Sinusitis in Thai asthmatic children.

The radiographic appearance of sinuses was studied in 146 Thai asthmatic patients aged 1-13 years. Forty-eight percent of cases showed sinusitis by the radiographic criteria. The maxillary sinus was most commonly involved (98.6%). Thirty-three percent had ethmoidal sinusitis and 7% of those with developed frontal sinuses had frontal sinusitis. Thirty-three percent had more than one sinus involved. Those with frontal sinusitis always had maxillary and/or ethmoidal involvement. Sixteen cases had signs and symptoms of sinusitis and all of the cases had the radiographic appearance of sinusitis. There was no correlation between the occurrence of sinusitis and duration or severity of asthma. There was no difference in the occurrence of sinusitis between those with or without allergic rhinitis. No correlation between severity of sinusitis and age of patients was observed.     

Inhaled salmeterol and fluticasone: a study comparing monotherapy and combination therapy in asthma.

BACKGROUND: The current stepwise approach to pharmacotherapy in the treatment of asthma includes the initiation of an inhaled corticosteroid with the addition of a long-acting inhaled bronchodilator if low dose inhaled corticosteroid fails to control asthma symptoms. OBJECTIVE: To determine whether initiation of salmeterol and fluticasone propionate treatment together improves asthma control greater than initiation of monotherapy with the individual agents alone with no additional safety risk in patients with asthma who had not previously been treated with inhaled corticosteroids. METHODS: A total of 136 male and female patients at least 12 years of age with asthma [forced expiratory volume in 1 second (FEV) between 50% and 80% of predicted] were randomized to twice daily salmeterol 42 microg, fluticasone propionate 88 microg, fluticasone propionate 220 microg, salmeterol 42 microg plus fluticasone propionate 88 microg, salmeterol 42 microg plus fluticasone propionate 220 microg, or placebo for 4 weeks. RESULTS: Patients treated with salmeterol combined with fluticasone propionate had improvements over baseline in FEV at endpoint that were at least twice as great (0.6 to 0.7 L) as improvements in patients treated with salmeterol (0.3 L) or fluticasone propionate alone (0.3 L) (P < .05). Patient-rated data (peak expiratory flow, asthma symptom scores, percent of days with no asthma symptoms) confirmed greater (P < .05) mean change from baseline improvements after combined treatment compared with fluticasone propionate alone. No clinically significant differences were noted between treatment groups in any safety measurement. CONCLUSION: Initiation of maintenance therapy with salmeterol and fluticasone propionate in patients with asthma treated with short-acting beta2-agonists alone provides greater improvements in pulmonary function and symptom control than initiation of maintenance therapy with fluticasone propionate alone.     

Inhaled corticosteroids and augmented bronchodilator responsiveness in Latino and African American asthmatic patients.

BACKGROUND: National asthma guidelines recommend that patients with persistent asthma regularly use an inhaled corticosteroid (ICS) in addition to as-needed albuterol, yet recent debates question whether this combination is equally efficacious in all ethnicities. OBJECTIVE: To examine the effect of ICS use on bronchodilator responsiveness to albuterol in 3 different ethnic populations. METHODS: A cross-sectional study of 106 Mexican Americans, 246 Puerto Ricans, and 163 African Americans with physician-diagnosed persistent asthma. Asthma severity, ethnicity, and medication use were evaluated using spirometry and questionnaires. Percentage change in forced expiratory volume in 1 second (FEV) was compared in patients who used ICSs vs those who used a short-acting beta2-agonist as their only asthma medication. RESULTS: Inhaled corticosteroid use was associated with improvements in the percentage change in FEV1 after albuterol administration in Mexican Americans (21.7%, P = .01) and Puerto Ricans (18.5%, P = .02) but not in African Americans (3.0%, P = .73). CONCLUSIONS: Inhaled corticosteroid use is associated with augmented bronchodilator responsiveness to albuterol in Mexican Americans and Puerto Ricans, but not in African Americans, with persistent asthma. This underscores the need for an improved understanding of ethnic-specific drug-drug interactions, particularly in those subgroups experiencing the highest burden of asthma morbidity and mortality in the United States.     

The use of humidity in asthmatic children.

