THÔNG TIN TÀI LIỆU
antibodies to Aspergillus Treatment consists of a prolonged course of oral steroids (prednisone or prednisolone), usually starting at mg/kg/day, with subsequent taper and close follow-up IgE levels should be followed at regular intervals both as indication of response to therapy and as a warning of reexacerbation There are no current studies to suggest a clear benefit of antifungal therapy along with steroids, although some physicians use oral itraconazole therapy as it may help shorten the course of oral steroids Pulmonary Embolism There is no current literature to suggest there is an increased incidence of pulmonary embolism (PE) in children with CF However, it should be considered in the differential diagnosis if there is acute onset of chest pain, shortness of breath, and tachypnea Because of chronic changes seen on CXR and CT with chronic lung disease, interpretation of imaging may be challenging to unequivocally confirm or refute PE The risks of anticoagulation or thrombolytic therapy for patients with more than mild pulmonary disease are not trivial, considering the propensity of CF patients to have hemoptysis Pleuritis Pleuritic chest pain can occur in CF patients during acute or subacute bacterial exacerbations or acute viral infections The pain usually improves with oral analgesia and antibiotic treatment if bacterial exacerbation is suspected Gastroesophageal Reflux Disease While many patients with CF take acid suppression medications (e.g., H2 blocker or protein pump inhibitor [PPI]) for enhancement of exogenous pancreatic enzyme function, the incidence of GERD in children with CF is as high as 55% in some studies Acute exacerbations of GERD can cause symptoms of gastritis and esophagitis including significant chest pain in the epigastrium and retrosternal regions Medications, such as NSAIDs, recent dietary changes, stress, and ethanol may exacerbate GERD An empiric trial of increased acid control may be warranted, but all patients with recurrent symptoms of GERD, including regurgitation and chest pain, should be followed closely after ED discharge In refractory cases, referral to a gastroenterologist for a formal evaluation is appropriate to determine need for upper GI series, pH/impedance probe study, and/or endoscopy Other Causes of Chest Pain Chest pain is a common complaint in patients with CF and can stem from a variety of underlying processes ( Table 99.5 ) Chest pain of cardiac origin is rare in the pediatric CF population While cardiac pain is more common outside the pediatric patient age group, the rare pediatric CF patient with severe pulmonary disease, nonpulmonary pain, and
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