Prevalence of respiratory symptoms among 7 and 11 year old schoolchildren and association with asthma.

A new self administered questionnaire completed by parents was used to study the prevalences of wheeze, shortness of breath, and cough in 2503 Southampton schoolchildren aged 7 and 11 together with exacerbating factors and background information including treatment and diagnosis. The questionnaire had a response rate of 84% and was found to be highly repeatable with respect to current symptoms. The overall prevalences of wheeze and shortness of breath in the current year (1986) were 12.1% and 8.5% respectively. Social class, home ownership, parental smoking, and presence of a family pet were unrelated to symptom prevalence. According to the parents the overall diagnosis rate for asthma was 9.5%. In common with other studies, however, we found considerable evidence for undertreatment. The symptoms of wheeze and nocturnal and morning breathlessness occurred more commonly in boys, but this sex ratio decreased with increasing age. The prevalences of wheeze and shortness of breath were similar in the two age groups. In contrast, there were only small differences between the sexes with respect to cough whereas, among children without wheeze or shortness of breath, there was a fall in the prevalence of cough from 18.9% at 7 years to 8.7% at 11 years. When controlling for the other respiratory symptoms, wheeze was the only symptom significantly related to parental asthma. The fall in the prevalence of cough between the two age groups is unlikely to be related to changes in asthma prevalence and, when not associated with wheeze, may be an indicator of separate pathology.     

Associations between respiratory symptoms,bronchial response to methacholine,and atopy in two age groups of schoolchildren.

Data on respiratory symptoms were obtained on 2503 schoolchildren aged 7 and 11 in Southampton by means of a self administered parental questionnaire. Children were classified into seven symptom groups from which 330 were tested for bronchial responsiveness to less than or equal to 6.4 mumol methacholine and skin tested for the presence of atopy. The symptoms of wheeze, cough, and shortness of breath were all significantly associated both with each other and bronchial responsiveness to methacholine but only wheeze was associated with atopy. The association of wheeze with both bronchial responsiveness to methacholine and atopy remained highly significant when controlling for the symptoms of cough and shortness of breath. Neither cough nor shortness of breath, however, were significantly related to bronchial responsiveness to methacholine when controlling for the symptom of wheeze. This study therefore calls into question the epidemiological relevance of these two symptoms as diagnostic features of asthma, particularly in the absence of wheeze, although they may be useful indicators of morbidity. Wheeze was not related to bronchial responsiveness to methacholine in the absence of atopy or to atopy in the absence of bronchial responsiveness to methacholine but was strongly related to the combination of the two phenomena. The presence of these three characteristics could therefore indicate a discrete disease entity. The decrease in the prevalence of cough between 7 and 11 years appeared to be mirrored by a similar decrease in the prevalence of wheeze when the symptom was not associated with the combination of bronchial responsiveness to methacholine and atopy. On the basis of these findings and those of others we suggest that the latter group may represent children with a separate disease entity(ies) or with residual symptoms secondary to acute viral or other infections of the lower respiratory tract.     

Symptoms,atopy, and bronchial response to methacholine in parents with asthma and their children.

We have studied 50 children with one parent with asthma at a mean age of 6.4 years by symptom questionnaire and performed allergy skin testing and measurement of bronchial responsiveness to methacholine in both parent and child in 29-32 cases. Ninety eight per cent of the parents were receiving medication for asthma. Fifty one per cent had visited their doctor and 20% had taken more than five days off work in the previous 12 months; 12% had been admitted to hospital during the preceding 10 years. In the children the prevalences of wheeze, shortness of breath, and cough were all about double that found in a general population survey of children of similar age. Atopy was present in 90% of parents, but the prevalence of atopy among the children was not significantly different from the children in the general population. Eczema and hay fever, however, had high prevalences of 40% and 24%, respectively. Responsiveness to methacholine (provocation dose achieving 20% fall in forced expiratory volume in one second less than 6.4 mumol) was found in 93% of parents and 45% of children, which is compatible with a large increase compared with the general population. All atopic but only 50% of non-atopic children with symptoms of asthma responded to methacholine. These findings indicate that children who have one parent with asthma have roughly double the chance of developing clinical features of asthma compared with the general population and suggests that, in these children, a causal interaction occurs between atopy and bronchial hyper-responsiveness.     

Prevalence of bronchial asthma among schoolchildren in a Swedish district

The prevalence of asthma among 10,527 children aged 7-16 years was investigated in 1985. Children were assigned to the asthma group when replies to a questionnaire stated that at least two of four stipulated symptoms had been experienced in the preceding year. A validation study, comprising exploration of medical history, pulmonary auscultation and physiological tests (spirometry and methacholine inhalation challenge) was performed in 73 children. The overall prevalence of asthma was 4%. The most common symptom-inducing factors were physical exertion, upper respiratory tract infection, contact with animals and tobacco smoke. The methacholine test had limited value as a diagnostic aid, being positive in only 25% of children with a clear history of asthma.     

