Biomedical subjects
Publications and source records attributed to L Couderc.
Two case-reports are used to examine the various options for the treatment of asthma in children. The rationale for monotherapy or combined treatment with bronchodilators, corticosteroids and leukotriene inhibitors according to type, circumstances, severity and frequency of attacks is analyzed.
The adverse events of the inhaled steroids on growth and bone mineralization concern the pediatricians. From the available current data, we exposed the following conclusions: 1) Inhaled steroids must be preferred to oral steroids; 2) Short, middle and long-term adverse effects of inhaled steroids have to be differentiated. Only the long-term effects reflect possible sequela; 3) The adverse effects are specific from the considered inhaled steroids, the most recent available drugs having less adverse effects on bone and growth; 4) Recent data did not show consequences on the adult height and bone mineralization; 5) Recommendations in the use of inhaled steroids must be known by the practitioners in order to limit the adverse events of these drugs. Growth need to be surveyed in children with inhaled steroids and more studies are still necessary. In addition, we enhanced that local adverse effects should be sought by the physicians. Cough after inhalation was frequent and might be a negative factor of compliance.
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After a brief review of airway inflammation mechanisms, the main results concerning the studies on airways inflammation in wheezing infants are commented. Infantile asthma differed from adult asthma by a predominance of neutrophils in airways, but less eosinophils or mastocytes. However, the presence of eosinophil or mastocyte markers does not allow to exclude a contribution of eosinophils in infantile wheeze. Studies on macrophages at cell level showed that a potent inflammation from macrophages exists in asymptomatic asthmatic infants. Lymphocyte subsets studies demonstrated a modulation of CD8 in these infants, suggesting the role of lymphocytes and the contribution of viruses in the pathophysiology of the disease. Lastly, the measurement of various mediators in airways confirmed that airway inflammation is present in infantile wheeze.
The medical approach of chronic cough suffers from the lack of a standardised definition. The most frequently encountered criterion is a recurrent cough observed during several consecutive months, each episode lasting at least 1 week. The link between recurrent cough and asthma is still discussed. Cough-related asthma diagnosis is facilitated when wheezing is clearly confirmed, or may be reminded by a nonproductive middle night cough, or an exercise-triggered cough, or the presence of personal or familial atopy. Conversely, an early morning and productive cough associated with tobacco exposure do not suggest asthma.
The recent availability of small-volume spacers has facilitated the general use of inhaled treatment in infants. The purpose of this study was to evaluate any errors made by parents when using this new inhalation technique and the child's behavior during the inhalation. Ninety-four young children (61% boys) under 5 years of age were enrolled in the study. Inhalation treatment was recommended either by a general practitioner or by a pediatrician. Data concerning treatment regimens, the ability of parents to use the spacer and metered-dose inhalers (MDIs), and the acceptance of the devices, were collected by means of a demonstration and questionnaire. Unexpectedly, the doses, administration times, and duration of the treatments varied from one child to the next. No explanation or training in administering the treatment via the spacers was given to 12% and 47% of the parents, respectively. Fourteen per cent of parents did not shake the MDIs, 12% did not monitor the valves, and 22% allowed too short a time for inhalation. The lack of explanation increased the occurrence of errors in manipulation of the devices. The procedure was judged to be easy to follow by 78% of the parents, but the face mask was accepted with difficulty by 22% of the children. Repeated crying during administration of the treatment was observed in 38% of the patients, particularly the youngest. Crying influenced the acceptance of the face mask, reduced parental compliance, and made the use of the devices more difficult. Errors altering the efficiency of inhalation treatment in infants are frequent. Most of these errors could be avoided by spending more time to inform the parents about correct usage. Furthermore, repeated crying during inhalation is common in young children and this problem should to be taken into consideration in the evaluation of treatment.
The medical part of the activity in the emergency units increased and has been ascribed to the raised number of infants or children admitted for acute dyspnea. This review is based on the published reports and the experience from the paediatric emergency unit from the Rouen area with 450,000 inhabitants, in France. We put forward the known epidemiological data and discussed the available means for the practitioner, which could help him in the decision to hospitalize. This review suggests that algorithms of treatment and severity evaluations must be set up in paediatric emergency units in order to validate them and specify the children who requires hospitalisation.
The increase in frequency of anaphylaxis, an acute allergic reaction which may be fatal, might be explained by the rise in food allergy. We report a cohort of 44 children, aged 2 months to 15.5 years, who were admitted in a pediatric emergency unit for serious allergic events. Thirty-two percent, 86% and 66% presented hypotension, severe edema and respiratory distress, respectively. Three patients were admitted to the ICU. One-fourth of all children had an angioneurotic edema history, 1/3 were asthmatics and 41% had known allergy. Etiologies were: food allergy (42.5%), drugs (14.8%), respiratory allergy (9%), miscellaneous (14.8%), idiopathic (6.4%) and unknown because of incomplete investigations (12.4%). Three-fourths of food allergies were comprised of the expected protein categories (milk, nuts, eggs and fish). Nine children had an allergic relapse during the following months. We otherwise assessed that adrenaline was underused by the medical staff.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.