Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents.


  • 影响因子:1.35
  • DOI:10.6061/clinics/2020/e1512
  • 作者列表:"Felicio-Júnior EL","Barnabé V","de Almeida FM","Avona MD","de Genaro IS","Kurdejak A","Eller MCN","Verganid KP","Rodrigues JC","Tibério IFLC","Martins MA","Saraiva-Romanholo BM
  • 发表时间:2020-01-24

OBJECTIVES:This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS:A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS:The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION:The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.


目的: 本研究旨在分析物理治疗技术在哮喘儿童和青少年痰液诱导和肺部炎症评估中的有效性。虽然高渗盐水 (HS) 广泛用于痰诱导 (SI),但物理治疗的特定技术和操作 (P) 可促进一些哮喘儿童和青少年的粘液收集。 方法: 在控制良好的哮喘患者中进行随机交叉研究,收集90份痰标本。使用肺活量测定法评估儿童和青少年,并在进入三种诱导痰技术中的一种时进行随机分组 :( i) 3% 高渗盐水-HS技术; (ii) 物理治疗 (振荡呼气正压、用力呼气和加速呼气流量)-P技术; 和 (iii)高渗盐水 + 理疗-HSP技术。ClinicalTrials.gov: nct03136042。 结果: 在所有技术中,总细胞 (mL) 和差异炎性细胞的百分比 (%) 相似。HSP技术的痰质量 (g) 显著高于HS技术。在所有技术中,活细胞的百分比> 50%,并且在HS和P技术之间没有差异。此外,痰诱导未引起患者肺功能的任何改变。 结论: 物理治疗痰液采集技术可有效地从粘液样本中获得活细胞,并获得与金标准技术 (高渗盐水) 相同的痰液量。此外,物理疗法对哮喘儿童和控制良好的哮喘青少年的痰液诱导既安全又有用。



作者列表:["van der Schans J","Cao Q","Bos EH","Rours GIJG","Hoekstra PJ","Hak E","de Vries TW"]

METHODS::In a recent meta-analysis, we found that atopic diseases, like asthma and allergic rhinitis, occur more frequently prior to the onset of attention-deficit/hyperactivity disorder (ADHD). Our aim was to determine the temporal order of the association between daily fluctuations in atopic disease symptoms and in ADHD symptoms in individual participants. In this observational study among 21 participants, age 7-16 years, we performed a replicated time-series analysis of symptom fluctuations in asthma and/or allergic rhinitis and ADHD. Data were collected through parents who filled in a daily online questionnaire during up to 50 days. In each individual, we investigated the temporal order of fluctuations in atopic disease symptoms and ADHD symptoms using a vector autoregressive (VAR) model while using sleep problems and medication use as covariates. For 16 out of 21 participants, we constructed a VAR model. For a majority of the participants, significant associations were detected between atopic disease symptoms and ADHD symptoms. The results were heterogeneous; the direction, sign, and timing of the relationship between ADHD, atopy, sleep problems, and medication use varied between individuals. This study provides additional evidence that the symptom expression of atopy and ADHD are related. However, the connection between both diseases in children is found to be heterogeneous within our study population.

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作者列表:["Whitworth KW","Berumen-Flucker B","Delclos GL","Fragoso S","Mata C","Gimeno Ruiz de Porras D"]

METHODS::The occupational hazards and respiratory symptoms of domestic cleaners in USA are largely unknown. We conducted a cross-sectional study among 56 Hispanic female domestic cleaner on their health status and frequency of cleaning products used and tasks performed. While women used multi-use products (60.0%) and toilet bowl cleaners (51.8%) most days of the week, many (39.3%) reported not using personal protective equipment while cleaning. Itchy/watery eyes (61.8%) and itchy nose (56.4%) were the most frequently reported symptoms. A history of physician-diagnosed asthma was reported by 14.3% while 33.9% had symptoms of bronchial hyperresponsiveness (BHR). In conclusion, this vulnerable population has high prevalence of physician-diagnosis asthma and BHR symptoms and is potentially exposed to myriad occupational hazards. Further research exploring associations between products use, cleaning tasks and respiratory symptoms is warranted.

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作者列表:["Sunadome H","Matsumoto H","Izuhara Y","Nagasaki T","Kanemitsu Y","Ishiyama Y","Morimoto C","Oguma T","Ito I","Murase K","Muro S","Kawaguchi T","Tabara Y","Chin K","Matsuda F","Hirai T"]

METHODS:BACKGROUND:Obesity affects the pathogenesis of various chronic diseases, including asthma. Research on correlations between obesity/BMI and eosinophilic inflammation in asthma has yielded contradictory results, which could be partly ascribed to the absence of epidemiological data on the correlations. We aimed to elucidate the correlations between blood eosinophil count, its genetic backgrounds, and BMI in the general population. METHODS:This community-based Nagahama study in Japan enrolled 9789 inhabitants. We conducted self-reporting questionnaires, lung function tests, and blood tests in the baseline and 5-year follow-up studies. A genome-wide association study (GWAS) was performed in 4650 subjects at the baseline and in 4206 of these at the follow-up to determine single-nucleotide polymorphisms for elevated blood eosinophil counts. We assessed the correlations between BMI and eosinophil counts using a multifaceted approach, including the cluster analysis. RESULTS:Eosinophil counts positively correlated with BMI, observed upon the interchange of an explanatory variable, except for subjects with the highest quartile of eosinophils (≥200/μL), in whom BMI negatively correlated with eosinophil counts. GWAS and human leukocyte antigen (HLA) imputation identified rs4713354 variant (MDC1 on chromosome 6p21) for elevated eosinophil counts, independent of BMI and IgE. Rs4713354 was accumulated in a cluster characterized by elevated eosinophil counts (mean, 498 ± 178/μL) but normal BMI. CONCLUSIONS:Epidemiologically, there may be a positive association between blood eosinophil counts and BMI in general, but there was a negative correlation in the population with high eosinophil counts. Factors other than BMI, particularly genetic backgrounds, may contribute to elevated eosinophil counts in such populations.

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