Background and objectiveThe obstructive sleep apnea (OSA) is a common respiratory disorder in children, especially those at preschool and school ages. This study aimed to describe the characteristics of asthmatic children with OSA and the symptoms for a high risk of OSA.Subjects and methodsIt was a prospective and descriptive study. The data of asthmatic children including medical history, clinical examination, blood tests, spirometry, exhaled nitric oxide (NO), and respiratory polygraphy were registered for analyses.ResultsEighty-five asthmatic children with a mean age of 9.5 ± 2.1 years were included. The prevalence of OSA was 65.9% (56/85) in study subjects. The prevalence of severe OSA in children with moderate asthma was significantly higher than intermittent and mild asthma. The percentage of asthmatic children with OSA who had snoring, sleep disturbance, and nocturnal sweats was significantly higher than that of asthmatic children without OSA (48.2% vs 17.2%, 71.4% vs 27.5%, and 55.1% vs 31.0%, respectively). The presence of allergic rhinitis and snoring was associated significantly with a high probability for the presence of OSA.ConclusionChildren with asthma have a risk of OSA. Asthmatic children with suggested symptoms such as snoring or waking up at night should be screened for OSA.

Background In children with asthma, the viral infection of airways is usually a main cause of acute asthma exacerbation and hospitalization. However, few studies on clinical and biomolecular characteristics of asthmatic children in this field have been done, especially in emergent countries. Objective This study described the clinical and biological characteristics of asthmatic children who had acute asthma exacerbation and rhinovirus (RV) infection. Methods Children under 15 years of age hospitalized for acute asthma exacerbation were included. They underwent clinical examination and peripheral blood analyses for the cytokine profile. The severity of acute asthma exacerbation was evaluated by Pediatric Asthma Score (PAS). Healthy children under 15 years of age were also invited in this study. Results One hundred fifteen asthmatic children were included in this study. There were 18.2% of mild PAS, 37.4% of moderate PAS, and 44.4% of severe PSA. Among them, 63/115 (54.8%) asthmatic children had positive RV infection (RV+). The percentages of asthmatic children with RV+ had increased polymorphonuclear leucocytes were significantly higher than asthmatic children with RV−. There were no significant differences of the concentrations of non-Th2-related cytokines in asthmatic children with RV− and RV+. The concentration of Th2-related cytokines (IL-5 and IL-13) in asthmatic children with RV+ was significantly higher than those with RV−. However, there was no significant difference for the cytokine profile between mild, moderate, and severe asthma. Conclusion RV infection is a main cause of acute asthma exacerbation in children with asthma. The increase of Th2-related cytokines, especially IL-5 and IL-13, is a relevant biomarker for RV infection in asthmatic children with severe exacerbation.

Backgroud Pneumonia is one of the leading causes of death in children under 5 years old. Viruses have historically been the most common cause of community‐acquired pneumonia in children. Co‐infections in severe pneumonia are more concern by clinicians. Method It was a perspective and descriptive study. Real‐time polymerase chain reaction (RT‐PCR) is a modern test that was used to detect many new pathogens, including microbiological co‐infections. RT‐PCR technique was used in this study to investigate the causes of severe pneumonia. Results Through the analysis of nasopharyngeal aspiration samples from 95 children with severe community‐acquired pneumonia, the positive RT‐PCR rate was 90.5%. Viral‐bacterial co‐infection accounted for the highest proportion (43.1%), followed by bacterial co‐infection (33.7%), viral infection (7.4%), bacterial infection (6.3%) and the remaining 9.5% was unknown. In the co‐infections groups, the five main bacteria species detected by PCR were Streptococcus pneumoniae, Haemophilus influenzae, MRSA, Moraxella catarrhalis and Mycoplasma pneumoniae. Conclusion Antibiotic treatment should focus on detected microbes in cases of severe pneumonia for having a good result.

ObjectiveTo determine the leucocyte profile and cytokine concentrations in the peripheral blood of children with an acute asthma exacerbation (AAE).MethodsThis descriptive, cross-sectional study enrolled paediatric patients admitted to hospital for AAE. The severity of AAE was assessed using the paediatric asthma score (PAS). Peripheral blood samples were collected for automatic quantification of white blood cell counts, CD3+, CD4+, and CD8+ T cells populations by flow cytometry and cytokine concentrations by flow cytometry-assisted immunoassay.ResultsA total of 127 children with AAE and 30 healthy control subjects were included in the study. The proportion of paediatric patients with decreased CD3+, CD4+ and CD8+ T cells was significantly higher in those with severe AAE compared with those with mild-to-moderate AAE. The concentrations of interleukin (IL)-2, IL-8, IL-12, and IL-4 in paediatric patients with rhinovirus infection were significantly higher than in those without rhinovirus infection. IL-2, IL-4, IL-6, TNF-α and GM-CSF concentrations during AAE were significantly lower than control. IL-5 and IL-13 concentrations during AAE were significantly higher than control.ConclusionsThe decrease of CD3+, CD4+, CD8+ T cells and IL-2, IL-4, IL-6, TNF-α, and GM-CSF combined with the increase of IL-5 and IL-13, were associated with AAE in children with asthma.

