Philip Keith Pattemore

The New Zealand Medical Journal (NZMJ) is the principal scientific journal for the medical profession in New Zealand. The Journal has become a fundamental resource for providing research and written pieces from the health and medical industry.

Objective: An imbalance in autonomic nervous system (ANS) activity may play a role in asthma, but it is unclear whether this is associated with specific pathophysiology. This study assessed ANS activity by measuring heart rate variability (HRV) in eosinophilic (EA) and non-eosinophilic asthma (NEA) and people without asthma. Methods: HRV, combined hypertonic saline challenge/sputum induction, exhaled nitric oxide (FeNO), skin prick tests to measure atopy, and spirometry tests were conducted in teenagers and young adults (14-21 years) with (n = 96) and without (n = 72) generally well-controlled asthma. HRV parameters associated with sympathetic and parasympathetic ANS branches were analysed. EA and NEA were defined using a 2.5% sputum eosinophil cut-point. Airway hyperreactivity (AHR) was defined as ≥15% reduction in FEV₁ following saline challenge. Results: HRV parameters did not differ between asthmatics and non-asthmatics or EA and NEA. They were also not associated with markers of inflammation, lung function or atopy. However, increased absolute low frequency (LFµs²; representing increased sympathetic nervous system (SNS) activity) was found in asthmatics who used β-agonist medication compared to those who did not (median: 1611, IQR 892-3036 vs 754, 565-1592; p < 0.05) and increased normalised low frequency (LF nu) was found in those with AHR compared to without AHR (64, 48-71 vs 53, 43-66; p < 0.05). Conclusion: ANS activity (as measured using HRV analysis) is not associated with pathophysiology or inflammatory phenotype in young asthmatics with generally well-controlled asthma. However, enhanced SNS activity can be detected in asthmatics with AHR or who use β-agonist medication.

Objective: Asthma is a risk factor for poor early reading in children, for reasons that are unclear. This analysis examines the relationship between changes in asthma severity during the first year of school and being in the lowest quartile of reading achievement after 1 year of school. Methods: We used previously unreported data from our cohort study. Parent interviews and teacher questionnaires enquired about asthma and covariates of achievement at school entry (T1) and 12 months later (T2). Asthma severity scores at T1 and T2 showed that in 27 of 51 children with asthma, symptoms improved over the year, whereas in 24, symptoms persisted or worsened. Word and story reading were assessed at T1 and T2. We compared reading achievement at both timepoints between children with asthma and children who had no reported respiratory symptoms between birth and T2 (controls, N = 74), and between those with persistent versus improved symptoms. Results: More children with asthma than controls were in the lowest quartiles for reading. Further, significantly more children in the persistent group compared to the improved group were in the lowest quartiles for word reading (58 versus 30%, respectively) and story reading (54 versus 26%, respectively). School absences, increased behavior problems, stressful life events or parental mental health were not associated with the differences in either comparison. Logistic regression modeling identified persistent asthma as the most important variable associated with being in the lowest quartile of reading after 1 year in school. Conclusions: Active asthma symptoms during early school may influence early reading achievement.

Objective: To investigate the relationship between hair nicotine levels at 15 months of age and prior parent‐reported smoking exposure, and the risk of wheezing and current asthma from 15 months to 6 years of age.Study Design: We measured hair nicotine levels at 15 months of age in 376 of 535 infants enrolled in a prospective birth cohort in Christchurch, New Zealand. We obtained detailed information from parents about smoking exposure during pregnancy and in the home at 3 and 15 months of age. Data for demographics, wheezing, and asthma were obtained from yearly questionnaires up to age 6 years. We assessed hair nicotine levels in relation to reported smoke exposure in pregnancy and up to age 15 months, and the association between high levels of hair nicotine and annual reports of current wheeze and current asthma using multiple logistic regression.Results: Hair nicotine increased with numbers of smokers and daily cigarettes smoked at home, and was also strongly associated with smoking in pregnancy. High level of hair nicotine was associated with increased risk of wheeze (Odds ratio 2.30, P = 0.001) and, though not significant, of current asthma (Odds ratio 2.02, P = 0.056) at 15 months of age, after controlling for socio‐economic status, ethnicity, body mass index, respiratory infections in the first 3 months of life, and duration of exclusive breastfeeding. At older ages the associations were non‐significant.Conclusion: In children aged 15 months hair nicotine level was related to smoking exposure, and was associated with increased risk of wheeze and asthma.

Our aim was to investigate the breathing patterns of children aged 5–9 years with asthma as they read aloud stories of increasingly difficulty. Eleven children with asthma were recruited from an outpatient clinic and 11 controls of similar age and sex were recruited from local schools. Non-contact respiratory monitoring methods were employed to yield acoustic recordings during baseline tasks and reading aloud from books which increased in difficulty. Measurements included breathing rate, pause time, and time ratio between inspiration and expiration (I/E ratio). The analysis showed that children with asthma breathed more slowly when reading books that were the most difficult for them and paused for longer compared to children without asthma. Among children with asthma those with severe asthma were more notably affected. The current research is the first of its kind and provides a base for future studies to investigate the relationship between breathing and the reading of children with asthma, which may be related to reported low reading achievement.

Aim: To describe the usage of multiplex polymerase chain reaction on nasopharyngeal swab (NPS) samples in pre‐school children presenting with lower respiratory tract infection (LRTI) at Christchurch Hospital, and its impact on the use of antibiotics empirically and at discharge.Methods: This retrospective cohort study included 237 children, ages 3 months to 5 years, admitted to hospital during the winter months of 2012–2015 with a diagnosis of community‐acquired LRTI. Children were identified by discharge coding and their notes reviewed.Results: A significantly larger proportion of children who had a NPS sample taken (42/146, 36%) received no empiric antibiotics compared with children who did not have a sample taken (7/91, 7.7%, P < 0.001). Of those who did have a NPS sample taken 17 of 146 (11.6%) had their antibiotics discontinued prior to or at the time of discharge compared with only 3 of 91 (3.3%) of those who did not have a NPS sample (P < 0.025). Children with influenza detected were more likely to receive no antibiotics or have their antibiotics discontinued prior to or at discharge. Only a small proportion of children with other viruses identified had their antibiotics discontinued.Conclusions: It appears that clinicians were generally reluctant to stop antibiotics prior to discharge in young children with LRTI in whom influenza or other viruses were identified. In our view, it makes sense to stop antibiotics when the clinical presentation and NPS testing is consistent with a viral aetiology. Not stopping antibiotics at or before discharge in these children represents a missed opportunity for antimicrobial stewardship.