BACKGROUNDAlthough chest radiography is a useful examination tool, it has limitations. Because not all chest conditions can be detected on a radiograph, radiography cannot necessarily rule out all irregularities in the chest. Therefore, further imaging studies may be required to clarify the results of a chest radiograph, or to identify abnormalities that are not readily visible. The aim of this study was to compare traditional chest radiography with acoustic-based imaging (vibration response imaging) for the detection of lung abnormalities in patients with acute dyspnea.

METHODSThe current investigation was a pilot study. Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique. Consecutive patients who presented to the emergency department with acute dyspnea and a normal chest radiograph on admission were enrolled and underwent imaging at the time of presentation. Dynamic and static images of vibration (breath sounds) and a dynamic image score were generated, and assessments were made using an evaluation form.

RESULTSIn healthy volunteer controls (n = 61), the mean dynamic image score was 6.3 ± 1.9. In dyspneic patients with normal chest radiographs (n = 51) and abnormal chest radiographs (n = 48), the dynamic image scores were 4.7 ± 2.7 and 5.1 ± 2.5, respectively (P < 0.05). The final assessment of the vibration images indicated abnormal findings in 15%, 86% and 90% of the participants in the above groups, respectively (P < 0.05).

CONCLUSIONSIn patients with acute dyspnea who present with normal chest radiographs, respiratory sound analyses often showed abnormal values. Hence, the ability of acoustic-based recordings to offer objective and noninvasive measurements of abnormal sound transmission may be useful in the clinical setting for patients presenting with acute dyspnea.

Adult ; Dyspnea ; physiopathology ; Emergency Service, Hospital ; Female ; Humans ; Lung ; physiopathology ; Male ; Middle Aged ; Respiratory Sounds ; physiopathology

OBJECTIVETo study the clinical significance of tidal breathing lung function test in 1-4 years old children with wheezing diseases.

METHODSA total of 141 1-4 years old children with wheezing diseases were enrolled as the observed groups (41 cases of asthma, 54 cases of asthmatic bronchitis, and 46 cases of bronchopneumonia). Thirty children without respiratory diseases were enrolled as the control group. All the recruits underwent tidal breathing lung function test. The observed groups underwent bronchial dilation test, and tidal breathing flow volume (TBFV) parameters were evaluated before and after bronchial dilation test.

RESULTSThe observed groups showed obstructive ventilatory disorder (65%) according to the TBFV loop, and their ratio of time to peak tidal expiratory flow (TPTEF) to total expiratory time (TE) and ratio of volume to peak expiratory flow (VPEF) to total expiratory volume (VE) were significantly lower than in the control group (P<0.05). The asthma subgroup had significantly improved TPTEF/TE and VPEF/VE after bronchial dilation test (P<0.05). Taking an improvement rate of ≥ 15% either for TPTEF/TE or for VPEF/VE as an indicator of positive bronchial dilation test, the bronchial dilation test had a sensitivity of 47% and a specificity of 84% in diagnosing asthma in 1-4 years old children. The positive rate was 28% among the children in the asthma subgroup with an TPTEF/TE ratio of ≥ 23% before bronchial dilation test, versus 65% in those with an TPTEF/TE ratio of <23%.

CONCLUSIONSObstructive ventilatory disorder is the main impairment of tidal breathing lung function in 1-4 years old children with wheezing diseases. Tidal breathing bronchial dilation test can reflect a reversal of airway obstruction to a certain extent. The sensitivity of bronchial dilation test for the diagnosis of asthma is not satisfactory in 1-4 years old children with wheezing diseases, but this test has a relatively high diagnostic value in children with severe airway obstruction.

Asthma ; diagnosis ; physiopathology ; Bronchitis ; diagnosis ; physiopathology ; Bronchopneumonia ; diagnosis ; physiopathology ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Respiration ; Respiratory Function Tests ; methods ; Respiratory Sounds ; diagnosis ; drug effects ; physiopathology

Human metapneumovirus (HMPV) shares clinical and epidemiological characteristics with well-known respiratory syncytial virus (RSV). The aim of this study was to investigate the clinical and epidemiological differences between HMPV- and RSV-induced wheezing illnesses. A total of 1,008 nasopharyngeal aspirate specimens was collected from 1,008 pediatric patients hospitalized with acute respiratory tract infection at Inje University Sanggye Paik Hospital from December 2003 to April 2008, and tested for seven common respiratory viruses. Conditions classified as wheezing illness were bronchiolitis, reactive airways disease, and bronchial asthma. HMPV caused a significantly lower proportion of wheezing illness when compared to RSV (48.1% vs. 82.2%, P<0.05). HMPV-induced wheezing illness occurred predominantly in older patients when compared to RSV patients (P<0.001). RSV infections peaked in the fall and winter followed by peaks of HMPV infection in winter and spring. Eosinophil counts were significantly higher (P<0.01) in RSV patients when compared to HMPV patients. These results show that human metapneumovirus patients exhibit several different clinical and epidemiological characteristics, such as higher proportion of wheezing illness, age and seasonal incidence, and eosinophil counts, when compared to RSV patients.
Bronchiolitis/physiopathology/virology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Korea/epidemiology ; Male ; Metapneumovirus/pathogenicity ; Nasopharynx/virology ; Paramyxoviridae Infections/*epidemiology/*physiopathology/virology ; Respiratory Sounds/*physiopathology ; Respiratory Syncytial Virus Infections/*epidemiology/*physiopathology/virology ; Respiratory Syncytial Viruses/pathogenicity ; Retrospective Studies ; Seasons

OBJECTIVEThe impact of human bocavirus (HBoV), a newly identified human parvovirus, on childhood persistent wheezing has not been identified. In this study, the clinical features of infantile persistent wheezing induced by HBoV was analyzed.

