Ozana Hofmann Jaeger

Background: Gastroesophageal reflux disease (GERD) has been implicated in recurrent wheezing, but mechanisms and diagnostic markers remain debated. Multichannel intraluminal impedance-pH (MII-pH) monitoring improves reflux detection compared to pH-metry, while bronchoalveolar lavage (BAL) cytology may provide evidence of aspiration-related airway inflammation. Objectives: This study aims to examine the relationship between reflux characteristics, BAL cytology and clinical outcomes in preschool children with severe recurrent wheeze. Methods: Preschool-aged children undergoing combined MII-pH and bronchoscopy for severe recurrent wheeze were included. BAL samples were assessed for lipid-laden macrophages (LLM). Associations between reflux parameters, BAL cytology and response to antireflux treatment were analysed. Results: GERD was identified in 70% of participants, with weakly acidic and proximal reflux episodes predominating. Children with GERD exhibited significantly higher percentages of LLM compared with those without GERD (12% vs. 1%, p < 0.001). LLM percentage correlated with multiple reflux characteristics, including weakly acidic, liquid and proximal reflux (p < 0.047; p < 0.047 and p < 0.047, respectively), as well as symptom indices (p < 0.001). Following antireflux therapy, wheezing episodes were substantially reduced. Conclusions: GERD, particularly weakly acidic and proximal reflux, is associated with airway inflammation and recurrent wheeze in preschool children. BAL LLM percentage may serve as a surrogate marker of reflux-related microaspiration. MII-pH monitoring enhances diagnostic accuracy beyond pH-metry and may help guide targeted antireflux interventions.

Background: Several studies have documented the detrimental impacts of secondhand smoke (SHS) exposure to a range of pediatric respiratory conditions, including asthma, bronchitis, and reduced lung function. The aim of the study was to investigate the influence of SHS exposure on lung function, physical fitness, and body mass index (BMI) in children aged 10 to 14 years. Methods: This cross-sectional study included children aged 10 to 14 years at the Elementary School “Trilj” in Trilj, Croatia. Data on SHS exposure were collected using a questionnaire. Antropometric and spirometry measurements were performed. Physical fitness was assessed using the shuttle run (BEEP) test. Results: This study included 157 children, 89 (56.69%) boys and 68 (43.31%) girls. Children exposed to every day SHS in households had significantly lower values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow (PEF) (p < 0.001) and higher z-score BMI levels (p = 0.018) in comparison to unexposed children. Logistic regression showed that children unexposed to SHS had higher odds for better results in the BEEP test (OR 62.45, 95% CI 21.26–179.24, p < 0.001). Children with poorer physical fitness, expressed by lower BEEP score levels, had significantly lower FVC, FEV1, FEV1/FVC, and PEF (p < 0.001). Conclusions: Every day SHS exposure in children was associated with poorer lung function, higher BMI, and poorer physical fitness.