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??Abstract??Wheezing in infants is common and the differential diagnosis is broad. For recurrent wheezing?? especially colds and without other causes?? a parental history of asthma?? and physicians diagnosis of eczema or atopic dermatitis?? and eosinophilia will increase the probability of a subsequent asthma diagnosis.Because objective measures of lung function are challenging to perform in infants?? clinical signs and symptoms thus suggest the diagnosis of asthma.     

Immunoglobulin G subclasses in wheezing infants

Background: The wheezing infant is a common but difficult patient to approach diagnostically. The prevalence of immunoglobulin (Ig) G subclass deficiency in wheezing infants is still controversial. Methods: We studied the serum concentration of IgG subclasses in 38 wheezing infants (aged6–24 months) who had not received systemic steroids before investigation and in 30 healthy age matched controls6–31 months). Results: The prevalence of one or more IgG subclass deficiencies was 3 1.6% in wheezing infants and 26.7% in controls. There was no significant difference in prevalence of IgG subclass deficiency between patients and controls (P > 0.05). The mean concentration of IgG subclasses in patients were compared with controls. There was no significant difference in mean serum concentration of IgG₁, G₂ and G₃ subclasses. However, there a trend towards higher concentrations of IgG₄ in wheezing infants and this difference for IgG₅ was significant (P < 0.01). Immunoglobulin G subclass deficiency was found in 25 and 36.4% of wheezing infants who experienced from two to four and five or more wheezing episodes in 2 years, respectively (P > 0.05). Conclusion: Our findings suggest that wheezing in infancy is not associated with IgG subclass deficiency, and in wheezing infants low IgG subclasses levels do not increase the frequency of wheezing. However, is a relationship between recurrent wheezing and serum IgG₄ subclass concentration.     

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??Abstract??Wheezing is common clinical symptoms in early childhood with respiratory diseases.In this paper,epidemidogy,risk factors and trend in development will be described.     

Cytomegalovirus infection and wheezing in infants

Background: Bronchial asthma‐like symptoms such as wheezing are commonly associated with respiratory tract infection including respiratory syncytial virus (RSV) infection in infants. No study on the association of wheezing with cytomegalovirus (CMV) infection in infancy has been reported, although CMV infection has been observed to play some role in prolonged and intractable wheezing in limited cases. Methods: The present study investigated 40 hospitalized infants who presented with first‐episode wheezing between October 2003 and September 2004. Nasopharyngeal aspirates were tested for RSV, and serum antibodies against CMV were measured. As controls, age‐matched infants with no wheezing were examined for CMV serostatus. Results: RSV‐antigen was detected in 21 subjects (53%), and seven (18%) were considered primary CMV infection serologically. Primary CMV infection was found more often in the wheezers than in the controls although the difference was not statistically significant (P = 0.06). The incidence of splenomegaly was significantly higher in wheezers with CMV infection (86%) than in those with RSV infection or without either infection. The duration of wheezing, fever, and radiographic and laboratory findings during hospitalization were not significantly different. Conclusions: CMV infection based on serologic diagnosis should be considered in infants with first wheezing episode and particularly those with splenomegaly.     

Outcome of wheezing in early childhood

In Acta Paediatrica 50 y ago, Boesen published a follow-up of children with "asthmatic bronchitis". Recent reinvestigations of children hospitalized because of wheezing in early childhood are remarkably consistent with Boesen's observations. Conclusion: Young children admitted to hospital because of wheezing have a clearly increased risk of subsequent asthma. Recent studies confirm Boesen's observations of the prognostic importance of eosinophilia and an inverse relation between age at admission with wheezing and risk of subsequent asthma. Allergy or atopic dermatitis is predictive of subsequent asthma, whereas family history of allergy has low predictive value in infants.     

婴幼儿反复、持续吼喘58例病因分析

目的提高临床儿科医师对婴幼儿反复吼喘的鉴别诊断能力。方法对临床持续吼喘≥4周或反复吼喘≥3次、年龄≤3岁的58例住院患儿进行病因分析。结果58例中诊断为婴幼儿哮喘26例,气管、支气管软化10例,气管、支气管狭窄9例,异物4例,支气管肺发育不良2例,胃食管返流4例,其他原因3例。结论婴幼儿出现反复吼喘最多见原因为婴幼儿哮喘;小婴儿必须排除先天性因素的可能性,6个月以内的小婴儿持续或反复吼喘最多见原因为先天性气道或肺发育异常疾病。     

