Biomedical subjects

Robert Castile

Publications and source records attributed to Robert Castile.

3 recordsLinked to original sources

PubMed2005

Screening for children's exposure to environmental tobacco smoke in a pediatric primary care setting.

BACKGROUND: The American Academy of Pediatrics (Elk Grove Village, Ill) has recommended that pediatricians assess their patients' environmental tobacco smoke (ETS) exposure, but the specific questions most likely to identify children with high ETS exposure are not known. Cotinine is a nicotine metabolite, present in hair, that can be used to quantify months of ETS exposure. OBJECTIVE: To develop a brief screening tool that will accurately predict ETS exposure as defined by child hair cotinine level. METHODS: We compared the performance of a series of easily administered screening questions regarding home ETS exposure to child hair cotinine levels. Subjects were a convenience sample of healthy children aged 2 weeks to 3 years of both self-reported smokers and nonsmokers. RESULTS: Hair samples and questionnaire data were obtained from 291 children. Based on clinical applicability and statistical significance, 3 questions ("Does the mother smoke?", "Do others smoke?", and "Do others smoke inside?") were selected as a valid screening tool to determine children's ETS exposure risk. Maternal report of smoking outside only or smoking few cigarettes per day had no impact on child hair cotinine levels. CONCLUSIONS: It was possible to derive a simple, specific, and valid screening tool that can be used in pediatric offices to identify children at risk for ETS exposure. Further research is needed to test this tool prospectively.

Adult↗

PubMed2004

Novel techniques for assessing infant and pediatric lung function and structure.

BACKGROUND: Voluntarily performed pulmonary function tests are used in adults and older children to assess lung dysfunction and changes in function that occur during disease progression and treatment. However, because infants are unable to comply with voluntary respiratory maneuvers, alternate testing methods are needed to allow similar progress in the treatment and prevention of respiratory disorders that begin in infancy. METHODS: Two new methods for assessing lung function and structure in infants and young children who are unable to perform voluntary respiratory maneuvers are described: raised volume rapid thoracoabdominal compression pulmonary function testing and controlled ventilation, high resolution computed tomography for lung imaging. CONCLUSIONS: Both methods are performed in sedated, sleeping infants and depend on the induction of a pause in normal respiratory effort. This pause is produced by delivering several deep breaths via the child's nose and mouth using a facemask. The induced pause in respiration permits the performance of the respiratory maneuvers needed to acquire pulmonary function and high resolution computed tomography results in infants. These results are virtually identical with those obtainable during voluntary maneuvers performed by adults and older children. Together these 2 new methods permit evaluation of the functional and structural changes that occur in the lungs and airways of infants and young children with respiratory disease. These 2 novel techniques permit the investigation of lung disorders as they first develop early in life, thus optimizing opportunities for early intervention and prevention.

Child, Preschool↗

PubMed2003

Assessing bronchodilator responsiveness in infants using partial expiratory flow-volume curves.

Our objective was to compare the effectiveness of maximum forced expiratory flow measured at functional residual capacity (V'maxFRC) and the ratio of flow at 75% of the forced expiratory volume to peak forced expiratory flow (FEF(75)/FEF(peak)) for detecting bronchodilator-related changes in wheezy infants. In 55 infants (mean age, 7.8 +/- 3.1 months) with a history of recurrent wheezing, V'maxFRC and FEF(75)/FEF(peak) were measured at baseline and 15 min following nebulized albuterol. Mean results from 4 baseline and 4 postalbuterol partial expiratory flow-volume curves were compared at baseline and following bronchodilator challenge. The strength (relative effect size) of each measure for assessing change was quantified by dividing the mean of the pre- to postdifferences by the standard deviation of the differences. Mean percent predicted V'maxFRC was 41.3 +/- 34.3% at baseline and 44.4 +/- 34.0% following albuterol. Mean FEF(75)/FEF(peak) was 26.7 +/- 13.4% at baseline and 35.8 +/- 14.3% following albuterol. The mean percent change from baseline [(post-pre)/pre] in percent predicted V'maxFRC was 18.3 +/- 39.3, and for FEF(75)/FEF(peak), it was 44.1 +/- 36.8. The change in FEF(75)/FEF(peak) following albuterol was significantly greater than the change in V'maxFRC (P < 0.0001). The relative effect size for mean percent change from baseline in V'maxFRC was 0.47, and for FEF(75)/FEF(peak), 1.20. Changes in FEF(75)/FEF(peak) appear to differentiate changes in airway function following administration of a bronchodilator better than do changes in V'maxFRC.

Asthma↗