METHODSTracheal aspirates were collected by bronchofibroscope or nasopharyngeal (NP) aspirates from April, 2006 to January, 2007. HBoV DNA in the tracheal aspirates of 33 children with persistent wheezing and in NP aspirates of 6 children with persistent wheezing, who had at least or more than four weeks wheezing. RSV was identified by virus isolation in Hep-2 cells and antigen detetion by direct immunofluorescence assay (DIFA) which was also used for diagnosis of adenovirus, influenza A and B, parainfluenza 1, 2, 3 infection.

RESULTSOf the 39 children with persistent wheezing, 12 cases (31%) were positive for HBoV DNA. Age of HBoV-positive patients ranged from 2 month to 1 year. The results of sequencing of PCR products proved that sequences of HBoV DNA from these 12 samples were exactly identical to the those of HBoV stored in GeneBank (accession numbers DQ000495 and DQ000496). Two cases with HBoV infection were found to be co-infected with RSV. Ten of the 12 HBoV-positive samples were collected during the period from winter to spring (1 in November, 4 in December, 2 in January and 3 in April), the other two HBoV-positive samples were collected during the period from summer to autumn (1 in May and the other in July). Seven of the 12 HBoV DNA-positive patients had fever, 5 of them had high fever. Significantly more patients with HBoV infection had fever as compared to patients with RSV infection. All the HBoV positive patients showed abnormal findings on chest X ray such as interstitial infiltrates, lung infiltration and hyperinflation. Abnormal findings on chest X ray were found in higher proportion of HBoV positive patients as compared with RSV positive patients. And other manifestations such as wheezing, cough and respiratory distress had no significant difference between HBoV and RSV infected patients.

CONCLUSIONSThis study further demonstrated that HBoV probably is a common pathogen of lower respiratory infection in children and might particularly be associated with persistent wheezing.

Child, Preschool ; Cough ; etiology ; Female ; Fever ; etiology ; Human bocavirus ; pathogenicity ; Humans ; Infant ; Male ; Nasopharynx ; pathology ; Paramyxoviridae Infections ; physiopathology ; Parvoviridae Infections ; physiopathology ; Respiratory Sounds ; etiology ; Respiratory Syncytial Virus Infections ; classification ; physiopathology ; Respiratory Tract Infections ; diagnosis ; physiopathology ; virology

OBJECTIVEBody plethysmography is a typical method to measure functional residual capacity (FRC) and airway resistance (Raw). The aim of the study was to test the feasibility of measuring lung function with the body plethysmography in young children with acute lower respiratory tract infection (ALRI) by evaluating changes and prognosis of lung function for infants with ALRI with or without wheezing via body plethysmograph.

METHODPulmonary function tests (PFTs) were performed by using body plethysmography in 444 children with ALRI, aged 1-36 months, to assess their tidal breathing parameters such as ratio of time to peak tidal expiratory flow to total expiratory time (TPTEF/TE), ratio of volume to peak tidal expiratory flow to total expiratory volume (VPTEF/VE), plethysmographic functional residual capacity (FRCP), FRCP per kilogram (FRCP/kg), specific effective airway resistance (sReff), effective airway resistance (Reff), Reff per kilogram (Reff/kg), etc. According to whether there was wheezing or not, children who had ALRI with wheezing were classified as Group-W, or without wheezing as Group-N. Changes or correlations of tidal breathing parameters and plethysmographic parameters were compared.One hundred and three contemporaneous healthy controls aged 1-36 months underwent the same tests for comparison. And 36 wheezing children accepted PFTs at follow-up in recovery phase.

