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The European Respiratory Journal Jun 2022In the pathogenesis of asthma in children there is a pivotal role for a type 2 inflammatory response to early life exposures or events. Interactions between infections,...
In the pathogenesis of asthma in children there is a pivotal role for a type 2 inflammatory response to early life exposures or events. Interactions between infections, atopy, genetic susceptibility and environmental exposures (such as farmyard environment, air pollution and tobacco smoke exposure) influence the development of wheezing illness and the risk of progression to asthma. The immune system, lung function and the microbiome in gut and airways develop in parallel, and dysbiosis of the microbiome may be a critical factor in asthma development. Increased infant weight gain and preterm birth are other risk factors for development of asthma and reduced lung function. The complex interplay between these factors explains the heterogeneity of asthma in children. Subgroups of patients can be identified as phenotypes, based on clinical parameters, or endotypes, based on a specific pathophysiological mechanism. Paediatric asthma phenotypes and endotypes may ultimately help to improve diagnosis of asthma, prediction of asthma development and treatment of individual children, based on clinical, temporal, developmental or inflammatory characteristics. Unbiased, data-driven clustering, using a multidimensional or systems biology approach may be needed to better define phenotypes. The present knowledge on inflammatory phenotypes of childhood asthma has now been successfully applied in the treatment with biologicals of children with severe therapy-resistant asthma, and it is to be expected that more personalised treatment options may become available.
Topics: Asthma; Child; Female; Humans; Hypersensitivity, Immediate; Infant, Newborn; Phenotype; Premature Birth; Respiratory Sounds
PubMed: 34711541
DOI: 10.1183/13993003.00731-2021 -
Revista Chilena de Pediatria Aug 2020Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to... (Review)
Review
Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.
Topics: Adolescent; Auscultation; Child; Child, Preschool; Clinical Decision-Making; Humans; Infant; Infant, Newborn; Observer Variation; Pediatrics; Respiratory Sounds; Terminology as Topic
PubMed: 33399725
DOI: 10.32641/rchped.v91i4.1465 -
Cleveland Clinic Journal of Medicine Mar 2021
Topics: Asthma; Auscultation; Humans; Pulmonary Disease, Chronic Obstructive; Respiratory Sounds
PubMed: 33648966
DOI: 10.3949/ccjm.88a.20198 -
Internal Medicine (Tokyo, Japan) Mar 2022
Topics: Exercise; Humans; Respiratory Sounds; Weight Lifting
PubMed: 34483215
DOI: 10.2169/internalmedicine.8179-21 -
The European Respiratory Journal Nov 1995Wheezes are continuous adventitious lung sounds. The American Thoracic Society Committee on pulmonary nomenclature define wheezes as high-pitched continuous sounds with... (Review)
Review
Wheezes are continuous adventitious lung sounds. The American Thoracic Society Committee on pulmonary nomenclature define wheezes as high-pitched continuous sounds with a dominant frequency of 400 Hz or more. Rhonchi are characterized as low-pitched continuous sounds with a dominant frequency of about 200 Hz or less. The large variability in the predominant frequency of wheezes is one of the difficulties encountered with automated analysis and quantification of wheezes. The large variations observed in automated wheeze characterization emphasize the need for standardization of breath sound analysis. This standardization would help determine diagnostic criteria for wheeze identification. The mechanism of wheeze production was first compared to a toy trumpet whose sound is produced by a vibrating reed. The pitch of the wheeze is dependent on the mass and elasticity of the airway walls and on the flow velocity. More recently, a model of wheeze production based on the mathematical analysis of the stability of airflow through a collapsible tube has been proposed. According to this model, wheezes are produced by the fluttering of the airways walls and fluid together, induced by a critical airflow velocity. Many circumstances are suitable for the production of continuous adventitious lung sounds. Thus, wheezes can be heard in several diseases, not only asthma. Wheezes are usual clinical signs in patients with obstructive airway diseases and particularly during acute episodes of asthma. A relationship between the degree of bronchial obstruction and the presence and characteristics of wheezes has been demonstrated in several studies. The best result is observed when the degree of bronchial obstruction is compared to the proportion of the respiratory cycle occupied by wheeze (tw/ttot). However, the relationship is too scattered to predict forced expiratory volume in one second (FEV1) from wheeze duration. There is no relationship between the intensity or the pitch of wheezes and the pulmonary function. The presence or quantification of wheezes have also been evaluated for the assessment of bronchial hyperresponsiveness. Wheeze detection cannot fully replace spirometry during bronchial provocation testing but may add some interesting information. Continuous monitoring of wheezes might be a useful tool for evaluation of nocturnal asthma and its treatment.
