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Biomedical subjects

P L Brand

Publications and source records attributed to P L Brand.

At least 19 recordsLinked to original sources
PubMed2004

['Sitting on air' in infants: a sign of simple delay in the gross motor milestones].

A delay in motor maturation of infants usually presents as late mastery of gross motor milestones, such as rolling over, sitting, crawling, standing up and walking. Because this can be a symptom of serious neuromuscular disease or cerebral palsy, parents' and doctors' concern is understandable. Three children, a girl aged 17 months, and two boys aged 20 and 18 months respectively, were referred to the paediatric outpatient department because of delayed motor development. Physical examination revealed no pathological disorder; fine motor development, social-adaptive and language behaviour were age-appropriate. All three patients showed the characteristic 'sitting on air' posture while lifted vertically. With this information the diagnosis was 'dissociation of maturation', which can be managed by watchful waiting and has an excellent prognosis. All three patients recovered spontaneously.

Child Development↗
PubMed2004

[Treatment of asthma in children: more than merely 'puffing'].

Five children, four boys aged 6, 9, 12 and 13 years and one girl aged 6 years, had persistent asthmatic symptoms despite maintenance treatment with inhaled corticosteroids and short-acting bronchodilators on demand. One of them required the addition of a long-acting beta 2-agonist to become symptom-free. The other four patients did not need to step up their asthma medication after correction of poor inhaler technique, treatment of dysfunctional breathing, treatment of allergic rhinitis, and elimination of passive cigarette-smoke exposure, respectively. All current guidelines on the treatment of asthma in children advise, in case of persistent asthmatic symptoms despite inhaled corticosteroids and short-acting bronchodilators, the addition of long-acting beta 2-agonists. However, various factors may play a role in the persistence of asthma despite adequate therapy and these factors should be evaluated before stepping up the medication.

Administration, Inhalation↗
PubMed2004

[Allergy testing possibly useful in children less than 4 years of age with recurrent cough and wheeze].

OBJECTIVE: To assess the diagnostic value of measuring allergen-specific IgE antibodies in children less than 4 years of age with recurrent cough and wheeze. DESIGN: Retrospective cohort study. METHOD: The prevalence of specific sensitisation for inhaled and food allergens that can be demonstrated by means of Phadiatop and enzymatic assays was determined on the basis of clinical data on 97 children under four years of age that had been referred to a paediatrician for recurrent cough and wheeze. RESULTS: Measurement of allergen-specific IgE antibodies was performed in 44 (45%) of the 97 patients (58 boys and 39 girls; median age: 13 months). Sensitisation was demonstrated in 15 of 44 patients (34%). Children who were three years old or older or who had eczema or rhinitis apart from colds had a statistically significantly higher chance of having specific antibodies than children who were younger or who did not have these symptoms. CONCLUSION: Measurement of allergen-specific IgE antibodies can also reveal sensitisation in young children with recurrent cough and wheeze. The likelihood of finding specific antibodies was higher in children in whom either the history or the physical examination revealed indications of eczema or rhinitis apart from colds.

Age Factors↗
PubMed2004

[Excessive crying in infants: a problem for both parents and children (only rarely caused by milk allergy)].

According to a systematic review published in 1998, hypoallergenic formula can be useful in treating infants who cry excessively. For this reason it is normal practice in the Netherlands to prescribe hypoallergenic formula for these infants. However, two of the three studies on which this systematic review was based were carried out in specialist paediatric allergy centres where there is a higher chance of encountering food allergy than in normal well-baby clinics. The third study was carried out in a well-baby clinic but only included babies who cried for more than 3 hours a day on more than 3 days per week. Experience with crying diaries has shown that by no means all babies who cry excessively according to their parents satisfy these criteria. It is not known if prescribing hypoallergenic formula is a useful intervention in infants whose parents report that they cry excessively. The tension and distress felt by the parents of infants who cry excessively are also important factors. In our opinion, support and guidance for the parents is a more effective treatment for excessive crying in infants than intervention with hypoallergenic formula.

Adult↗
PubMed2003

[Guideline 'Treating asthma in children' for pediatric pulmonologists (2nd revised edition). II. Medical treatment].

