Paediatric Respiratory Reviews

Nanoparticles and Children's Lungs: is there a need for caution?

Peter D. Sly, Karen Schüepp — 2012-06-01

Nanoparticle research is currently an area of considerable interest due to the potential applications both in industry and in medicine. In addition, there is increasing recognition of the potential health dangers of environmental exposure to nanoparticles. There are currently no registration regulations so actual human exposure to nanoparticles, as well as toxicological consequences to humans remain unclear. Nevertheless, nanotechnology has found its way into a wide range of everyday applications, such as food containers, clothes and sun screens. As any new technology is introduced, there is an imperative to ensure that unexpected adverse health consequences do not accompany technological advances. This is especially true when children may be exposed. We must not fall for the trap of assuming that technologies developed for, or assessed in, adults can be applied to children without addressing the peculiarities of this age group.

Deposition of small particles in the developing lung

Israel Amirav, Michael T. Newhouse — 2011-10-12

Summary: Infancy is a time of marked and rapid changes in respiratory tract development. Infants (0–1 year of age) and young children (1– 3 years of age) are a unique subpopulation with regard to therapeutic aerosols. Anatomical, physiological and emotional factors, peculiar to these age groups, present significant challenges for aerosol delivery to the respiratory tract. Most studies with inhaled corticosteroids (ICS) have administered aerosols with relatively large particles, frequently > 3μm in mass median aerodynamic diameter (MMAD). These drugs were designed for use in adults and older children and were administered with masks which were frequently rejected by children under age 3-4 years. We review the reasons that large-particle aerosols are likely to be less effective in infants and young children. We suggest that the benefit of inhaled medications in this age group requires further evaluation to determine if better therapeutic outcomes might be achieved using smaller particles and more patient-friendly delivery systems.

Airborne Engineered Nanoparticles: Potential Risks and Monitoring Challenges for Assessing their Impacts on Children

G. Biskos, A. Schmidt-Ott — 2012-06-01

Summary: Engineered nanoparticles (ENPs) are the building blocks of novel materials and consumer products that hold great promise for our societies. When ENPs are released to the environment, however, they can induce irreversible processes that can affect human health. To ensure safety for all nanoparticle-based products throughout their life cycle we urgently need to develop techniques for determining their toxic effects and the exposure levels of humans to ENPs. In an attempt to estimate whether nanotechnology can threaten more sensitive parts of the population such as children, we provide a brief overview of the potential pathways of introducing ENPs into the environment and the state-of-the-art techniques for assessing human exposure, as well as our current knowledge on their toxic effects.

Imaging the paediatric lung: what does nanotechnology have to offer?

K.L. Ordidge, B.A. Duffy, J.A. Wells, T.L. Kalber, S.M. Janes, M.F. Lythgoe — 2011-10-12

Summary: This review will provide an overview of current research into lung imaging with nanoparticles, with a focus on the use of nanoparticles as molecular imaging agents to observe pathological processes and to monitor the effectiveness of nanoparticulate drug delivery systems. Various imaging modalities together with their advantages and limitations for lung imaging will be discussed. We will also explore the range of nanoparticles used, as well as active or passive targeting of nanoparticles.

The occurrence of ultrafine particles in the specific environment of children

Heinz Burtscher, Karen Schüepp — 2012-06-01

Summary: Interest in ultrafine particles (UFP) has been increasing due to their specific physico-chemical characteristics. Ultrafine particles are those with an aerodynamic diameter of<0.1μm and are also commonly know as nanoparticles (0.1μm=100nm). Due to their small size UFP contribute mostly to particle number concentrations and are therefore underestimated in actual pollution measurements, which commonly measure mass concentration. Children represent the most vulnerable group in regard to particulate exposure due to their developing status and different exposures compared to adults. This review discusses the sources of ultrafine particles as well as the specific exposures of children highlighting the importance and uniqueness of this age group.

The developing respiratory tract and its specific needs in regard to ultrafine particulate matter exposure

Karen Schüepp, Peter D. Sly — 2011-10-12

Summary: Nanoparticles have unique physico-chemical properties compared to larger particles that have the potential to provide promising new possibilities for biomedical applications. Considerable research is currently exploring these potentials of nanotechnology. In contrast, airborne particles as components of indoor air, ambient air pollution associated with traffic-related pollution, industry, power plants, and other combustion sources have the potential to harm children's health. However, a similar research effort into the potential health effects of exposure to nanoparticles is lacking. Children differ markedly from adults in their developmental biology rendering young children the most vulnerable group with regard to potentially harmful effects induced by particulate exposure. This review discusses the differences between children and adults in regard to nanoparticle exposure highlighting the uniqueness and vulnerability of children.