In children with asthma, the responsiveness of inhaled corticosteroids (ICS) is depended on asthma endotype and phenotype. This study aimed to describe the clinical and biological characteristics, and its correlation with polymorphism of rs28364072 in FCER2 of asthmatic children. This work aimed to study the correlation between fractional concentration of exhaled nitric oxide (FENO) level and rs28364072 polymorphism of FCER2 gene with ICS responsiveness and disease control in children with asthma. This study was a prospective and descriptive study. All clinical characteristics, FENO, blood eosinophil counts (BEC), skin prick test (SPT), total IgE, asthma control test, and FCER2 gene polymorphism were performed for each patient. One hundred and seven asthmatic children who were over 5 years old (9.2 ± 2.6), were included. Patients with FENO > 20 ppb had higher percentage of positive SPT, total IgE level, and BEC (89.2 vs 80.0%, 851.1 vs 656.9 UI ml−1, and 785 ± 576 G L−1 vs 425 ± 364 G L−1; respectively). Among them, there were 54.2% of homozygous TT, 36.4% of heterozygous TC, and 9.4% of homozygous CC of rs28364072 polymorphism in FCER2. The percentage of patients with controlled asthma was increasing after 1 month and 3 months (47.1% and 58.8%; respectively). During the study, the ICS was decreasing as indicated by asthma control (348 ± 118 mcg at 1st month vs 329 ± 119 mcg at 3rd month; p < 0.05). CC genotype had the lowest level of increasing FEV1 compared to that in genotype TC and TT (8.4% vs 8.7% and 27.1%; p > 0.05 and p < 0.05; respectively). The percentage of polymorphism in rs28364072 of FCER2 was significant higher in patients with controlled asthma compared to uncontrolled asthma. Asthmatic children with high FENO and rs28364072 polymorphism in FCER2 gene are good responders to ICS; however, asthmatic children with homozygous variant CC of rs28364072 are poorly responsive to ICS.

(1) Background: Exhaled nitric oxide (NO) has been considered as a biomarker of airway inflammation. The measurement of fractional exhaled NO (FENO) is a valuable test for assessing local inflammation in subjects with allergic rhinitis (AR). (2) Objective: To evaluate (a) the correlation between nasal FENO with anthropometric characteristics, symptoms of AR and nasal peak flows in children without and with AR; and (b) the cut-off of nasal FENO for diagnosis of AR in symptomatic children. (3) Methods: The study was a descriptive and cross-sectional study in subjects with and without AR < 18 years old. All clinical and functional characteristics of the study subjects were recorded for analysis. They were divided into healthy subjects for the control group and subjects with AR who met all inclusion criteria. (4) Results: 100 subjects (14 ± 3 years) were included, including 32 control subjects and 68 patients with AR. Nasal FENO in AR patients was significantly higher than in control subjects: 985 ± 232 ppb vs. 229 ± 65 ppb (p < 0.001). In control subjects, nasal FENO was not correlated with anthropometric characteristics and nasal inspiratory or expiratory peak flows (IPF or EPF) (p > 0.05). There was a correlation between nasal FENO and AR symptoms in AR patients and nasal IPF and EPF (p = 0.001 and 0.0001, respectively). The cut-off of nasal FENO for positive AR diagnosis with the highest specificity and sensitivity was ≥794 ppb (96.7% and 92.6%, respectively). (5) Conclusion: The use of nasal FENO as a biomarker of AR provides a useful tool and additional armamentarium in the management of allergic rhinitis.

Background: Fractional exhaled nitric oxide (FENO) is currently used as a biomarker of airway inflammation in patients with asthma. However, the role of alveolar nitric oxide (CANO) in asthmatic children has not been clearly demonstrated Methods: It was a prospective and descriptive study. The measurement of FENO and CANO, spirometry, blood eosinophil counts (BEC), and total IgE levels were performed for each study subject. Results: This study included 109 uncontrolled asthmatic children without inhaled corticosteroid (ICS) treatment. The exhaled NO level in asthmatic patients was significantly higher than in control subjects: FENO: 22.5 vs. 8.4 ppb; CANO: 5.9 vs. 2.8 ppb; J’awNO (maximum airway nitric oxide flux): 56.9 vs. 18.7 ppb; respectively. The sensitivities and specificities for asthma diagnosis with the cut-off of CANO at 3.5 ppb and 5.0 ppb were 74.3% and 73.3%, and 46.0% and 83.3%, respectively. There were the moderate and the weak correlations between CANO with FENO and CANO with IgE in asthmatic patients (r = 0.465, 95%CI (0.133-0.659), P=0.001; r=0.133, 95%CI (0.068- 0.497), P=0.184; respectively). The percentage of controlled asthma in patients with CANO ≥5 ppb at inclusion was higher than that in CANO <5 ppb group. Conclusion: Exhaled NO is a relevant biomarker of allergic asthma. The level of FENO and CANO might be used to predict asthma control in children.

Introduction: Inhaled corticosteroid (ICS) is the most widely used and effective treatment of asthma. However, some patients do not respond to ICS, which might be due to various genetic factors. Hence, understanding the genetic factors involved in the ICS response could help physicians to individualize their treatment decision and action plans for given patients. This study aimed to analyze the characteristics of corticotropin-releasing hormone receptor 1 (CRHR1) genotypes in children with asthma and the correlation between rs242941 polymorphism of CRHR1 gene and ICS responsiveness. Methods: This prospective study included children with uncontrolled asthma, assessing their eosinophil count, IgE concentration, lung function, and fractional concentration of nitric oxide in exhaled breath (FENO) and performing CRHR1 polymorphism sequencing. The level of asthma control was assessed by asthma control test (ACT); the responsiveness of asthma treatment with ICS was evaluated by measuring the change of ACT and forced expiratory volume in 1 s (FEV 1 ) after treatment versus at inclusion.