Oral Presentations / Paediatric Respiratory Reviews 11S1 (2010) S1–S78
nasopharynx (NP). Carriage by healthy individuals is the source of transmission for both pathogens, and carriage is the initial step of invasion. Several epidemiologic studies have reported a negative association between S. pneumoniae nasopharyngeal colonization and S. aureus nasal colonization, which was most signiﬁcant for S. pneumoniae serotypes included in the 7-valent pneumococcal conjugate vaccine (PCV7). This ﬁnding raised public health concern that a rise in S. aureus colonization and disease may follow PCV7 implementation. While other vaccines have had dramatic effects on disease as well as on colonization by potentially pathogenic bacteria, the pneumococcal conjugate vaccine is probably unique in having had such a dramatic impact on one of most common colonizing pathogen of the nasopharynx of healthy children. The full impact of this universal immunization strategy has yet to be fully determined, several questions have already been raised. The purpose of this talk will be to review the direct and indirect effects of pneumococcal conjugate vaccination on carriage, with a speciﬁc emphasis on what is currently known on the interaction between pneumococcus and S. aureus. In vitro studies and epidemiologic data will be presented to suggest a possible interaction between these two pathogens and an impact of current vaccination strategies. Implications with respect to future pneumococcal and also staphylococcal vaccines will be discussed as well. General Topics Aerosol Science 16:00–17:30
O.9.1 New inhaler and devices I. Amirav. Pediatric department, Ziv Medical Center, Safed, Israel Due to their local effects in the lung and minimal systemic side effects, aerosol medications have long been used to treat various lung diseases. Apart from patient factors, the other two major determinants of the effectiveness of aerosol therapy are the formulation and delivery system. Aerosol generators can be divided into three major categories – small volume nebulizers, metered dose inhalers (MDI) and dry powder inhalers (DPI). Patients who require aerosol therapy will beneﬁt from innovative devices that achieve reliable and intuitive airway and lung targeting, shorter treatment times, less frequent dosing and greaterpatient friendliness to ensure adherence. Other innovations may include greater delivery efﬁciency, reduced drug waste (especially for expensive drugs), and the ability to deliver large molecules (proteins, peptides) and drugs complexed with carriers (viral vectors, liposomes). This presentation will highlight major advances in all of these areas with particular emphasis on infants and children. O.9.3 Aerosol deposition and effectiveness: it’s more than particle size B.K. Rubin. Richmond, VA 23298, USA Many factors go into the effective use of aerosols. Some of these factors are related to the properties of the aerosol cloud generated, some are design factors of the device, but far and away the most important inﬂuence for effective aerosol delivery are patient education, understanding and adherence. The site of particle deposition in the airway depends on particle size (MMAD), size distribution (GSD), inspiratory airﬂow, breath hold, etc. We know that the smaller the GSD, the greater the proportion of particles will be in the respirable mass. There is no evidence that smaller particles (on the order of 1 mm, MMAD) will lead to more side effects or to better asthma control. Although ultra ﬁne particles will have greater peripheral (small airway) deposition, there are no data showing that this leads to better asthma control. There are very clear data from Usmani and his research group in London, that larger salbutamol particle size (on the order of 6 mm, MMAD)
will produce greater bronchodilation in persons with asthma when compared to smaller particles when inhaled at very ﬂow inspiratory ﬂow. Thus although MMAD and GSD can be important considerations, most of the medications and delivery devises available today do a good job. It is far more important to give complete education to the devise used so that they use the device properly, recognize when the canister is empty, use correct inhaler technique, and of greatest important, take the medications as they have been prescribed (Adherence!).
Sunday, June 20, 2010 Plenary Session Invited Speaker 08:30–09:00
O.10.I Pulmonary edema H. O’Brodovich. Department of Pediatrics, Stanford School of Medicine, Stanford CA, 94305, USA My lecture will provide an overview of the physiology underlying normal ﬂuid and solute movement within the lung and how this is altered in various diseases associated with excess ﬂuid within the lung’s interstitium and airspaces. Small increases in lung ﬂuid are too subtle to detect by currently available clinical and laboratory methods. Only when the extravascular ﬂuid volume has increased considerably is the condition obvious clinically whether by physical examination, imaging or other approaches. Many diseases are associated with pulmonary edema and there has been much effort to classify the different causes of pulmonary edema into cardiogenic and noncardiogenic pulmonary edema. Although useful, it should be remembered that both abnormal transvascular pressure gradients and increased permeability to solutes are present or subsequently develop in many lung diseases characterized by pulmonary edema. Understanding the mechanisms and consequences of pulmonary edema provides logical approaches to therapy. These include reversing the hypoxemia, reducing the rate of ﬂuid ﬁltration into the lung, minimizing treatment related damage to the lung and investigating new approaches to accelerate the epithelium’ active clearance of the airspace ﬂuid. How quickly pulmonary edema resolves, once the basic condition producing the edema is reversed, depends on whether the ﬂuid is conﬁned to the interstitium, from which it can be cleared in hours, or is also located in the alveolar space, from which it may take days to clear. This clearance involves a wide variety of mechanisms and sites for protein and electrolyte clearance and ﬂuid removal, including pulmonary and bronchial circulations, lymphatics, active transport of ions, macromolecular metabolism and degradation, and mononuclear cell activity. More detail is available in review article outlining pediatric  and adult  disorders associated with pulmonary edema. Reference(s)  O’Brodovich, H. 2006. Pulmonary Edema. In: V. Chernick, T. Boat, R. Wilmott, and A. Bush, editors, Kendig’s Disorders of the Respiratory Tract in Children, 7th ed. Saunders Elsevier, Philadelphia, 622–638.  Ware, L.B. and M.A. Matthay. 2005. Clinical practice. Acute pulmonary edema. N. Engl. J. Med. 353: 2788–2796.