Abstract
In “Assessing The Role Of Aspiration In Paediatric Lung Disease,” Wallis and Ryan provide a detailed, comprehensive review of swallowing function—and dysfunction. 1 Aspiration should be considered in the differential diagnosis of coughing, wheezing, and recurrent pneumonia—especially in the infant, those with significant neurological impairments (such as cerebral palsy), and those with craniofacial and upper airway anomalies. It is not uncommon for physicians to see the cough and wheeze and think that the patient needs asthma medication without considering carefully what is causing the cough and wheeze.
In “Search of the Elusive Laryngotracheal Cleft,” Ongkasuwan reviews the history, embryology, presentation, diagnosis, and management of the laryngeal cleft. 2 Difficulties and controversies in making the diagnosis are highlighted. A rare and challenging diagnosis to make (particularly the more mild variants), it can lead to chronic aspiration, and thus it is very important to recognize.
In “Asthma Research for All of US,” 3 Nguyen et al. review why it is important to include diverse populations in research to understand the complex genetics of asthma. This is highlighted by a large study from the EVE Asthma Genetics Consortium, which found novel genetic polymorphisms associated with asthma in populations of European ancestry—but were unable to replicate the findings in African American or Latino populations. 4
A pro–con debate evaluates the use of intrapleural fibrinolytics versus thoracoscopic decortication in the management of empyema in children. Intrapleural fibrinolytics avoids the need for surgery and specialized skills in pediatric thorascopy. Fitzsimons and Thompson describe the evidence supporting use of intrapleural fibrinolytics and their protocols for intrapleural fibrinolytic use. 5 Rothenberg provides the surgical perspective for the non-surgeon on the technique and benefits of video-assisted thoracoscopic surgery. 6
Original research in this issue includes an analysis by Jay et al. Using data from a New York City school-based asthma intervention study, the impact of obesity on asthma morbidity is examined. 7 Besides the alarmingly high rate of obesity observed (56%) in this sample with asthma, those with obesity did not have increased asthma morbidity. This suggests that although obesity is associated with increased asthma prevalence, it does not appear to impact adversely the distribution of asthma severity among school-age children with asthma.
Clinical decision support systems as part of electronic medical records systems are being advocated to improve processes of care and adherence to management guidelines. Carroll et al. describe a randomized controlled trial testing the effect of a clinical decision support system on physician diagnosis of asthma. 8 A tailored prescreening form is filled out by the patient and then the data are scanned into the electronic medical record. Patients in the intervention group who did not have a previous diagnosis of asthma were asked about asthma symptoms. If the patient replied yes to the asthma symptoms, the physician received a prompt to consider the diagnosis of asthma. The study found that by providing this prompt the rate of physician diagnosis of asthma increased. Although this study does not tell us if the increased diagnoses were correct, it is an important demonstration that physician prompts in the electronic medical record can change physician's asthma care behavior.
In this month's Pharmacotherapy Update column, Raissy and Blake critically review evidence supporting the intermittent use of inhaled corticosteroids for toddlers with asthma. 9 The MIST trial suggests that high-dose intermittent inhaled corticosteroid (nebulized budesonide) is just as good as low-dose daily treatment. 10 Daily therapy is the guideline recommended standard of care—but is intermittent therapy ready for prime time? Read this review and you decide.
I hope that you find this issue of Pediatric Allergy, Immunology, and Pulmonology interesting and stimulating. Your contributions to this journal are valued. You can find instructions for authors online at www.liebertpub.com/manuscript/pediatric-allergy-immunology-and-pulmonology/48/.