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n with a primary goal of patient-centred benefits. Bi-level ST-PSV and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.
Multiple-breath washout techniques are increasingly used to assess lung function. The principal statistic obtained is the lung clearance index (LCI), but values obtained for LCI using the nitrogen (N
)-washout technique are higher than those obtained using an exogenous tracer gas such as sulfur hexafluoride. This study explored whether the pure oxygen (O
) used for the N
washout could underlie these higher values.
A model of a homogenous, reciprocally ventilated acinus was constructed. Perfusion was kept constant, and ventilation adjusted by varying the swept volume during the breathing cycle. The blood supplying the acinus had a standard mixed-venous composition. Carbon dioxide and O
exchange between the blood and acinar gas proceeded to equilibrium. Tozasertib The model was initialised with either air or air plus tracer gas as the inspirate. Washouts were conducted with pure O
for the N
washout or with air for the tracer gas washout.
At normal ventilation/perfusion (
'/
') ratios, the rate of washout of N
and exogenous tracer gas was almost indistinguishable. At low
'/
', the N
washout lagged the tracer gas washout. At very low
'/
', N
became trapped in the acinus. Under low
'/
' conditions, breathing pure O
introduced a marked asymmetry between the inspiratory and expiratory gas flow rates that was not present when breathing air.
The use of pure O
to washout N
increases O
uptake in low
'/
' units. This generates a background gas flow into the acinus that opposes flow out of the acinus during expiration, and so delays the washout of N
.
The use of pure O2 to washout N2 increases O2 uptake in low V'/Q' units. This generates a background gas flow into the acinus that opposes flow out of the acinus during expiration, and so delays the washout of N2.
Asthma is the most common chronic disease in childhood and anti-inflammatory medication is the cornerstone of treatment. Inhalers are frequently used incorrectly when demonstrated in the hospital, suggesting poor technique at home. We aimed to 1) compare daily inhalation technique with the Diskus and Autohaler in asthmatic children by filming inhalations at home and 2) compare daily inhalation technique with technique demonstrated in the hospital.
We performed a randomised study in asthmatic children (aged 6-18 years) from the outpatient clinic of Medisch Spectrum Twente hospital (Enschede, The Netherlands) from July 2014 to April 2016. Children received inhalation instructions for the Diskus and Autohaler and were randomised to use one device in the morning and the other in the evening. During the 28-day study period, inhalations were filmed at home and subsequently demonstrated in the hospital. All inhalations were checked for seven critical errors per device.
636 videos with the Diskus and 663 with the Autohaler were provided by 27 children. The most common critical error in daily life was an incorrect device position during preparation of the Diskus (n=271) and an insufficiently deep inhalation (n=39) using the Autohaler. Percentage of correct days using the Diskus was 44%, compared to 96% with the Autohaler (p<0.001). The two most common errors with the Diskus were made at least twice as often at home than in the hospital.
Inhalation technique at home was markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus.
Inhalation technique at home was markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus.
The clinical presentation of children sensitised to dog dander varies from asymptomatic to severe allergic airway disease, but the genetic mechanisms underlying these differences are not clear. The objective of the present study was to investigate nasal transcriptomic profiles associated with dog dander sensitisation in school children and to reveal clinical symptoms related with these profiles.
RNA was extracted from nasal epithelial cell brushings of children sensitised to dog dander and healthy controls. Blood sample analyses included IgE against dog dander, dog allergen molecules, other airborne and food allergens, basophil activation and white blood cell counts. Clinical history of asthma and rhinitis was recorded, and lung function was assessed (spirometry, methacholine provocation and exhaled nitric oxide fraction).
The most overexpressed gene in children sensitised to dog dander compared to healthy controls was
, coding for Cystatin 1. A cluster of these children with enhanced
expression showed lower forced expiratory volume in 1 s, increased bronchial hyperreactivity, pronounced eosinophilia and higher basophil allergen threshold sensitivity compared with other children sensitised to dog dander. In addition, multi-sensitisation to lipocalins was more common in this group.
Overexpression of
is associated with more severe allergic airway disease in children sensitised to dog dander.
is thus a possible biomarker of the severity of allergic airway disease and a possible therapeutic target for the future treatment of airborne allergy.
Overexpression of CST1 is associated with more severe allergic airway disease in children sensitised to dog dander. CST1 is thus a possible biomarker of the severity of allergic airway disease and a possible therapeutic target for the future treatment of airborne allergy.Real-world evidence is important to help unravel unanswered problems in severe asthma and is valuable to better understand the patient experience and common clinical practice. The Severe Heterogeneous Asthma Registry, Patient-centred (SHARP) Clinical Research Collaboration is created as a network of national registries and severe asthma centres that work together to perform registry based real-world research and clinical studies on a pan-European scale. Such collaboration requires a new, innovative design to overcome the many issues that arise with large-scale data collection across national borders. SHARP has developed a platform that offers a federated analysis approach where national registry data are transformed and integrated into a common data model (CDM). The CDM then allows a local analysis of de-identified patient data and subsequent aggregate (meta-)analysis. To facilitate an easily accessible way to set up new registries, SHARP enables new registries to take part in a central database, based on already proven technology.