Controversy exists as to the advisability of mist therapy in pulmonary disease. We studied the effects of several forms of humidity on asthmatic airways. Thirty-four children were tested over a period of 8 months as follows: (1) mist with a mean particle size of 3 mu was delivered for 30 min by an ultrasonic nebulizer to 11 children individually in a plastic tent; (2) to another 11 subjects in a tent, mist with a mean particle size of 10 mu was delivered by a jet nebulizer for 30 min;3) 15 patients in a croup room recieved for 30 min water droplets ranging from a microscopic fog to large rain particles (mean 16 mu) generated by a Melco natural fog generator; (4) 10 children were challenged with 3 solutions used commonly for the production of mist: distilled water, half-normal saline, and normal saline. Pulmonary functions were studied on each patient pre- and post-mist exposure. Approximately two thirds of the patients had a significant response, either improvement or deterioration, when challenged with the various forms of mist. No particular group trends were produced either by increasing the mean particle size of humidity, or by using solutions of increasing salinity.     

In vitro IgE biosynthesis in asthmatic children.

Forty-seven asthmatic children and eight non-allergic adults were studied by the co-culture technique of Wadman et al to test the postulated deficiency of IgE suppressor T-cell function in allergic patients. The results showed that (1) lymphocytes from asthmatic children synthesize more IgE than those from normal adults, (2) there was no correlation between serum IgE and in vitro IgE biosynthesis, (3) co-culture of lymphocytes from normal adults and patients often resulted in deviation, both enhancing and inhibiting, from expected values; therefore, no consistent suppressor T-cell defect could be demonstrated in patients; and (4) after hyposensitization, while there was a tendency for the serum IgE to decline, the capability of IgE biosynthesis tended to increase.     

Assessment of anxiety disorders in asthmatic children.

The study's objective was to determine whether the State Trait Anxiety Inventory for Children, Trait version (STAIC), is suitable for the assessment of DSM-IV anxiety disorders in asthmatic children and adolescents. Ninety-two outpatients were given a semistructured diagnostic interview. They completed STAIC; another questionnaire about anxiety, the Echelle Comportementale d'Anxiété et de Peurs (ECAP); and the Child Depression Inventory. The parents filled in the Child Behavior Check-List (CBCL) and the Conners Parent Rating Scale (CPRS). A group of healthy children was assessed with STAIC. Thirty asthmatic children had anxiety disorders. They had significantly higher STAIC scores than the nonanxious asthmatic and the nonasthmatic children. STAIC scores were independent of age and sex and were correlated with ECAP, CPRS anxiety subscore, CBCL total score, internalizing score, and CBCL anxiety-depression subscore. Internal consistency was 0.75. With a threshold value of 34 for anxiety disorders, this method had a sensitivity of 73% and a specificity of 70%. STAIC was thus a useful method for anxiety disorder screening in a pediatric population.     

Plasma endothelin-1 immunoreactivity in asthmatic children.

BACKGROUND: Endothelin-1 (ET-1) has been formerly demonstrated to have potent vasocontractile as well as bronchoconstrictor effects in vitro. This followup study was aimed to evaluate the possible changes in ET-1 levels in the plasma of asthmatic children, according to disease activity and severity. METHODS: Plasma ET-1 was estimated by enzyme-linked immunoadsorbent assay in 30 asthmatic patients (6 to 12 years old) during and after remission of an acute attack. Thirty age- and sex-matched healthy children were included as a control group. RESULTS: Plasma ET-1 immunoreactivity was significantly increased in the asthmatic children during the attacks (17.2+/-6.9 pg/mL) in comparison to the levels during quiescence of symptoms (0.9+/-1.13 pg/mL). Further, both values were significantly higher than the control value (0.22+/-0.29 pg/mL). The severity of attacks as judged clinically and by peak expiratory flow rate measurement did not influence the plasma endothelin status; neither did the family history of atopy nor the absolute eosinophil count. However, serum total IgE levels could be positively correlated to the plasma endothelin concentrations measured after remission of the asthmatic attacks (P < 0.05). CONCLUSIONS: Our findings reinforce the concept that ET-1 may be implicated in the pathogenesis of bronchoconstriction. This may encourage further studies on the value of ET-1 antagonism among alternative therapeutic modalities of childhood asthma.     

Cromolyn sodium prophylaxis in asthmatic children under five.

A technique for the administration of cromolyn sodium in 58 severely afflicted asthmatic children is described. This technique offers no difficulty in the youngsters and had no observable side effects.     

Dose-response characteristics of nebulized isoproterenol in asthmatic children.

