PubMed · 8076262
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S N Breit, S C Thornton, R Penny. Lung involvement in scleroderma.. https://doi.org/10.1016/s0738-081x(94)90328-x
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OBJECTIVES: To determine the influence of pre- and postnatal tobacco exposure in the development of bronchiolitis. PATIENTS AND METHODS: A questionnaire was given to the parents of children hospitalized between August 2001 and August 2002. It included items on parental smoking habits and maternal smoking during pregnancy. Clinical, analytical and radiological criteria were used to diagnose bronchiolitis. RESULTS: Of 450 children, 123 (27.3 %) were diagnosed with bronchiolitis. The control group was composed of 327 children. A total of 61.6 % of the children had at least one parent who smoked and 32.9 % of these children developed bronchiolitis; 39.1 % had non-smoking parents and 18.2 % were hospitalized with bronchiolitis (OR 2.20 [1.39-3.47]). Of the entire group of children studied, 35.3 % had mothers who smoked and 37.7 % of these children had bronchiolitis compared with 21.4 % of children whose mothers were non-smokers (OR 2.22 [1.45-3.39]). A total of 49.6 % had fathers who smoked, and 32.3 % of these children were diagnosed with bronchiolitis compared with 22 % of children whose fathers were non-smokers (OR 1.65 [1.10-2.57]). Forty-four percent of children whose mothers smoked during pregnancy were hospitalized with bronchiolitis compared with only 20.9 % of non-exposed children (OR 2.96 [1.90-4.62]). The large number of mothers who smoked during pregnancy (27.8 %) was notable. Multivariant analysis with logistic regression was performed and the only variable that remained statistically significant was smoking during pregnancy (p < 0.00001; OR 3.27 [1.39-7.71]). CONCLUSIONS: Maternal smoking during pregnancy seems to be the main risk factor for the subsequent development of bronchiolitis
We developed a polymerase chain reaction (PCR) to detect human metapneumovirus (hMPV) in French children hospitalized for acute respiratory tract disease during the winter of 2001 to 2002. This assay showed that 19 (6.6%) of 337 respiratory specimens that were negative for other respiratory viruses were positive for hMPV. Seven hMPV infections were also detected in the previous winter. The patients had the following clinical syndromes: bronchiolitis, 16; acute exacerbation of asthma, 4; bronchitis, 1; laryngitis, 1; high fever with diarrhea, 2; high fever with rhinopharyngitis, 1; rhinopharyngitis with conjunctivitis and otitis, 1. The sequences of the seven amplified products were similar for all cases and had 99% homology with the previously described N gene sequence.
OBJECTIVE: High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions. The objective of this study was to describe pediatric emergency medicine physicians' management preferences regarding infants with moderately severe bronchiolitis and to assess the influence of specific differences in oxygen saturation as measured by pulse oximetry (SpO2) and respiratory rate (RR) on the decision to admit. METHODS: Physicians who are members of the American Academy of Pediatrics Section of Emergency Medicine and living in the United States were randomized into 4 groups and mailed a survey that contained 1 of 4 vignettes. Vignettes were identical except for given SpO2 values (94% or 92%) and RR (50/min or 65/min). Subjects were asked to answer questions regarding laboratory tests, treatment options, and the decision to admit for the patient in their vignette. RESULTS: We received completed surveys from 519 (64%) of the 812 physicians contacted. Most respondents recommended use of bronchodilators (96%), nasal suction (82%), and supplemental oxygen (57%). Few respondents recommended decongestants (9%), steroids (8%), or antibiotics (2%). When asked to rank therapies, respondents gave nasal suction 182 number 1 votes; bronchodilators received 164. The decision to admit varied with SpO2 and RR. Forty-three percent of respondents who received a vignette featuring SpO2 of 94% and a RR of 50/min recommended admission for the infant in their vignette. Fifty-eight percent recommended admission when the vignette SpO2 was 94% and RR was 65/min (chi2 = 5.021). Respondents who received a vignette with SpO2 of 92% were nearly twice as likely to recommend admission: 83% recommended admission when vignette RR was 50/min, and 85% recommended admission when vignette RR was 65/min (chi2 = 0.126). CONCLUSIONS: When treating infants with moderately severe bronchiolitis, pediatricians who work in emergency departments frequently use bronchodilators and nasal suction, 2 practices for which supporting data are either conflicting (bronchodilators) or nonexistent (nasal suction). In addition, their decisions to admit differ markedly on the basis of only a 2% difference in SpO2. It is possible that increased reliance on pulse oximetry has contributed to the increase in bronchiolitis hospitalization rates seen during the past 2 decades.