Rev Pneumol Clin
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Asthma is the most frequent chronic disease in children. Its prevalence has increased over the last 20 years. In the newborn, the diagnosis can be retained after 3 episodes of whistling dyspnea. ⋯ Asthma in childhood can be classed in different categories depending upon the nature of the allergen and the degree of bronchial obstruction. Recommended management has been the object of several consensus conferences and should include symptomatic treatment and prevention, adapted to the age of the child and the severity of the episodes. To be effective, preventive treatment must be given daily and for a long period.
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Several studies have been devoted to the possible deleterious effects of inhaled corticosteroids. These products are effective and have been widely used for longer and longer periods. Tests used to detect systemic effects are now quite sensitive allowing us to identify infraclinical purely biological effects resulting from minimal doses. ⋯ Despite the description of multiple systemic effects, the clinical consequences of long-term inhaled corticosteroids are not at all in the same range as oral corticosteroids. Nevertheless, there is some debate as to the strict indications for inhaled corticosteroids in adults and in children. The use of minimal effective doses in asthma is a primum non nocere.
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Cystic fibrosis is an often fatal hereditary disease mainly affecting the epithelium, especially in the airways, the pancreatic ducts, the sudoriparous glands and bile ducts. The pathophysiologic mechanism is complex but involves abnormal epithelial ion transport which controls water movement through the epithelial layers. In the bronchi, there is deficient secretion of chloride activated by cyclic AMP and exaggerated sodium absorption which contributes to dehydrated bronchial secretion and impaired mucociliary clearance. ⋯ The most frequent mutation is a phenylalanine deletion in position 508 or delta F508 which occurs in approximately 70% of the mutations observed in France. Progress in our understanding of the molecular and functional consequences of the different mutations has been rapid, but the correlations between each mutation and the clinical phenotypes observed have not been fruitful. Many advances in the last years using murine models of cystic fibrosis have been developed and clinical trials using genetic therapy are now being conducted.