Topics: Asthma; Auscultation; Bronchial Hyperreactivity; Bronchial Provocation Tests; Humans; Lung Diseases, Obstructive; Respiratory Sounds
PubMed: 8620967
DOI: 10.1183/09031936.95.08111942 -
The New England Journal of Medicine Aug 2018
Topics: Bronchoscopy; Child, Preschool; Cough; Foreign Bodies; Humans; Lung; Male; Radiography, Thoracic; Respiratory Sounds; Singing
PubMed: 30089074
DOI: 10.1056/NEJMicm1716704 -
Anesthesiology Oct 2013
Topics: Humans; Infant, Premature; Inhalation; Intubation, Intratracheal; Respiratory Sounds
PubMed: 24195882
DOI: 10.1097/ALN.0b013e3182a354a8 -
Revista Chilena de Pediatria Dec 2020Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both... (Review)
Review
Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both congenital and acquired, that can produce shortness of breath which may be severe and potentially life-threatening. The clini cal diagnosis must be complemented with an endoscopic airway assessment and sometimes with imaging, to try to determine the areas involved and possible associated malformations. Treatment should be individualized, considering the patient's overall condition, stridor etiology, its impact on breathing and swallowing, prognosis, and technical capacity of the managing team, among others. Alternatives may include observation, non-pharmacological measures, local or systemic medications, endoscopic and open surgeries, or a temporary or long-term tracheostomy. A thorough understan ding of the pathophysiology and etiopathogenesis of persistent pediatric stridor is essential for the correct management of these complex patients, ideally in a multidisciplinary manner.
Topics: Airway Obstruction; Child; Endoscopy; Humans; Prognosis; Respiratory Sounds; Tracheostomy
PubMed: 33861835
DOI: 10.32641/rchped.vi91i6.2115 -
American Journal of Respiratory and... Apr 2022
Topics: Asthma; Child; Humans; Respiratory Sounds
PubMed: 35196479
DOI: 10.1164/rccm.202201-0108ED -
Early Human Development Oct 2013Wheezing is a common condition in pediatric practice, it can be defined as a musical sound, high-pitched and continuous, emitting from the chest during breath... (Review)
Review
Wheezing is a common condition in pediatric practice, it can be defined as a musical sound, high-pitched and continuous, emitting from the chest during breath exhalation. Although almost 50% of children experiences wheeze in the first 6 years of life, only 40% of them will report continued wheezing symptoms after childhood. The classification of wheeze in preschool children is more difficult compared to school aged children. It is based on the onset and duration of symptoms and divided children in three categories: transient early wheezing, non-atopic wheezing and atopic wheezing/asthma. History and physical examination, skin prick test, exhaled nitric oxide, lung function test are the parameter to evaluate children with wheezing. The aim of management of wheezing is to finalize the control of symptoms, reduce exacerbations and improve the quality of life. All guidelines underline the complexity in making a diagnosis of asthma under five years and the need to identify phenotypes that may help paediatricians in the therapeutic choices.
Topics: Asthma; Child, Preschool; Humans; Phenotype; Respiratory Sounds
PubMed: 24001476
DOI: 10.1016/j.earlhumdev.2013.07.017