October 2012

Section Meeting Scheduled for New Orleans

If you’ll be in New Orleans, Nov. 10–13, for AARC CONGRESS 2012, be sure to attend our section membership meeting. We’ll be gathering on Sunday from 4:30–5:00 p.m. Check your program onsite for the room number.

Inhaled Steroids Lead to Shorter Adult Stature

New evidence suggests children who take inhaled steroids for asthma end up slightly shorter than their peers. Washington University School of Medicine researchers followed more than 943 children ages 5–12 taking part in the four year Childhood Asthma Management program clinical trial until they reached adult height. The study compared kids who took budesonide with those who took nedocromil or placebo. The mean adult height was about one-half inch shorter in the budesonide group than in the nedocromil or placebo groups. The patients who experienced the slower growth were primarily between 5–11 years old when they began using budesonide, and the slower growth took place only in the first two years of the initial four year study. As the study progressed, children who took budesonide remained one-half inch shorter through adulthood. “This was surprising because in previous studies, we found that the slower growth would be temporary, not affecting adult height,” study author Robert C. Strunk, MD, was quoted as saying. “But none of those studies followed patients from the time they entered the study until they had reached adult height.” The study was published ahead of print by the New England Journal of Medicine on Sept. 3. READ PRESS RELEASE

HFNC: Jury Still Out for Preemies

Australian researchers publishing ahead of print in Neonatology on Sept. 6 review the medical literature on the use of high-flow nasal cannulae (HFNC) as a form of noninvasive respiratory support for preterm infants. They looked for randomized and nonrandomized original research studies via an Internet search, finding 19 studies that met their criteria. An analysis of the results showed:

• Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size and varies according to the amount of leak around the prongs.
• HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but probably only at flow rates >2 liters/min.

Given potential efficacy and safety concerns, the authors believe the jury is still out on the advisability of using HFNC as an alternative to other forms of noninvasive respiratory support in preterm infants. They write, “Until the results of larger randomized trials are known, widespread use of HFNC to treat preterm infants cannot be recommended.” READ ABSTRACT

Secondhand Smoke Exposure Weakens Cough Reflex in Kids

Exposure to secondhand smoke may curtail the natural cough reflex in children and could help explain why more children of smokers develop respiratory conditions like pneumonia and bronchitis. Researchers from the Monel Center arrived at that conclusion after having 38 healthy children aged 10–17 inhale increasing concentrations of the respiratory irritant capsaicin from a nebulizer. Seventeen were from homes where someone smoked while 21 were from nonsmoking homes. The amount of capsaicin in the nebulizer was increased after each inhalation until the subject coughed twice. The capsaicin concentration that induced the two coughs was labeled as the individual’s cough threshold. Children who were regularly exposed to secondhand smoke required twice as much capsaicin to trigger cough as did non-exposed children. In addition to putting kids at greater risk for respiratory infections, the authors believe this diminished cough reflex could make it easier for kids to take up smoking themselves, since they may not have the typical strong adverse reaction to that first puff of tobacco that most people have. The study was published in Tobacco and Nicotine Research. READ PRESS RELEASE

Half of All Potentially Avoidable Pediatric Admissions are Respiratory

A new study out of the University of Arkansas suggests nearly half of all potentially avoidable pediatric inpatient admissions—defined as admissions that could have been cared for in the primary care setting—are respiratory in nature. The investigators based that conclusion on a review of data from the 2006 Kids’ Inpatient Database, which includes records on more than 7.5 million children age 0–17 who were hospitalized with 16 ambulatory care-sensitive (ACS) conditions. Hospitalizations for these conditions accounted for a little over one million hospital days in 2006 and cost the U.S. $4.05 billion. ACS admissions were more common in boys, non-whites, and children admitted through the emergency department. Hospitalizations for ACS asthma and bacterial pneumonia accounted for 48.4% of hospital days and 46.7% of hospital costs. The total price tag: $1.96 billion. “Future research to prevent pediatric hospitalizations should examine targeted interventions in the primary care setting, specifically around respiratory conditions and minority populations,” conclude the authors. The study was published in a recent issue of Academic Pediatrics. READ PRESS RELEASE