The second revision of the guidelines for the treatment of asthma in children is largely based on the evidence of comparative studies. Short-acting beta 2-sympathicomimetics are the medication of choice for acute exacerbations and should therefore be prescribed to each patient. Inhaled corticosteroids (ICS) are the medication of choice for maintenance treatment. Starting with a high dose of ICS which is then reduced to a lower but effective level on the basis of the complaints (step-down approach) is no longer recommended, as this strategy is not more effective than a constant dosage schedule. If asthmatic symptoms persist despite ICS maintenance treatment then 3 therapeutic options are available in the following order: doubling the ICS dose, the addition of a long-acting beta 2-sympathicomimetic, and the addition of a leukotriene receptor antagonist.

Administration, Inhalation↗
PubMed2001

One-year treatment with different dosing schedules of fluticasone propionate in childhood asthma. Effects on hyperresponsiveness, lung function, and height.

Dose-dependent effects of inhaled corticosteroids have been described. Although it has been advised to start treatment with inhaled corticosteroids with a high dose tapering off subsequently (stepdown approach), no clinical studies have assessed this strategy. We compared two different dosage schedules of inhaled fluticasone propionate (FP) in chronic persistent childhood asthma with respect to efficacy (airways hyperresponsiveness [PD(20)], lung function, exhaled nitric oxide [eNO]) and safety (height). During this double-blind study, children with asthma (aged 6-10 yr) were randomized to receive either FP 200 microg/d (constant dose approach) or to start with 1000 microg/d with two monthly reductions to 500, 200, and 100 microg/d (stepdown approach). PD(20) improved in both approaches during treatment with FP, with a significantly better PD(20) after 2 mo of 1000 microg/d followed by 500 microg/d in the stepdown approach versus 200 microg/d in the constant dose approach. No significant differences in PD(20) or other efficacy parameters were found after 1 yr. Changes in standing height were similar in both treatment approaches. This study showed no superior clinical effect of a stepdown approach compared with a constant dose strategy of FP for 1 yr in children with chronic persistent asthma.

Administration, Inhalation↗
PubMed2001

[Perinatal pertussis: from mother to child].

Two infants, a girl, aged four weeks, and a boy, aged three weeks, came to our attention with poor feeding and weight loss. Later the typical cough of pertussis appeared. Serological testing confirmed that both patients' mothers had recently had pertussis. One mother suffered from severe and typical coughing periods even throughout labour. Despite the vaccination program in the Netherlands, each year new-born infants with pertussis require hospitalisation. Pertussis during the neonatal period is seldom described. Adults can suffer from pertussis, even when they have been vaccinated in childhood. They then become contagious for unvaccinated infants. Pertussis during the neonatal period is an insidious disease with sometimes severe complications. If pertussis is suspected in mothers with new-born infants or pregnant women towards the end of the pregnancy, they should be treated with antibiotics to prevent pertussis in the new-born infant.

Adult↗
PubMed2001

Education, self-management and home peak flow monitoring in childhood asthma.

Current asthma guidelines focus on self-management by the patient, in which monitoring of peak flow plays an important role. To be able to participate in self-management, the patient must be educated rigorously on pathophysiological mechanisms of the disease, principles of treatment, correct inhalation technique, treatment goals and the action to take when symptoms or peak flow worsen. This is a time-consuming but important and worthwhile task. The pivotal role of home peak flow monitoring in asthma self-management is based on the assumptions that peak flow variation is a useful measure of disease activity and that peak flow diaries are kept reliably by patients. There is now evidence that neither of these assumptions are true. Self-management plans based on education alone are just as effective as those incorporating peak flow monitoring. Education, therefore, is the most important component of asthma self-management, and home peak flow monitoring is not needed in the majority of asthmatic children.

Adolescent↗
PubMed2001

Comparison of handling and acceptability of two spacer devices in young children with asthma.

UNLABELLED: This study compared parents' preference for two spacer devices, NebuChamber and Babyhaler for the treatment of young children with asthma. In this open, cross-over study 141 patients (aged 5-57 mo) who used inhaled steroids via a spacer device were randomized to budesonide via NebuChamber or beclomethasone dipropionate via Babyhaler. Both treatments were given by the parents twice daily for 2 wk. At the final visit parents completed a questionnaire on preference in general and for a given set of features. Acceptability and handling were scored in a diary. Diary scores on acceptability by the child and handling of both spacer devices were comparable. In the preference questionnaire, 68% of parents preferred NebuChamber [95% confidence interval (CI) 60-76] and 25% Babyhaler (95% CI 18-33). The preference was independent of the type of spacer used before the study and was also apparent in the different features: acceptability by child, carrying around, cleaning, close fitting of face mask, assembling and disassembling, damage resistance and size. These differences were statistically significant for all features, except for acceptability by the child. CONCLUSION: Two-thirds of parents prefer NebuChamber over Babyhaler for the treatment of their young asthmatic children.