RESULTMean values of TPTEF/TE in Group-W,Group-N and the Control respectively were (20.5 ± 6.7)%,(22.8 ± 6.5)%,(34.6 ± 5.0)% (F = 110.500, P < 0.001), while VPTEF/VE respectively were (23.0 ± 6.3)%,(25.2 ± 6.8)%,(34.5 ± 4.2)% (F = 107.800, P < 0.001). Compared to the Control,Group-W and Group-N had significantly higher values of FRCP (226 vs. 176 vs. 172 ml, χ(2) = 64.870, P < 0.001), FRCP/kg(24.40 vs.17.80 vs.17.60 ml/kg,χ(2) = 68.890, P < 0.001), sReff(1.00 vs. 0.52 vs. 0.46 kPa·s,χ(2) = 75.240, P < 0.001), Reff (3.90 vs.2.74 vs.2.20 kPa·s/L, χ(2) = 36.480, P < 0.001) and Reff/kg [0.42 vs. 0.29 vs.0.22 kPa·s/(L·kg), χ(2) = 29.460, P < 0.001]. Although 25 (12.8%) wheezing children with ALRI had normal values of tidal breathing parameters, they already had increased FRCP, FRCP /kg, sReff, Reff and Reff/kg (t = 2.221, 1.997, 2.502, 2.587, 2.539, all P < 0.05). Values of FRCP and Reff in infants caught ALRI were inversely correlated to that of TPTEF/TE and VPTEF/VE (P < 0.05); 36 children with wheezing who accepted PFTs at follow-up had shown significant decline in the specific parameters of plethysmography such as FRCP, FRCP/kg, sReff, Reff and Reff/kg (Z = -1.999, -2.195, -2.038, -1.823, -2.054, all P < 0.05), while no improvement in the main parameters of tidal breathing such as TPTEF/TE.

CONCLUSIONMeasuring lung function with the body plethysmography in young children with ALRI is feasible. FRC and Raw, as special lung function testing parameters of body plethysmography, were sensitive indicators reflecting impairment of lung function in infants with ALRI (especially for children caught ALRI with wheezing) and shows significant correlation with parameters from lung function testing via tidal breathing. Therefore plethysmography is worthy of clinical promotion.

Airway Resistance ; physiology ; Case-Control Studies ; Child, Preschool ; Female ; Functional Residual Capacity ; physiology ; Humans ; Infant ; Lung ; physiopathology ; Male ; Plethysmography, Whole Body ; Respiratory Function Tests ; Respiratory Sounds ; diagnosis ; physiopathology ; Respiratory Tract Diseases ; diagnosis ; physiopathology ; Tidal Volume

Anti-Asthmatic Agents ; therapeutic use ; Asthma ; physiopathology ; prevention & control ; therapy ; virology ; Child ; China ; Chronic Disease ; Cough ; physiopathology ; virology ; Drug Therapy, Combination ; Humans ; Respiratory Sounds ; drug effects ; physiopathology ; Respiratory Syncytial Virus Infections ; complications ; physiopathology ; prevention & control

Animals ; Asthma ; drug therapy ; immunology ; metabolism ; physiopathology ; Child, Preschool ; Humans ; Infant ; Leukotrienes ; immunology ; metabolism ; pharmacology ; Respiratory Sounds ; drug effects ; immunology ; physiopathology

OBJECTIVETo investigate the clinical features of readmitted children with bronchopulmonary dysplasia (BPD) in the first 2 years of life.

METHODSA retrospective analysis was performed for the clinical data of 242 children with BPD who were readmitted due to recurrent lower respiratory tract infection (LRTI) in the first 2 years of life.

RESULTSAmong all the 242 children with BPD, 115(47.5%) had wheezing, and the children aged 1-2 years had a significantly higher incidence rate of wheezing than those aged less than 1 year (P<0.05). Chest imaging was performed for 193 children, among whom 31 (16.1%) had hyperlucent areas. Pulmonary function examination showed that the BPD children had significantly lower TV/kg, TPEF/TE, VPEF/VE, TEF50 and TEF75, and significantly higher respiratory rate than the controls without respiratory disease (P<0.05). Bronchoscopy was performed for 28 children, among whom 21 (75%) had airway dysplasia. All the 242 children used inhaled corticosteroids (ICS) and experienced no treatment-related adverse reactions. Six children were given intravenous infusion of human umbilical cord blood mesenchymal stem cells (hUCB-MSCs) and experienced no infusion-related events or adverse reactions, among whom one child successfully stopped oxygen therapy.

CONCLUSIONSThe incidence rate of wheezing increases with the increase in age in children with BPD who are readmitted due to LRTI. Pulmonary function examination shows small airway obstruction, reduced expiratory flow rate in case of low lung capacity, and increased respiratory rate, and most children have airway dysplasia. ICS can be used to inhibit inflammatory response in the acute stage. Infusion of hUCB-MSCs is safe and feasible and may bring some benefits to the recovery from BPD.

Bronchopulmonary Dysplasia ; physiopathology ; therapy ; Cord Blood Stem Cell Transplantation ; Female ; Humans ; Infant ; Infant, Newborn ; Lung ; physiopathology ; Male ; Patient Readmission ; Respiratory Sounds ; Retrospective Studies

Diagnosis, Differential ; Diarrhea ; etiology ; Humans ; Infant ; Male ; Mediastinal Cyst ; complications ; diagnosis ; surgery ; Mediastinal Neoplasms ; complications ; diagnosis ; Respiratory Sounds ; etiology ; physiopathology ; Treatment Outcome ; X-Rays

Asthma ; diagnosis ; drug therapy ; physiopathology ; Child, Preschool ; Diagnosis, Differential ; Glucocorticoids ; therapeutic use ; Humans ; Infant ; Recurrence ; Respiratory Sounds ; diagnosis ; drug effects ; etiology ; Treatment Outcome