© Borgis - Postępy Nauk Medycznych 9/2008, s. 625-626
Due to the development of knowledge, more paediatric patients with chronic respiratory diseases are being referred for further medical care to adult specialists, for example CF patients suffering from this serious genetic disorder. Progress in its treatment in the final decade of the 20th century has resulted in increased life expectancy and a better quality of life.An exact molecular diagnosis of every patient will allow us to work out how to repair the CFTR protein defect caused by particular mutations, i.e. an individual therapeutic approach in specific classes, and even in single mutations of the CFTR gene. There are attempts at gene therapy of CF, but in the most advanced conditions the only efficient method of treatment is a lung transplant.
The next, very important issue is tuberculosis, still dangerous from a social point of view. The improvement of TB epidemiology in Poland, despite the application of modern bacteriology and molecular biology techniques, is making diagnosis more and more difficult.
Children suffering from TB are oligobacillous and the illness has only a few symptoms. Children often suffer from non-pulmonary localization, which makes the diagnosis even more difficult. That is why we consider it necessary to bear in mind the epidemiology and criteria of diagnosis of tuberculosis among children.
Respiratory system infections are still an important problem in children and diagnosis, treatment and prevention are still the primary concern of paediatricians. Children suffer more often from atypical pneumonias, and widely applied beta-lactam antibiotics are inefficient in these patients.
That is why it is so important to know how to diagnose and treat such conditions. In this light the review paper on atypical bacterial pneumonia and the case study of Chlamydophila pneumonia serve as an interesting reminder.
Nevertheless the most important matter is active prevention in the form of vaccinations. Streptococcus pneumoniae and Haemophilus influenzae type B are the essential bacteria, resulting in the death of children from pneumonia. Vaccination against Heamophilus influenzae type B is covered by the Preventive Vaccination Program in Poland. According to WHO recommendations, vaccination against pneumococci should be widely introduced in Poland because 17 other European countries have already done so. The clinical efficiency of the only available conjugated vaccine against pneumococcal pneumonias (PCV7) is about 67-87%. The introduction of the vaccine in the USA has resulted in a 30% decrease in the hospitalization rate due to pneumonias in children aged up to 2 years. Presentation of the latest information about recommendations concerning vaccination against pneumococci should be interesting for doctors, both paediatricians and GPs. An enormous increase of morbidity due to bronchial asthma, especially in children, has been observed recently. An answer to the question what agents influence the phenomenon and how to prevent it is being sought. At the same time, substantial achievements in asthma treatment have been reached. Due to progress in the last 15 years, the illness is well controlled, at least in the majority of patients. Papers on this subject constitute a review of the most recent clinical research and promising preclinical research.
A rapid development of knowledge of breathing disorders during sleep is being observed. Despite the descriptions in literature over the centuries, only in the last 30 years has the obstructive apnea syndrome been defined. The history of research into that topic in children is much shorter, but it is widely accepted that this is a very important health problem in that age group of patients. Due to the recent progress, non-invasive diagnostic procedures and efficient treatment are available. We believe that the presented papers on this subject are extremely important because these issues are little known, and overnight polysomnography should be used more widely.
In the issue, indications and contraindications, and ways of conducting and clinical benefits resulting from respiratory function tests among children are presented. Individual spirometric parameters and their diagnostic significance are elaborated and then the principle of plethysmographic measurements together with an explanation of the diagnostic value of the method are described. It seems that even though doctors are familiar with these issues, they are rarely used in practice. Also, indications for bronchofibroscopy in the diagnosis of diseases of the respiratory system among adults as well as children presented in the issue are extremely important because bronchofibroscopy has significantly widened the possibilities of diagnosing diseases of the respiratory system.
A global view of the epidemiology of respiratory system disorders in children allows one to understand the importance of the problems covered by paediatric pulmonology, a medical speciality which does not formally exist in Poland today.
The question whether it was a correct decision to delete that speciality should be answered. General pulmonology teaching pushes the problems of paediatric respiratory disorders to the sidelines. A rapid decrease of pulmonology specialists has been observed recently, and we may expect serious organizational problems in the future.
We hope that this issue of PNM will contribute to an increase in knowledge within the field of paediatric pulmonology, and that the readers will realize that the founding of a paediatric section of the Polish Society of Lung Diseases and a pulmonology section of the Polish Paediatric Society is needed.