Aerosols↗
PubMed2001

Crushed prednisolone tablets or oral solution for acute asthma?

In a randomised trial, treatment with prednisolone in two formulations (oral solution or crushed tablets) was compared in 78 young children with acute asthma. Prednisolone oral solution was better tolerated than crushed tablets (less vomiting, superior taste); clinical resolution was similar.

Acute Disease↗
PubMed2001

Effect of bacterial filters on spirometry measurements.

Lung function measurements with and without a disposable bacterial filter were compared in 60 children. Although statistically significant, the reduction of lung function measurements caused by using bacterial filters was small and clinically irrelevant (2-4% of predicted for forced expiratory volume in one second and vital capacity).

Adolescent↗
PubMed2001

Peak flow diaries in childhood asthma are unreliable.

BACKGROUND: A study was undertaken to investigate the compliance with and accuracy of peak flow diaries in childhood asthma. METHODS: Forty asthmatic children (5-16 years) were asked to perform peak flow measurements twice daily for 4 weeks by means of an electronic peak flow meter and to record values in a written diary. Patients and parents were unaware that the device stored the peak flow values on a microchip. In random order, half of the patients were only told that the device allowed for more accurate assessment of peak flow while the other half were told that accurate recording of peak flow was important because the results would be used in guiding adjustments to treatment. Data in the written diary (reported data) were compared with those from the electronic diary (actual data). RESULTS: In the entire study population the mean (SD) actual compliance (77.1 (20.5)%) was much lower than the mean reported compliance (95.7 (9.1)%) (95% CI for difference 12.7% to 24.4%) The percentage of correct peak flow entries decreased from 56% to <50% from the first to the last study week (p<0.04), mainly as a result of an increase in self-invented peak flow entries. Results were comparable for both groups. For incorrect peak flow entries the mean difference between written and electronically recorded entries ranged from -72 to 34 l/min per patient. CONCLUSIONS: Peak flow diaries kept by asthmatic children are unreliable. Electronic peak flow meters should be used if peak flow monitoring is required in children with asthma.

Adolescent↗
PubMed2001

Inhaled corticosteroids reduce growth. Or do they?

The class label warning in the United States for inhaled corticosteroids (ICS's) states that these drugs may reduce growth velocity in children. In this paper, the evidence for this warning is reviewed from a clinical point of view. Children with asthma tend to grow slower than their healthy peers during the prepubertal years because they go into puberty at a later age. However, asthmatic children do achieve a (near) normal adult height. In randomized controlled clinical trials, the use of inhaled beclomethasone, budesonide and fluticasone is associated with a reduced growth during the first months of therapy, in the order of magnitude of approximately 0.5-1.5 cm x yr(-1). It is, however, unlikely that such an effect continues or persists because accumulating evidence shows that asthmatic children, even when they have been treated with ICS for years, attain normal adult height. Individual rare cases have been reported, however, where ICS use was associated with clinically relevant growth suppression. Inhaled corticosteroids are the most effective therapy available for maintenance treatment of childhood asthma. Fear of reduced growth velocity is based on exceptional cases and not on group data. It should, therefore, not be a reason to withhold or withdraw such highly effective treatment in children with asthma.

Administration, Inhalation↗
PubMed2001

The feasibility of airways hyperresponsiveness as an inclusion criterion for studies on childhood asthma.

