BDR can be assessed reliably using FEV(0.75) in wheezy preschoolers, provided within-subject variability and responsiveness in health are taken into consideration.

The role of atopy on cystic fibrosis (CF) progression remains unclear but evidence suggests that it may influence the appearance of co-morbid conditions such as CF asthma or allergic bronchopulmonary aspergillosis (ABPA). Recognising asthma in patients with CF is not always easy but the identification of atopic markers favours the diagnosis. Physicians should be aware of this fact in order to achieve a better control of respiratory symptoms in patients with CF. Bronchial mucosa inflammation and abnormal mucus predispose to mould colonisation. These patients are at higher risk of allergic sensitisation, especially when atopic susceptibility is present. In the particular case of A. fumigatus, allergic sensitisation precedes ABPA development, which occurs in up to 10% of CF patients. Progression of lung function deterioration is most strikingly pronounced in patients with ABPA. Therefore, sensitisation with A. fumigatus should be regularly tested in patients with CF, especially those at higher risk. Recombinant allergens constitute an important advance in differentiating Aspergillus sensitisation from ABPA itself.

Background: Although several risk factors for asthma have been identified in infants and young children with recurrent wheeze, the relevance of assessing lung function in this group remains unclear. Whether lung function is reduced during the first 2 years in recurrently wheezy children, with and without clinical risk factors for developing subsequent asthma (ie, parental asthma, personal history of allergic rhinitis, wheezing without colds and/or eosinophil level .4%) compared with healthy controls was assessed in this study. Methods: Forced expiratory flows and volumes in steroid naïve young children with >3 episodes of physician confirmed wheeze and healthy controls, aged 8-20 months, were measured using the tidal and raised volume rapid thoracoabdominal compression manoeuvres. Results: Technically acceptable results were obtained in 50 wheezy children and 30 controls using tidal rapid thoracoabdominal compression, and 44 wheezy children and 29 controls with the raised volume technique. After adjustment for sex, age, body length at test and maternal smoking, significant reductions in z scores for forced expiratory volume at 0.5 s (mean difference (95% CI) 21.0 (21.5 to 20.5)), forced expired flow after 75% forced vital capacity (FVC) has been exhaled (FEF 25 ) (20.6 (21.0 to 20.2)) and average forced expired flow over the mid 50% of FVC ) (20.8 (21.2 to 20.4)) were observed in those with recurrent wheeze compared with controls. Wheezy children with risk factors for asthma (n = 15) had significantly lower z scores for FVC (20.7 (21.4 to 20.04)) and FEF 25-75 (20.6 (21.2 to 20.1)) than those without such risk factors (n = 29). Conclusions: Compared with healthy controls, airway function is reduced in young children with recurrent wheeze, particularly those at risk for subsequent asthma. These findings provide further evidence for associations between clinical risk factors and impaired respiratory function in early life.Recurrent wheeze is a common symptom during infancy and early childhood. Although the majority of children will outgrow their symptoms, some go on to develop asthma.3 4 Early onset of asthma has been associated with persistence of symptoms and reduced lung function that continues into adulthood. [5][6][7] A recently described clinical index considers young children with recurrent wheezing in the first 3 years of life to be at high risk of developing asthma if there is a parental history of asthma or personal history of eczema, or if two of the following are present: personal history of allergic rhinitis, wheezing without a cold and/or serum eosinophil level .4%.8 Other predictive indices additionally take immunological measurements 1 and clinical parameters into account 9 but these indices cannot be easily applied to daily practice.Apart from clinical risk factors, lung function evaluation may contribute to the assessment of wheezing phenotypes during early life. A reduction in premorbid lung function has been associated with increased risk of wheezing in the first years.3 10-12 Track...

Few studies have assessed the quality of life (QOL) related to chronic respiratory diseases in the elderly. In the framework of the geriatric study on the health effects of air quality in elderly care centers (GERIA) study, a questionnaire was completed by elderly subjects from 53 selected nursing homes. It included various sections in order to assess respiratory complaints, QOL (World Health Organization QOL (WHOQOL)-BREF), and the cognitive and depression status. The outcome variables were the presence of a score lower than 50 (<50) in each of the WHOQOL-BREF domains (physical health, psychological health, social relationships, and environmental health). Chronic bronchitis, frequent cough, current wheezing, asthma, and allergic rhinitis were considered as potential risk factors. The surveyed sample was (n = 887) 79% female, with a mean age of 84 years (SD: 7 years). In the multivariable analysis, a score of <50 in the physical domain was associated with wheezing in the previous 12 months (odds ratio (OR): 2.03, confidence interval (CI): 1.25-3.31) and asthma (OR: 1.95, CI: 1.12-3.38). The psychological domain was related with a frequent cough (OR: 1.43, CI: 0.95-2.91). A score of <50 in the environmental domain was associated with chronic bronchitis (OR: 2.89, CI: 1.34-6.23) and emphysema (OR: 3.89, CI: 1.27-11.88). In view of these findings, the presence of respiratory diseases seems to be an important risk factor for a low QOL among elderly nursing home residents.