Asthma and atopy in schoolchildren in a defined population

We investigated the frequency of allergic disorders, the pattern of allergen sensitization and serum total IgE concentration in a population-based sample of schoolchildren screened on the basis of respiratory symptoms ( A = 244). The children were classified on clinical grounds into three groups, asthma ( N = 43), other symptoms from lower airways (OSLA; N = 34) and control children ( N = 167). The frequency of allergic disorders (allergic rhinitis, conjunctivitis or dermatitis) differed significantly between children with asthma (81%), children with OSLA (62%) and in control children (48%) ( p < 0.001). The presence of at least one positive skin prick test result was equally common in children with asthma or OSLA (77%), but lower in control children (40%) ( p < 0.001). Serum total IgE concentrations did not differ between the three groups. Two conclusions can be drawn: (i) there is a strong association between clinical allergy, skin reactivity and asthma in school age children, and (ii) a similar association is present between allergy and asthma-like conditions.     

Prevalence of bronchial hyperreactivity asd etermined by several methods among Estonian schoolchildren

There is a lack of established criteria to identify asthma and bronchial hyerreactivity (BHR) in epidemiological studies, although both conditions appear to bear some relationship to atopy, at least in children. Recent studies indicate a low prevalence of atopy in former Socialist countries in Europe, yet the prevalence of BHR has been reported to be high. We have analysed the relationship between the outcome of various lung function tests, atopy and clinical symptoms of bronchial asthma in an epidemiological survey of Estonian 10-12 year old schoolchildren. Metacholine provocation test (four steps with the cumulative doses 100, 300, 700 and 1100uμg), exercise challenge test and PEF-variability over two weeks were done in 806 children in Tallinn (coastal, industrialised city) and 774 children in Tartu (inland, uniersity town). A positive response to the metacholine challenge test was recorded in 19% in Tallinn and in 32% in Tartu (p < 0.001). A similar tendency was observed for a more than 15% decrease of FEV¹ in the exercise challenge test, i. e. 6% in Tallinn and 18% in Tartu. There was only a weak relationship between BHR, as defined by either a positive metacholine challenge and/or exercise test, diagnosed asthma and reported wheezing. Thus, 47% of the wheezing children and 30% of the children with asthma had negative test results. Only 17% of the children with a positive metacholine challenge were atopic, as defined by at least one positive skin prick test. In conclusion, none of the methods employed to assess bronchial hyperre-sponsiveness were very useful for the identification of wheezing and asthmatic children in this epidemiological study. In contrast to the results of studies in Western Europe, most children with bronchial hyperreactivity in Estonia are not atopic.     

Wegener's granulomatosis in a 7 year old child

A 7 year old boy presented with a history of recurrent episodes of sinusitis and otitis. He developed paresis of the external muscle of his right eye with exophthalmos. A biopsy of his sinus mucosa demonstrated necrotizing granulomatous involvement of the membranes with the presence of multiple giant cells interspersed in zones of fibrosis. A diagnosis of Wegener's granulomatosis was entertained. However the absence of pulmonary and renal manifestations did not allow for a definitive diagnosis to be made. He later developed hematuria and a renal biopsy demonstrated a renal lesions consistent with Wegener's granulomatosis. He has responded well to Cyclophosphamide and Prednisone therapy.     

Panarteritis nodosa in an 11 year old boy.]

The polyarteritis nodosa is a disease which can be observed in children. Its occurence in early infancy is extremely seldom and infants who contract this disease show a remarkable rate of high mortality. In 4 cases of polyarteritis in early infancy death occured within the age of three months (8, 9, 12, 13). Patients who contract this disease have involvements of different organs. This report discribes a case of polyarteritis nodosa in an older child of 12 years of age with renal, cerebral and cardiac involvement. The histological clinical and laboratory findings are discussed.     

Hormonal response to surgical stress in schoolchildren.

PURPOSE: To determine hormone concentrations (ACTH, cortisol, beta-endorphin) in children before and after surgery, to assess the correlation between any hormonal changes and to study the influence exercised on them by the severity of surgical stress and the elective/emergency nature of the surgery. PATIENTS AND METHODS: Prospective cohort of 78 children (age= 10+/-2.6 years, range 6-13 years) undergoing elective or emergency surgery. Preoperative and postoperative (1 and 24 hours postoperation) plasma concentrations of ACTH, cortisol and beta-endorphin were determined in all children. The severity of surgical stress was evaluated as low (< 6) or high (> 6) according to the Oxford scale. Student's t-test was used to analyse hormonal changes and the influence of degree of surgical stress and elective/emergency character of the surgery, and Pearson's coefficient for correlations between hormonal values. p < 0.05 was regarded as significant. RESULTS: We observed a significant increase in hormonal concentrations one hour after surgery. ACTH and cortisol values normalised 24 hours after surgery, but beta-endorphin concentrations remained increased. There was a correlation between ACTH and beta-endorphin values both before surgery and one hour after. Operations with high surgical stress significantly increased cortisol concentrations one hour after surgery and beta-endorphin concentrations 24 hours after surgery. Patients selected for emergency surgery showed significantly higher concentrations of cortisol and ACTH both before and after surgery. CONCLUSIONS: Postoperative hormonal response among children of school age is characterised by increases in ACTH, cortisol and beta-endorphin one hour after surgery, and by high concentrations of beta-endorphin 24 hours after surgery. Cortisol is an index of surgical stress. Emergency surgery is associated with significant increases in ACTH and cortisol.     