The feasibility of moderately severe airway hyperresponsiveness (AH) was examined as an inclusion criterion for clinical trials in asthmatic children. During the baseline period of a long-term clinical trial in asthmatic children, maintenance therapy with fluticasone (200 microg x day(-1)) was stopped for a maximum of 8 weeks and methacholine challenges were performed at 2-week intervals or earlier if the patients' condition deteriorated. Patients were eligible to continue the study if the provocative dose of methacholine causing a 20% fall in forced expired volume in one second (FEV1) (PD20) was <80 microg. Fifty-one per cent of the children did not develop a PD20 < 80 microg after withdrawal of fluticasone. Patients with or without a PD20 <80 microg did not differ in duration of asthma, duration of treatment, or peak flow variation. Patients with a PD20 <80 microg had higher levels of total and specific immunoglobulin-E, and lower levels of FEV1 and mean maximal expiratory flow than patients with a PD20 > or = 80 microg. Forty-four per cent of the patients with a PD20 > or = 80 microg did not have any symptoms during the wash-out period and 39% of these patients remained free from symptoms during one year follow-up. The results of this study suggest that recruiting asthmatic children for clinical trials may be difficult if airways hyperresponsiveness is used as the sole inclusion criterion.

Androstadienes↗
PubMed2001

Respiratory tract infections caused by respiratory syncytial virus in children. Diagnosis and treatment.

Respiratory syncytial virus (RSV) is the most common viral cause of lower respiratory tract infection in infancy and young children. No effective treatment for RSV lower respiratory tract infection (RSV-LRTI) exists. Ribavirine initially was reported to be an effective anti-viral drug for RSV-LRTI. However, subsequently performed trials could not reproduce these positive results and based on the current available evidence there is no place of ribavirin in the routine treatment of RSV-LRTI. The use of nebulised bronchodilator therapy in RSV-LRTI has been subject of many trials, with conflicting RESULTS. Although the individual patient may have some short term benefit of nebulised bronchodilators there does not seem to be a sufficient scientific base for the standard use of bronchodilator therapy in infants and children with RSV-LRTI. There is increasing evidence that RSV-LRTI is an immune-mediated disease and therefore corticosteroids may be an effective treatment. The results from efficacy trials have demonstrated that corticosteroids are not effective for patients with mild RSV infection. In contrast, there is some evidence suggesting that it may be beneficial in patients with more severe RSV-LRTI. Immunoprofylaxis with hyperimmune immunoglobulins and monoclonal antibody against the viral F-protein have been shown to be effective in the prevention of severe RSV-LRTI. From the results of the therapeutic efficacy trials, however, it is evident that immunoglobulins have no place in the treatment of RSV-LRTI. In conclusion, although RSV infections each year have a considerable socio-economic impact attempts to find an effective therapy have been quite unsuccessful so far.

Adrenal Cortex Hormones↗
PubMed2000

[Underlying cow's milk protein intolerance in excessively crying infants; desirable and undesirable effects of an elimination diet].

In three infants with excessive crying, two girls aged 3 and 13 months and a boy aged 5 weeks, feeding with a hypoallergenic formula was started because cow's milk protein intolerance was suspected. Yet in two of the cases, another explanation for the excessive crying, notably parental distress, was more likely based on the history. In these 2 cases, no provocation test with cow's milk had been performed, and the hypoallergenic formula had been continued for a prolonged period of time (without introduction of solid foods), even though the excessive crying had not ceased. Prolonged feeding with the hypoallergenic formula when cow's milk protein intolerance is not confirmed by appropriate provocation testing, may strengthen the parents' misconception that their baby has severe food intolerance, causing unnecessary delay in the introduction of solid foods. This may hamper the normal development of taste and oral motor development.

Crying↗
PubMed2000

[Adverse effects of a liberal diagnosis of 'food intolerance'].

Signs and symptoms of food intolerance in young children are manifold and non-specific. When confronted with a patient with a sign or symptom that can be caused by food intolerance, the physician can take two approaches. One approach is aimed at not missing food intolerance (liberal approach), the other at not overdiagnosing food intolerance (restricted approach). Each approach has its own pros and cons. The main disadvantage of the restricted approach is that food intolerance may not be recognized straightaway. However, this is hardly ever harmful to the patient. The disadvantages of the liberal approach are more numerous and more serious. They include the excessive use of expensive hypoallergenic formulae, unjustified focus on food intolerance as the cause of numerous harmless and self-limiting symptoms in young children, increased risk of poor growth, and insufficient attention for any of the true cause of the patient's symptoms. Therefore, when confronted with a young child with signs and symptoms that could be caused by food intolerance, other causes should be considered prior to focusing on the food intolerance.

Child↗