婴幼儿喘息与呼吸道病毒感染及过敏的关系

目的探讨婴幼儿喘息与呼吸道病毒感染及过敏的关系。方法选择反复喘息(哮喘和喘息性支气管炎)患儿152例、毛细支气管炎(毛支)患儿191例、肺炎患儿101例,取鼻咽分泌物进行7种常见呼吸道病毒检测,同时取血筛查过敏原。结果3组患儿病毒检测总阳性率为60.4%,各组患儿病毒检测阳性率差异有显著性(P<0.01),但均以呼吸道合胞病毒(RSV)为主,其他病毒阳性率很低。所有患儿食物过敏阳性率为25.5%,吸入过敏原阳性率仅5.6%。3组患儿的过敏原阳性率差异有显著性(P<0.05或0.01),反复喘息组显著高于毛支组和肺炎组(P均<0.05),而后两组间差异无显著性。结论RSV是诱发婴幼儿喘息和喘息反复发作的主要病原;过敏是婴幼儿反复喘息发生的重要危险因素,而呼吸道合胞病毒感染的发生与患儿是否存在过敏无关。     

喘息婴幼儿鼻咽分泌物嗜酸粒细胞与血清特异性IgE的关系分析

目的 探讨婴幼儿喘息时鼻咽分泌物涂片中嗜酸粒细胞计数及与血清特异性IgE的关系.方法 选择2002-2004年收治的1个月～3岁的喘息及支气管肺炎患儿223例,分为3组,其中反复喘息(包括婴幼儿哮喘和喘息发作≥2次)组76例,毛细支气管炎组65例,支气管肺炎(无喘息症状)组82例.吸取鼻咽分泌物1ml进行嗜酸粒细胞计数,并测定血清特异性IgE的水平.结果 反复喘息组鼻咽分泌物嗜酸粒细胞计数明显高于其他两组,差异有统计学意义(P=0.000);反复喘息组血清食物变应原(fx5E)的阳性检出率及吸入性变应原(Phadiatop)阳性检出率均明显高于其他两组,差异有统计学意义(P=0.000),毛支组和支气管肺炎组之间差异则无统计学意义;血清特异性IgE与鼻咽分泌物嗜酸粒细胞计数之间存在显著正相关;鼻咽分泌物嗜酸粒细胞水平在同时存在喘息和特应性的患儿最高,在既没有喘息也无个人特应性的患儿最低,有喘息或血清IgE一项者介于两组之间.结论 鼻咽分泌物嗜酸粒细胞计数方法操作简单、无创、快速,费用低,且能在一定程度上反映哮喘的病理特征,与血清特异性IgE之间呈正相关,可以在临床进一步推广应用.     

Wheezing due to rhinovirus infection in infancy: Bronchial hyperresponsiveness at school age

Background: Characteristics related to decreased lung function and increased bronchial responsiveness after early childhood wheezing requiring hospitalization are not fully established.
Methods: Seventy-nine children with wheezing requiring hospitalization at age <2 years were prospectively followed up and re-investigated at age 5.6–8.8 years when the measurements of baseline lung function and bronchial responsiveness to exercise were performed.
Results: At early school age, 23% of children had decreased lung function, and 13% had increased bronchial responsiveness to exercise. Predictors of decreased lung function were maternal history of smoking during pregnancy (odds ratio [OR], 12.8; 95% confidence interval [CI]: 1.2–139.6), parental history of asthma (OR, 4.3; 95%CI: 1.1–17.1), and female gender (OR, 4.0; 95%CI: 1.2–13.7). Increased bronchial responsiveness was associated with rhinovirus infection-induced wheezing in infancy (OR, 6.5; 95%CI: 1.2–36.3), and early cat or dog exposure leading to sensitization (OR, 26.6; 95%CI: 1.3–525.2). Inhaled anti-inflammatory therapy was common in children with rhinovirus infection-induced wheezing in infancy ( n  = 13/19; P  = 0.001 vs children with other/no confirmed virus infection etiology for wheezing in infancy, n  = 16/60), which may have improved lung function and attenuated bronchial responsiveness in them.
Conclusions: After early childhood wheezing requiring hospitalization, one-fourth of children will have decreased lung function and one-eighth of children will show increased bronchial responsiveness at school age. Gender, heredity of asthma, and antenatal exposure to tobacco smoke are predictors of decreased lung function, whereas rhinovirus infection etiology of wheeze and early animal exposure leading to sensitization are associated with increased bronchial responsiveness later in childhood.     

