Background: Pulmonary involvement in adult patients with inflammatory bowel disease (IBD) seems more common than previously appreciated. Its prevalence and development over time in pediatric IBD patients are largely unknown. Objectives: The aim was to study lung function including fraction of exhaled nitric oxide (FeNO) and transfer capacity for carbon monoxide (TLCO) in pediatric IBD patients and to describe the longitudinal development in a subset of patients with lung function abnormalities. Methods: Sixty-six measurements were made in 48 IBD patients (30 patients with Crohn's disease and 18 with ulcerative colitis) and 108 matched controls. Patients with abnormal TLCO or elevated residual volume/total lung capacity (RV/TLC) ratios were invited for a follow-up. Statistical comparisons were made by nonparametric tests and ANOVA. Results: TLCO was decreased in IBD patients [median: 88% predicted (interquartile range, IQR, 22) vs. 99% predicted (IQR 19) in controls]. RV/TLC ratios were mildly elevated in patients with ulcerative colitis [32% (IQR 9) vs. 27% (IQR 8) in controls], and maximum expiratory flows at 50 and 25% of vital capacity were mildly reduced in patients with Crohn's disease. FeNO and disease activity did not correlate with lung function abnormalities. Abnormalities did not consistently persist over a median follow-up period of 34 months. Conclusions: This study supports evidence that variable and fluctuating pulmonary involvement also occurs in pediatric IBD patients. Its clinical significance is unclear.

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In Austria, newborns have been screened for cystic fibrosis (CF) by analyzing immunoreactive trypsinogen (IRT) from dried blood spots (DBS)s for nearly 20 years. Recently, pancreatitis-associated protein (PAP) analysis was introduced as a second-tier test with the aim of reducing recalls for second DBS cards while keeping sensitivity high. For 28 months, when IRT was elevated (65-130 ng/ml), PAP was measured from the first DBS (n = 198,927) with a two-step cut-off applied. For the last 12 months of the observation period (n = 85,421), an additional IRT×PAP cut-off was introduced. If PAP or IRT×PAP were above cut-off, a second card was analyzed for IRT and in case of elevated values identified as screen-positive. Above 130 ng/mL IRT in the first DBS, newborns were classified as screen-positive. IRT analysis of first DBS resulted in 1,961 (1%) tests for PAP. In the first 16 months, 26 of 93 screen-positive were confirmed to have CF. Two false-negatives have been reported (sensitivity = 92.8%). Importantly, less than 30% of families compared to the previous IRT-IRT screening scheme had to be contacted causing distress. Adding IRT×PAP caused a marginally increased number of second cards and sweat tests to be requested during this period (15 and 3, respectively) compared to the initial IRT-PAP scheme. One case of confirmed CF was found due to IRT×PAP, demonstrating an increase in sensitivity. Thus, the relatively simple and economical algorithm presented here performs effectively and may be a useful model for inclusion of CF into NBS panels or modification of existing schemes.

A cross-sectional analysis of the Third National Health and Nutrition Examination Survey (NHANES III) found that overweight children aged between 6 and 16 years had three times more asthma risk than their healthy weight peers (1) . Another cross-sectional study supported the relationship between asthma and being overweight in childhood and showed that the prevalence of asthma was greater in overweight children (2) .Leptin, a 167-amino-acid peptide, is a recently discovered hormone which is believed to play a major role in the regulation of body weight. Recently, it has been reported that serum leptin levels are increased in asthmatic children (3) . Leptin has also been reported to have a specifi c effect on T-lymphocyte responses. It has been hypothesized that leptin is involved in the regulation of asthmatic airway infl ammation levels by regulating T-cell responses by polarizing Th cells toward a Th1 phenotype and by inhibiting immune responses, such as Th2 activation and may have a role in asthma (4) . Mai et al. (5) found twice as high serum levels of leptin in overweight asthmatic children compared to overweight children without current asthma. Serum leptin levels are associated with asthma in adult women, independent of BMI (6) . In children with asthma close associations have been shown between serum adiponectin and leptin and pulmonary function, but it has been suggested that they may play a regulatory role rather than being an etiologic mechanism of asthma development (7) .As very little is known about the role of leptin within the airways and lung tissue and asthma, non-invasive tools to investigate, such associations would allow epidemiological and longitudinal studies to be performed on a larger scale. Such studies are needed to confi rm the relationships of leptin and asthma and improve our understanding of associations between asthma and being overweight.Exhaled breath condensates (EBC) contain aerosolized airway lining fl uid and volatile compounds from the airways and the lung periphery. The assessment of EBC compounds is recognized to be a potentially useful research tool in children for the non-invasive quantifi cation of airway infl ammation and metabolic processes in asthma and other airway diseases.The aim of this pilot study was to evaluate whether leptin can be found in EBC and to investigate differences between condensate leptin levels in overweight and healthy weight children.A total of 20 children (fi ve overweight asthmatics, fi ve healthy weight asthmatics, fi ve overweight healthy and fi ve healthy weight healthy controls), aged 6 -15 years, were included in this study. We obtained data on weight and length (body mass index), lung function, fractional exhaled nitric oxide (FE NO ) and allergic sensitization by the means of skin prick testing using a panel of common allergens including house dust mite, mold mix, tree mix, grass mix, weed mix, cat and dog hair. Informed consent was taken from the parents.Exhaled breath condensates were collected using the commercial EcoScreen breath c...

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