightly between 1995 and 2003, whereas the diagnosis of asthma increased. However, the health and functional impact of asthma did not diminish. Asthma is being diagnosed more often, but many children with asthma are still not achieving good asthma control.

Adolescent↗
PubMed2004

Impact of adolescence and gender on asthma hospitalization: a population-based birth cohort study.

Our objective was to determine the impact of gender and age on asthma hospitalization rates among children. We used a population-based retrospective birth cohort study to determine yearly age- and gender-specific asthma hospitalization rates between ages 2-18 years in a cohort of all children born in Washington State between 1980-1985. In addition, we assessed factors associated with the hospitalization of a given child for asthma both before and during adolescence, and factors associated with an initial asthma hospitalization during adolescence. Outcome measures included age- and gender-specific rates of hospitalization for asthma, diabetes, seizures/epilepsy, and nonasthma respiratory diagnoses. Asthma hospitalization rates for boys were significantly higher than for girls between ages 2-12 years, the gender gap in asthma hospitalizations reversed between ages 13-14 years, and rates for girls were significantly higher than boys between 16-18 years of age. The male peak asthma hospitalization rate per 100,000 cohort members occurred at age 4 years (12.7; 95% confidence interval (CI), 11.1-14.3), and the male trough rate occurred at age 18 years (4.1; 95% CI, 2.8-5.4), whereas the female peak asthma hospitalization rate occurred at age 17 years (9.4; 95% CI, 7.8-11) and the female trough rate at age 2 years (5.2; 95% CI, 4.2-6.2). Age-specific hospitalization rates for diabetes mellitus and epilepsy were similar for boys and girls throughout childhood. Female gender was strongly associated with asthma hospitalization occurring in an individual child both prior to and during adolescence (rate ratio (RR), 2.0; 95% CI, 1.4-2.9), and was modestly associated with initial hospitalization in adolescence (RR, 1.15; 95% CI, 1.0-1.3). In conclusion, asthma hospitalization rates for boys and girls exhibit strikingly different patterns during adolescence. Potential explanations for these gender differences include hormonal changes during puberty, or gender-specific differences in environmental exposures such as diet, obesity, allergen exposure, or cigarette smoking.

Adolescent↗
PubMed2004

Prevalence of asthma and chronic respiratory symptoms among Alaska Native children.

STUDY OBJECTIVES: To quantify the prevalence and impact of chronic respiratory symptoms among predominantly Alaska Native (AN)/American Indian (AI) middle school students. DESIGN: School-based prevalence assessment using the International Study of Asthma and Allergy in Children survey, with supplemental video material and added questions about productive cough, exposure to tobacco smoke, and the functional impact of symptoms. SETTING: The Yukon-Kuskokwim delta region of western Alaska. PARTICIPANTS: A total of 466 children in the sixth to ninth grades, 81% of whom are AN/AI (377 children). INTERVENTIONS: No study intervention. RESULTS: Among the 377 AN/AI children, 40% reported one of the following three categories of chronic respiratory disease: physician-diagnosed asthma, 7.4%; asthma-like symptoms (ALS) without an asthma diagnosis, 11.4%; and chronic productive cough (CPC) without asthma diagnosis or symptoms, 21.5%. Symptom prevalence differed substantially between the largest town in the region and rural villages. After an adjustment for demographic factors, exposure to environmental tobacco smoke, active tobacco smoking, and self-report of atopy, village residents were 63% less likely to have ALS (p = 0.009), and had a twofold greater risk of CPC (p < 0.001) compared to children living in the town. Children with respiratory symptoms experienced sleep disturbances and accessed clinic visits for respiratory problems more often than did asymptomatic children. CONCLUSIONS: Chronic respiratory symptoms are very common among AN children. CPC is an important nonasthmatic respiratory condition in this population. The differing patterns of respiratory illness within this region may help to elucidate the specific risk factors for asthma and chronic bronchitis in children.

Adolescent↗
PubMed2002

Bronchiectasis in children: orphan disease or persistent problem?

More than a decade ago, bronchiectasis unrelated to cystic fibrosis was termed an "orphan disease", because it had become an uncommon clinical entity among children in the developed world. Bronchiectasis is more common among children in lower socioeconomic classes and in developing countries, presumably due to more frequent and recurrent respiratory infections, environmental airway irritants, poor immunization rates, and malnutrition. Reports from the Southern Pacific and from Alaska Native children reveal persistently high rates of childhood bronchiectasis. Better epidemiologic data throughout the world are needed to reassess the importance of this condition. The pathophysiology includes airway inflammation, mucus production, and regional airway obstruction, yet the reasons why some children develop bronchiectasis while other do not is unclear. The coexistence of asthma with bronchiectasis is associated with more severe disease, yet the impact of asthma therapy in children with both disorders has not been studied. Similarly, the pattern of antibiotic use for children with bronchiectasis varies by region with little data to justify one particular approach. It may be that public health measures aimed at improving living conditions for children and prevention of respiratory infections with antiviral vaccines will have more impact on childhood bronchiectasis than medical treatments in the future.

Bronchiectasis↗
PubMed2002

Plastic bronchitis in children: a case series and review of the medical literature.

Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts. We reviewed our experience and the literature to determine whether mortality rates are determined by underlying disease or cast type. We present 3 children with obstructive bronchial casts. One 3-year-old patient with Noonan's syndrome developed respiratory failure following surgery for tetralogy of Fallot requiring support with extracorporeal membrane oxygenation (ECMO) the first such case. There were 42 cases in the literature of children with plastic bronchitis. Casts may be divided into two types. Type I casts are inflammatory, consisting mainly of fibrin with cellular infiltrates, and occur in inflammatory diseases of the lung. Type II, or acellular casts, consist mainly of mucin with a few cells, and usually occur following surgery for congenital cardiac defects. Patients categorized by underlying disease included 31% with asthma or allergic disease, 40% with underlying cardiac defects, and 29% with other diseases. Mortality was 16%, but increased to 29% in patients with cardiac defects. Deaths occurred as long as 1 year after surgical repair for underlying defects. There were no deaths in patients with asthma. Life-threatening events were statistically higher in patients with cardiac defects (41%) than in those with asthma (0%, P = 0.02). Higher mortality in patients with type II casts compared to type I casts did not reach statistical significance (28% vs. 6%; P = 0.06). In conclusion, patients presenting with plastic bronchitis are at high risk for serious complications, especially with underlying cardiac disease.

Bronchi↗