Cough, wheezing and asthma in children: lesson from the past

Recurrent cough is an important medical and sometimes frustrating problem encountered by pediatricians, especially if it is not associated with wheeze or other evidence of systemic disease. In the past, many children with chronic cough have been diagnosed as asthmatic. However, epidemiological, clinical and laboratory studies conducted over the last ten years elucidated many aspects of the relationship between cough and bronchoconstriction. It is difficult to make a diagnosis of asthma on cough alone, but the setting in which the patient is seen (i.e., in a primary care setting or ain a specialistic clinic) may address doctors to the right diagnosis. A prudent 'wait and see' approach may be useful in many occasions.     

婴幼儿喘息患者鼻咽分泌物中嗜酸性粒细胞计数染色方法比较

目的 对婴幼儿喘息患者鼻咽分泌物涂片中嗜酸性粒细胞计数的四种染色方法进行比较。方法 62例喘息患儿各取鼻咽分泌物1 ml,制成4张涂片。经Carnoy氏液固定后,分别采用HE、Wright、WrightGiemsa及“1min染色”4种方法进行染色、读片和比较。结果 4种染色检出嗜酸性粒细胞的阳性率分别为77．4％、79．0％、73．8％和75．8％。结论 Wright或Wright Giemsa染色的方法较简便,显色清楚,可作为诊断哮喘的辅助手段。     

Increased serum IL-10/IL-12 ratio in wheezing infants

To investigate the association between various serum markers and atopic symptoms in the first year of life, and to evaluate the prognostic value of these markers for the development of wheezing and skin rash in the second year of life. Data of 86 children on the development of wheezing and skin rash in the first 2 years of life were collected prospectively, making use of parental completed questionnaires, weekly symptom cards, structured interview and physical examination. Serum markers (IL-10, IL-12, IL-13, eotaxin, sE-selectin, sICAM-1, sIL-2R) and total and specific IgE were determined at age 1. Children who developed wheezing in the first year of life had lower serum levels of IL-12 than children without symptoms (median 40.3 pg/ml vs. 49.0 pg/ml, p = 0.01) and a higher serum IL-10/IL-12 ratio (0.41 vs. 0.31, p = 0.001) at age 1. The IL-10/IL-12 ratio increased with an increasing number of wheezing episodes. Levels of sE-selectin in children with wheezing and in children with itchy skin rash in the first year of life were higher than in symptom free children (6.1 ng/ml and 5.9 ng/ml vs. 4.9 ng/ml, p = 0.01 and p = 0.03, respectively). Children who developed wheezing in the second year of life already had increased sICAM-1 levels at age 1. Children who developed wheezing in the first year of life showed a serum cytokine response that is skewed towards a T-helper 2 profile, with lower IL-12 levels and an increased IL-10/IL-12 ratio. Children who developed wheezing in the second year of life had elevated sICAM-1 levels at age 1. Follow-up of the children is needed to evaluate the prognostic value of various serum markers for the development of allergic disease in later childhood.     

Wheezing bronchitis reinvestigated at the age of 10 years

We have reinvestigated 92/101 children aged 10, who before the age of 2 years were admitted to a paediatric ward due to wheezing bronchitis. At the present time, 70% are symptom-free without medication, 20% have mild asthma, 8% moderate and 2% severe asthma. Persistent asthma correlated significantly to the presence of some other atopic disease in recent years, to early start of wheezing during infancy and to intense obstructive disease as a young child, while initial respiratory syncytial virus infection did not. A clear-cut relationship between smoking in the home in infancy and persistent asthma emerged (not visible at a preschool follow-up). The histamine challenge results correlated to the clinical picture. A normal histamine challenge was seen in 63%, mild hyperresponsiveness in 19%, moderate in 12% and pronounced hyper-responsiveness in 6%. The figures for persistent asthma and bronchial hyperresponsiveness are high compared with the prevalence of asthma in the overall population of schoolchildren.     