Management of asthma in children with long QT syndrome

Samuel Collins, John Widger, Andrew Davis, John Massie — 2011-10-12

Summary: The Long QT syndrome (LQTS) is a rare disorder in which patients are prone to life threatening ventricular arrhythmia and is a leading cause of sudden death in childhood. Asthma is common and its management in those with LQTS presents a number of potential difficulties. The mainstay of therapy in LQTS is beta-blockade, which may worsen symptoms of asthma. Conversely, beta-agonist therapy is the mainstay of asthma management; which, in those with LQTS, may provoke ventricular arrhythmias. We review available data regarding the management of coexistent LQTS and asthma, and provide a summary of the necessary considerations in managing these patients.

Beyond the guidelines: Fatal and near-fatal asthma

Bruce K. Rubin, Vladimir Pohanka — 2011-10-12

Summary: While asthma is extremely common, fatal and near fatal asthma is rare and often preventable if there is early recognition of symptom progression and appropriate intervention. In the past decade, asthma mortality has progressively declined in association with the widespread use of inhaled corticosteroids and asthma care plans. Management of life threatening asthma requires patient education to ensure the proper use of medications and to enable the patient to recognize when additional therapy for poorly controlled asthma is required. There is some evidence that suggests that the overly aggressive use of asthma medications when treating a severe exacerbation may contribute to morbidity. Because of the risks of air trapping and barotrauma associated with partial airway obstruction, it is best to avoid mechanical ventilation if possible but when this is used, low tidal volumes, longer exhalation times, and permissive hypercarbia can minimize these risks. There is the promise that a better understanding of asthma immunology and severe asthma “phenotypes” will lead to better prevention and therapy.

Pulmonary Embolism in Children

F. Nicole Dijk, Julie Curtin, David Lord, Dominic A. Fitzgerald — 2012-06-01

Summary: Unlike in adults, pulmonary embolism (PE) is an infrequent event in children. It has a marked bimodal distribution during the paediatric years, occurring predominantly in neonates and adolescents. The most important predisposing factors to PE in children are the presence of a central venous line (CVL), infection, and congenital heart disease. Clinical signs of PE are non-specific in children or can be masked by underlying conditions. Diagnostic testing is necessary in children, especially with the lack of clinical prediction rules. Recommendations for tests are derived from adult studies with ventilation/perfusion (V/Q) scintigraphy being well established. There exists an increasing role for computerised tomography pulmonary angiography (CTPA) and magnetic resonance pulmonary angiography (MRPA). Thrombotic events in children are initially treated with unfractionated heparin (UFH) or low molecular weight heparin (LMWH). For the extended anticoagulant therapy LMWH or vitamin K antagonists can be used with duration of treatment recommendations extrapolated from adult data. Mortality rates for PE in children are reported to be around 10%, with death usually related to the underlying disease processes. Exact data about recurrence risk in children is unknown. Because of the difference in aetiology, presentation, diagnostic methods and treatment between adults and children further research is necessary to assess the validity of recommendations for children.

Inpatient paediatric rehabilitation in chronic respiratory disorders

Andreas Jung, Irmela Heinrichs, Christian Geidel, Roger Lauener — 2011-10-12

Summary: Inpatient pulmonary rehabilitation programs have evolved from tuberculosis sanatoriums to modern medical centres providing standardized comprehensive care in a multidiciplinatory environment. Goals of rehabilitation programs for children and adolescents include restoration of professional activity, improvement of health condition, compliance and disease management as well as restoration of quality of life. Eligibility for an intervention is assessed by defined social and medical criteria. Comprehensive pulmonary rehabilitation programs provide a wide range of health care recourses, including diagnostic procedures, specific medical care, educational interventions and a multiprofessional team. Paediatric rehabilitation programs for chronic respiratory diseases, such as asthma or cystic fibrosis, have been shown to reduce symptoms, increase aerobic fitness and physical strength, improve pulmonary function and inflammation and enhance compliance, self-management, quality of life and psychological symptoms. Regional climatic effects have demonstrated an additional positive effect on the rehabilitation outcome. In addition, first evidence suggests an overall reduction of health care costs.

How to get your paper accepted for publication

Victor Chernick — 2011-10-12

Summary: This paper is an attempt to convey in a lucid way how to go about writing a scientific article for publication in an appropriate journal. Topics covered are: a) reasons to write a paper b) types of papers c) asking a question and formulating an hypothesis d) the complex series of steps necessary before you begin your study e) additional considerations once your study is complete f) the process of writing the paper and g) writing skills. In the concluding remarks I comment on the possibility of rejection of your submission which should not be taken personally. If this does occur it should not deter you from contributing to medical science.