The optimal dose of nebulized isoproterenol for nontoxic bronchodilation in asthmatic children is not established. In this study the response of 23 asthmatic children to four doses of nebulized isoproterenol hydrochloride, 1:200, a metered dose form of isoproterenol, and placebo were compared for onset, duration, and degree of bronchodilatation as well as cardiovascular responses and side effects. Data, including forced expiratory volume in 1 sec (FEV₁), maximum mid-expiratory flow (MMEF), heart rate, and blood pressure obtained before and at 5, 15, 30 and 60 min after each test nebulization, were analyzed. The results show that all doses of isoproterenol produced significant bronchodilatation at all times. The lowest dose of nebulized isoproterenol produced bronchodilatation which was initially equal to the higher doses but was significantly less effective at 60 min. There was no significant difference in the bronchodilator response to doses 2, 3, and 4. There was, however, a progressive increase in heart rate with increasing doses of isoproterenol, but significant effects were observed on blood pressure only with doses 3 and 4. We conclude that a dose of 0.005 ml/kg (0.025 mg/kg) of inhaled isoproterenol by the nebulization technique described and using the same equipment (air compressor, T tube apparatus, and nebulizer) is optimal for bronchodilatation in asthmatic children with minimal cardiovascular side effects.     

Theophylline compliance in asthmatic children

Thirty-nine chronic asthmatic children were enrolled in a 6-month outpatient theophylline compliance study. Seventy-two percent of these patients maintained mean theophylline levels greater than or equal to 5 mcg/ml, the definition of theophylline compliance. Both compliant and noncompliant patients showed significant reduction in wheezing symptoms (P less than .005). Demographic factors including age, race, sex, and number of parents at home were not correlated with drug compliance behavior. Specific behavioral interventions were implemented to promote drug compliance. Behavioral interventions that were most effective in achieving compliance were parental encouragement and increasing parental supervision of medication (compliance, asthma, theophylline, behavioral intervention).     

Suppressor cells in asthmatic children

Peripheral blood mononuclear cells (PBMC) from thirteen asthmatic children, and from normal control subjects, were pre-incubated with and without concanavalin A (con A), washed, and cultured with fresh allogenic PBMC from healthy donors. The con A pre-treated cells from fifteen of seventeen normal controls clearly suppressed the blast transformation response to con A by normal allogeneic PBMC. However, con A-generated suppressor activity was found in only seven of the asthmatic patients studied, most of whom could be classified as ‘short-term’ asthmatics. It is thus possible that either dysfunction or a reduction of the (con A)-inducible, T-suppressor cell subpopulation in peripheral blood is frequent among ‘long-term’ asthmatic patients. This may suggest that a different pathogenesis may be operating in early-onset, long-continued asthma, when compared with those investigated early in the course of asthma which has begun later in childhood.     

Effect of treadmill exercise on asthmatic children.

Measurement of peak expiratory flow rate before and after treadmill walking repeated at hourly intervals in asthmatic children disclosed progressive decreases in exercise-induced asthma. Treadmill running was followed by more extreme excercise-induced bronchospasm than treadmill walking. Exercise-induced asthma occurred in some children whose heart rates did not reach 160 during treadmill exercise, and heart rate during exercise was not correlated with the extent of exercise-induced bronchospasm.     

Oxatomide modifies methacholine- and exercise-induced bronchoconstriction in asthmatic children.

Oxatomide is a potent inhibitor of both the release and effects of allergic mediators and is similar to calcium antagonists in chemical structure. It prevents histamine release by inhibiting not only the increase in calcium intake, but also intracellular calcium release. We investigated its effect on methacholine-induced and exercise-induced bronchoconstriction in asthmatic children. Methacholine challenges were performed after oral administration of 0.88 mg/kg oxatomide or placebo in nine asthmatic children in a double-blind placebo-controlled study. Respiratory thresholds were improved in seven patients and log PC20 in the oxatomide group (6.65 +/- 1.34 micrograms/mL) was significantly higher than that in the placebo group (5.74 +/- 1.04 micrograms/mL) (P < .05). Exercise challenges were performed after oral administration of 1.5 mg/kg oxatomide or placebo in eight asthmatic children in a double-blind placebo-controlled study. Oxatomide produced acute bronchodilatation with 6.1% improvement on an average in FEV1. The mean maximal % fall obtained by oxatomide was 13.5%, while that by placebo was 22% (P < .05). These results indicate that oxatomide reduces nonspecific bronchial hyperresponsiveness.