Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent’s quality of life was assessed as secondary outcome. In 36 children (2–8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children’s Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters. Conclusion : Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed. What is Known: • Cough and wheezing are the predominant symptoms of acute bronchitis . • There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies . What is New: • Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies .

Background A hallmark of many respiratory conditions is the presence of nocturnal symptoms. Nevertheless, especially in children there is currently still a huge diagnostic gap in detecting nighttime symptoms, which leads to an underestimation of the frequency in clinical practise. Methods We evaluated the clinical applicability and determined the formal test characteristics of the LEOSound ® system, a device for digital long‐time recording and automated detection of acoustic airway events. Airway sounds were recorded overnight in 115 children and adolescents (1–17 years) with and without respiratory conditions. The automated classification for “cough” and “wheezing” was subsequently validated against the manual acoustic reassessment by an expert physician. Results The general acceptance was good across all age groups and a technically successful recording was obtained in 98 children, corresponding to 92,976 sound epochs (à 30 s) or a total of 774 h of lung sounds. We found a sensitivity of 89% and a specificity of 99% for the automated detection of cough. For detection of wheezing, sensitivity and specificity were both 98%. The cough index and the wheeze index (events per hour) of individual patients showed a strong positive correlation (cough: rS = 0.85, wheeze: rS = 0.95) and a sufficient agreement of the two assessment methods in the Bland–Altman analysis. Conclusion Our data show that the LEOSound® is a suitable device for standardized detection of cough and wheezing and hence a promising diagnostic tool to detect nocturnal respiratory symptoms, especially in children. However, a validation process to reduce false positive classifications is essential in clinical routine use.

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RESUMO OBJETIVO. Avaliar as implicações éticas do emprego das ONR na prática clínica.MÉTODOS. Os autores realizaram uma análise crítica dos problemas éticos mais importantes associados às ONR, enfocando principalmente os seus riscos e benefícios e aplicando os conceitos da bioética personalista.RESULTADOS. As ONR não são universalmente aceitas. Além disso, isoladamente não resolvem os problemas mais complexos associados ao manejo dos doentes terminais e da futilidade terapêutica. Podem, em alguns casos, servir de instrumento de orientação, mas não devem ser coercivas. Além disso, existe uma preocupação relativa aos possíveis abusos que possam advir do seu emprego na prática clínica.CONCLUSÃO. . Na década seguinte, a técnica passou a ser utilizada na maioria dos hospitais e o treinamento nela foi estendido a médicos, enfermeiros e leigos.Mais de uma centena de estudos, dentro e fora dos hospitais, foram realizados subseqüentemente. Uma análise cumulativa deles sugere três importantes conclusões. A primeira é que aproximadamente 25 a 50% dos pacientes podem sobreviver logo após uma PCR, entretanto apenas 5 a 25% desses conseguem recuperar-se ao ponto de receberem alta do hospital. A segunda é que cerca de 2 a 3% dos pacientes ressuscitados acabam com comprometimento neurológico severo e permanente. Por último, os índices maiores de sucesso na RCP ocorrem quando há PCR na indução da anestesia, infarto agudo do miocárdio e taquiarritmias. Contudo, nos pacientes com falência crônica de órgãos, como rim e fígado, esses índices encontram-se entre 0 e 3% [3][4][5][6][7][8][9][10][11][12][13] . Especificamente nos casos de câncer, um estudo do Memorial Sloan-Kettering Cancer Center demonstrou 10,5% de sobrevida e alta hospitalar após a RCP 14 . A grande complexidade ética das ONR fez com que não fossem universalmente aceitas. São empregadas em muitos hospitais nos Estados Unidos, sendo que, em alguns deles, como no Childrens Hospital em Boston, é o primeiro dado que aparece no prontuário do paciente. Entretanto, na maioria dos hospitais da Europa são ainda pouco comuns 13 . No Brasil, as ONR não são oficialmente reconhecidas na prática médica 15 . O objetivo desse estudo foi analisar os aspectos éticos envolvidos nessas decisões, principalmente relativos às dificuldades e benefícios potenciais da adoção dessas normativas dentro dos hospitais. Aspectos Éticos das ONROs elementos éticos mais importantes associados às ONR são: fundamentos éti-