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Everest research focuses on children with chronic breathing disorders

Smiths Medical : 17 April, 2008  (Company News)
The Smiths Medical Young Everest Study (SMYES) has reported the findings of its investigation into how nine healthy British children, then aged six to 13, coped with low oxygen levels (hypoxia) on the world’s highest mountain in March 2007.
The research should enable children with chronic breathing disorders such as cystic fibrosis to soon be monitored at home instead of in hospital.

By investigating how healthy children’s bodies cope and adapt at altitude the SMYES team hoped to improve the chances of survival for very sick children.

The children underwent regular heart and lung function tests as they climbed progressively towards the Smiths Medical High Altitude Laboratory at Namche Bazaar, Nepal, at 3,500m (11,154ft). Oxygen levels at this altitude are much lower than at sea level, replicating the low oxygen levels experienced by babies born very prematurely or with heart abnormalities, children with chronic lung diseases such as cystic fibrosis and very sick children in intensive care units.

The preliminary findings of the study, which were presented at a Royal College of Paediatrics and Child Heath conference in York, UK, provide valuable insights into how doctors and scientists can improve methods of assessing lung disease in children as well as methods of home monitoring to reduce the number of hospital visits required; easing the considerable stress involved for patients and families of sick children.

The key findings of the study are:

Doctors could improve the quality of life of those with chronic long term lung diseases, such as cystic fibrosis, by enabling more sleep and respiratory studies to be performed at home. Non-invasive methods such as the spirometry blowing test were used to measure changes in breathing pattern and blood oxygenation levels as the subjects of the study were healthy children, providing doctors and scientists accompanying the children on the expedition with an opportunity to assess how well such methods performed under field conditions away from the specialised laboratory facilities they are familiar with. These methods could help to lower stress for patients and their families, reduce waiting times and enable hospitals to use their resources more effectively.

The children coped better than anticipated when exposed to oxygenation levels which would be deemed a matter of concern at sea level or in an intensive care unit. This means that, after further study, doctors may be able to lower the levels of oxygenation presently required for some preterm babies and patients in need of intensive care, minimising the risks and side effects. Overdosing preterm babies with oxygen can potentially lead to blindness and lung injury with long term consequences. The findings from this study will help doctors to better balance the need to avoid brain damage caused by hypoxia, with the need to prevent serious lung injury.

Children’s responses to low oxygen levels are extremely variable and dependent upon the individual, and could mean that their ability to cope with hypoxia is genetic. This explains why doctors cannot always predict how a child will cope in intensive care. Around one quarter of all children will suffer particularly badly from exposure to low oxygen as a result of disease or trauma. Increased knowledge from studies in healthy subjects at altitude could help to stratify risk, and develop tailored treatment plans for such children.

Smiths Medical supported the study and has contributed around 4 million towards medical research at University College London over the last decade. The study worked closely with Caudwell Xtreme Everest, a pioneering study of over 200 healthy adults which was being undertaken at the same time.

More analysis of the SMYES preliminary findings needs to be completed and the results coordinated with those from the Caudwell Xtreme Everest adult study.

Professor Janet Stocks, professor of respiratory physiology at UCL, who led SMYES, said: “It is fair to say that under the challenging conditions experienced in Nepal, we learned a massive amount. Insight from the Young Everest study is already affecting the way in which we assess sick children at the Institute and at Great Ormond Street Hospital for Children. “
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