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??Objective??To evaluate the efficacy and safety of combined de-escalation therapy in the treatment of infant wheezing. Methods??Stratified random??open??parallel control method was adopted. A total of 206 cases of infant wheezing??mild-to-moderate at acute exacerbation?? were recruited from 4 clinical research centers from Feb. 2013 to Jan. 2015??and were divided into the experiment group??n??106?? and the control group??n??100??. ??The experiment group was given the combined de-escalation therapy??prednisone acetate tablets 0.5 mg/??kg·d????QD for 3 d??azithromycin suspension 10 mg/??kg·d????QD for 3 d??tulobuterol tape 0.5 mg/d??QD for 7 d??loratadine syrup 3 mg/d??QD for 14 d??montelukast sodium 4 mg/d??QD for 28 d. The drugs were taken orally or used externally. ??The control group was given the conventional therapy??methylprednisolone 1 mg/??kg·d????QD for 3 d??cephalosporin??medication dosage referring to the drug instructions?? for 3 d??ambrocol oral solution??2.5-7.5 mL each time??Q12 h??taken as prescribed but not more than 7 d??. Both methylprednisolone and cephalosporin were administered by intravenous drip. Before and after treatment??observe the symptom and sign improvement??the treatment effect and the repeatedness of wheezing. Results??After 7 d of treatment??the mean decreased value of symptom score was 5.89 in experiment group and 4.84 in control group??the total effective rate was 98.11% in experiment group and 92.00% in control group??P??0.05??. After 28 d of treatment??the experiment group has lower rate of recurrent wheezing incidence??12.26%?? than the control group??24.00%????P??0.05??. Conclusion??The efficacy of combined de-escalation therapy for infant wheezing??mild-to-moderate at acute exacerbation?? is superior to conventional therapy with good clinical safety. The combined de-escalation therapy may achieve good social and economic benefits by reducing the risk of recurrent wheezing.     

Internet survey of childhood asthma and use of inhaled therapy in the home in Japan

Background: The aim of the present study is to undertake a survey of childhood asthma and details of the use of inhaled therapy from mothers with asthmatic children ≤15 years old, using the Internet.
Methods: This study was done on a nationwide scale in Japan during the latter half of July 2001.
Results: Responses were obtained from 748 mothers. Four hundred and three children (53.9%) had been diagnosed with asthma when ≤2 years old and 263 children (35.2%) when 2–5 years old. Three hundred and ninety-seven children (53.1%) were in remission or had mild asthma, 295 children (39.4%) had moderate asthma, and 56 (7.5%) had severe asthma. Of 563 children who required some pharmacological treatment, 266 used inhaled therapy. One hundred and forty-four children used metered-dose inhaler (MDI), 136 used powered nebulizer, and 34 used dry powder inhaler (DPI). Of children treated with inhaled sodium cromoglycate, 63 used MDI, 129 used nebulizer solution and 23 used DPI. Of children treated with inhaled corticosteroids, 43 used MDI and six used DPI. Of children using powered nebulizer, 48 were well satisfied and 76 were slightly satisfied. More than 90% of mothers commented that this form of treatment improved the quality of life both of the asthmatic children and of the family.
Conclusion: Internet survey of childhood asthma is effective, and powered nebulizer therapy may be encouraged more acceptable by infants and young children in the treatment of asthma.     

The combination of nebulized sodium cromoglycate and salbutamol in the treatment of moderate‐to‐severe asthma in children

The aim of this multi‐centre prospective study was to evaluate the efficacy, tolerability, and safety of the combination of sodium cromoglycate (SCG) and salbutamol (administered as a nebulized solution), compared to SCG alone and salbutamol alone, in the management of severe, intractable asthma in childhood. The study was an open, randomized, cross‐over trial of 12 weeks' duration in children with moderate‐to‐severe intractable asthma. All treatments were administered twice daily by powered nebulizer. The primary outcome measure was the change in asthma severity, as measured by the mean asthma score during the last 2 weeks of a baseline period and the last 2 weeks of each treatment. Secondary outcome measure was the patient's opinion of the effectiveness of treatment. The change in asthma scores from baseline values were significantly greater with the combination treatment compared to each component administered separately. The mean difference in asthma score between the combination and salbutamol was: ?7.5; 95% CI, ?11.70 to ?3.29 (p < 0.0001). The mean difference between the combination and SCG was: ?8.53; 95% CI, ?14.03 to ?3.25 (p < 0.0001). Patients were also significantly in favor of combination treatment (p < 0.001 vs. salbutamol; p < 0.01 vs. SCG). Two patients reported adverse effects. We concluded that regular twice‐daily inhalation of a combination of SCG and salbutamol gave better control of symptoms than previous treatments in patients with severe, intractable asthma. Few adverse effects with this therapy suggest that it is extremely useful, safe, and effective.