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Clippings
Theme: Pediatric Pulmonology & Sleep Medicine
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Ankit Parakh
Email:
[email protected]
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ERS statement on protracted bacterial bronchitis in children. (Eur
Respir J. 2017;50:pii: 1602139.)
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Protracted bacterial bronchitis (PBB) has been increasingly been
recognized as a cause of isolated chronic wet cough in under-five
children. PBB is commonly misdiagnosed as asthma or wheezing, and leads
to inappropriate treatment with bronchodilators and steroids. The
awareness regarding the disease entity is poor amongst pediatricians,
and there is no epidemiological data from India. The European
Respiratory Society consensus statement provides a comprehensive
guidelines regarding the diagnosis, evaluation, treatment and follow-up
of children with PBB. The article also describes clinical case vignettes
and algorithm for evaluation of a child with chronic wet cough.
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A meta-analysis of montelukast for recurrent wheeze in
preschool children. (Eur J Pediatr. 2017;176:963-9)
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Wheezing children below the age of five years are a hetrogenous group of
population ranging from virus-induced wheezing to early-onset asthma.
The clinical distinctions between these phenotypes can sometimes be
difficult. Montelukast is a commonly used drug in under-five children
with recurrent wheezing, and is recommended by a few international
guidelines. It has been used intermittently as a pre-emptive treatment
to prevent wheezing at the onset of an upper respiratory infection, and
also as daily controller therapy. This meta-analysis evaluates the
efficacy of montelukast in all phenotypes of pre-school wheezing. The
pooled results of studies on intermittent montelukast showed no
difference in reducing the number of wheezy episodes, reducing
unscheduled medical attendance, and reducing the use of oral
corticosteroids. The pooled results of the continuous regimen showed no
significant difference in the number of wheezing episodes between the
montelukast and placebo groups.
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Neuropsychiatric adverse drug reactions in
children initiated on montelukast in real-life practice. (Eur
Respir J. 2017;50:pii:1700148.)
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The use of montelukast is rampant considering its oral form, and the
assumption that it is without any adverse effects compared to the
corticosteroids. This retrospective nested cohort study from Canada
evaluated the neuropsychatric adverse effects — leading to drug
cessation – of montelukast compared to inhaled corticosteroids (ICS) in
children with asthma. The incidence of adverse effects was 16%, most
occurring within the first two weeks. Most frequent adverse effects were
irritability, aggressiveness and sleep disturbances. The relative risk
(95% CI) of neuropsychiatric adverse effects associated with montelukast
over ICS was 12 (2–90). These data are comparable to the results from
VigiBase, WHO Global Individual Case Safety Report (ICSR) database.
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Metabolic consequences of obstructive sleep apnea in
adolescents with obesity. (Child Obes. 2017;13:102-10)
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Sleep disordered breathing in children with obesity is under recognized
in children and adolescents. Both obstructive sleep apnea (OSA) and
hypoventilation are described, and can occur in combination as well. It
can lead to various complications such as sleep fragmentation, pulmonary
hypertension, systemic hypertension and metabolic syndrome. Dyslipidemia,
insulin resistance, cardiovascular disease risk, nonalcoholic fatty
liver disease, and difficulty with weight loss are well described in
adults but data in children and adolescents are sparse. This
meta-analysis of 10 studies concluded that although obesity leads to
increased metabolic risk, OSA appears to independently increase
metabolic impairment. Adolescents with obesity should be frequently
screened for OSA to determine need for treatment and reduce this
metabolic burden.
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Position paper for the use of a home sleep apnea test in
children. (J Clin Sleep Med. 2017 Aug 29. pii:
jc-17-00431)
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The gold standard for diagnosis of obstructive sleep apnea/hypopnea
syndrome (OSA/H) in children is a polysomnography. As this involves
performing a sleep study in a sleep laboratory, miniature versions have
been manufactured for performing sleep studies at home, especially in
resource-poor settings. This is fraught with problems such as poor
signal quality, lack of monitoring and limited channels. The market of
home sleep apnea testing devices has increased many-folds with most
manufacturers claiming easy testing at home. The American Academy of
Sleep Medicine (AASM) has suggested its use in adults for screening in
uncomplicated OSA/H. The current position paper by the AASM has
recommended against home sleep apnea test for the diagnosis of OSA/H in
children. Testing in a proper sleep laboratory would remain as the gold
standard but the individual circumstances of the patient, available
diagnostic tools, accessible treatment options, and resources would also
need to be considered.
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