title: Does a parent-reported history of pneumonia increase the likelihood of respiratory symptoms needing therapy in asthmatic children and adolescents?
abstract: BACKGROUND
  Asthmatic children and adolescents attending outpatient clinics often have a history of pneumonia. Whether respiratory symptoms, lung function, and airway inflammation differ in asthmatic patients with and without a history of pneumonia remains controversial.
  
  
  OBJECTIVE
  To compare clinical, lung functional, and inflammatory variables in asthmatic outpatients with and without a history of pneumonia. Methods. In 190 asthmatic outpatients, aged 6-18 years, we assessed respiratory symptoms, lung function (flows, volumes, and pulmonary diffusion capacity, DLCO/VA), and atopic-airway inflammation as measured by the fractional concentration of exhaled nitric oxide (FE(NO)). A previous medical and radiological diagnosis of pneumonia was defined as "recurrent pneumonia" if subjects had at least three pneumonia episodes or two episodes within a year.
  
  
  RESULTS
  Of the 190 outpatients studied, 38 (20%) had a history of pneumonia. These patients had more frequent upper-respiratory symptoms, nighttime awakenings in the past 4 weeks, daily use of inhaled corticosteroids, and lower FE(NO) than the 152 asthmatic children without previous pneumonia (FE(NO): 20.6 ppb, 95% CI: 15.2-28.0 vs. 31.1 ppb, 95% CI: 27.0-35.8; p < .05). Of the 38 patients with previous pneumonia, 14 had recurrent pneumonia. Despite comparable lung volumes and flows, they also had lower DLCO/VA than asthmatic children with no recurrent pneumonia and asthmatic children without previous pneumonia (DLCO/VA%: 91.2 ± 11.3 vs. 108.5 ± 14.7 vs. 97.9 ± 18.6, p < .05).
  
  
  CONCLUSIONS
  Respiratory assessment in asthmatic children and adolescents with a history of pneumonia, especially recurrent pneumonia, often discloses symptoms needing corticosteroid therapy, and despite normal lung volumes and flows, mild reductions in the variables reflecting gas diffusion and atopic-airway inflammation (DLCO/VA and FE(NO)). Whether these respiratory abnormalities persist in adulthood remains an open question.
authors.affiliation: NESMOS Department, Faculty of Medicine and Psychology, Pediatric Unit Sant'Andrea Hospital, University La Sapienza, Rome, Italy. mario.barreto@uniroma1.it
authors.forename: Mario
authors.initials: M
authors.lastname: Barreto
authors.forename: Susanna
authors.initials: S
authors.lastname: Bonafoni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Barberi
authors.forename: Francesco
authors.initials: F
authors.lastname: La Penna
authors.forename: Rosanna
authors.initials: R
authors.lastname: Zambardi
authors.forename: Susy
authors.initials: S
authors.lastname: Martella
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Villa
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D012008:Recurrence