Cognition in 4-11 year old children in Turkey

OBJECTIVES: The purpose of this study was to determine the relationship among age, sex and academic performance with cognitive ability on healthy age groups. METHODS: The subjects were 71 children, aged 4-11 years (x = 7.11). The children were divided into four age groups: 22 of the 71 children were at kindergarten and 49 children were in primary education. Thirty nine children were girls and 32 were boys. Twenty six children had good academic achievement and 23 did not. Each child was tested on the LOTCA battery by the Occupational Therapy Unit of Hacettepe University School of Physical Therapy and Rehabilitation. In this study, seven subtests were used from LOTCA (Loewenstein Occupational Therapy Cognitive Assessment). These are orientation for place, orientation for time, overlapping figures, praxis, reproduction of a two dimensional model, drawing a clock, and categorization. RESULTS: Statistical analysis of the relationships demographic variables, academic achievement and performance on the battery revealed that age was significant, sex was insignificant and academic achievement was significant when correlated with cognitive abilities. CONCLUSIONS: The results suggest that cognitive abilities tested show some differences. For this reason, in the school or other educational settings, children who have low academic achievement should be assessed also for cognitive abilities and then provided with occupational therapy.     

Airway response to exercise and methacholine in children with respiratory symptoms.

Thirty atopic and 30 non-atopic subjects were identified from a population of 7-8 year old children with current respiratory symptoms. The response of the airways to exercise and provocation by methacholine were compared. In these children, who had symptoms but were not necessarily asthmatic, there was no significant correlation between the two stimuli. The atopic children were, however, significantly more responsive than the non-atopic children to both. For the whole group, odds ratios derived for atopy and for an increased response to methacholine (expressed as a PD20--the dose that caused the forced expiratory volume in one second (FEV1) to fall by 20%--of less than 6.4 mumol/l), a positive exercise test (greater than 15% fall in FEV1), and the presence of asthma were 13.5, 3.3, and 21.0, respectively; that for positive response to methacholine and positive exercise challenge was 1.5. Thus though increased bronchial responsiveness to methacholine and exercise challenge are both associated with a diagnosis of asthma, the association between the two stimuli is complex, and supports the view that they reflect entirely different components of airways dysfunction.     

Prevalence of asthma in schoolchildren

OBJECTIVE: To assess the prevalence of asthma symptoms and of asthma in children due to the high frequency of pediatrics patients with symptoms suggestive of the disease and to the lack of data regarding prevalence of asthma in this population. METHODS: We carried out a cross-sectional study with 2,735 school-age children aged 6-7 years and 3,509 adolescents aged 13-14 years selected by random sampling. Data were collected between 1998 and 1999 using a translated version of the questionnaire of the International Study of Asthma and Allergies in Children, which has been previously tested and approved. Guardians were responsible for answering the questionnaire of younger children, whereas adolescents answered their own, in classroom. The data were computed and analyzed using EPI-info software. RESULTS: The response rates for questionnaires were 73.2% (6-7-years old) and 94% (13-14 years old). The prevalence of symptoms in children and adolescents were, respectively: wheezing ever 46.7% and 44.3% (P<0.05); wheezing in the last 12 months 22.7% and 21.2%; speech limited due to wheezing 4.7% and 4.0%; wheezing following exercise 6.3% and 18.2% (P<0.05); nighttime cough in the last 12 months 38.5% and 45.8% (P<0.05); asthma (bronchitis) ever 28.2% and 26.4% (P=0.11). CONCLUSIONS: The prevalence of asthma symptoms and of asthma of the two groups are among the highest results ever reported in Brazil; these results were compatible with those of high prevalence results reported worldwide using ISAAC questionnaires. The high prevalence of symptoms suggests a high prevalence of the disease, which makes asthma an important problem for public health in the region.     

Hypothyroidism and hypoparathyroidism in an 11 year old boy with hemochromatosis secondary to aplastic anemia

This is the first reported case, to our knowledge, of hypoparathyroidism and hypothyroidism due to secondary hemochromatosis with onset during childhood. The patient was a boy with refractory aplastic anemia in whom primary hypothyroidism and hypoparathyroidism became apparent at the age of 10 and 11 years old, respectively. He had received a total of 100 L of transfused blood by the age of 10 years. The patient showed poor annual height gain due to primary hypothyroidism, together with hypocalcemia, cataract and intracranial calcification due to hypoparathyroidism. The early appearance of both thyroid and parathyroid dysfunction in this patient may have been due to the delay of initiation of iron-chelating agents and liver dysfunction due to hepatitis type C.     

Liposarcoma of the renal capsule in a 7 year old girl

An unusual case is reported of a liposarcoma of the renal capsule in a 7 year old girl. Initial radiological studies revealed a fatty tumor related to the lower pole of the kidney. Selective renal angiography located the tumor to renal capsule and demonstrated its malignant nature.