Clinical value of monitoring eosinophil activity in asthma

The prevalence and clinical features of migraine headache and abdominal migraine were studied in the well defined population of Aberdeen schoolchildren. Ten per cent of all children (2165) aged 5-15 years were given a questionnaire inquiring, among other symptoms, about the history of headache and abdominal pain over the past year. A total of 1754 children (81%) responded. Children with at least two episodes of severe headache and/or sever abdominal pain, attributed by the parents either to unknown causes or to migraine, were invited to attend for clinical interview and examination. After interview, 159 children fulfilled the International Headache Society's criteria for the diagnosis of migraine and 58 children had abdominal migraine giving estimated prevalence rates of 10.6% and 4.1% respectively. Children with abdominal migraine had demographic and social characteristics similar to those of children with migraine. They also had similar patterns of associated recurrent painful conditions, trigger and relieving factors, and associated symptoms during attacks. The similarities between the two conditions are so close as to suggest that they have a common pathogenesis.     

哮喘儿童连续性监测呼出气一氧化氮水平的临床意义

目的：探讨哮喘儿童呼出气一氧化氮水平（FeNO）的变化特点及临床意义。方法：20例在哮喘专科就诊的的轻-中度哮喘患儿,分別在治疗后8周、16周、24周、32周、40周进行随访。随访时记录哮喘症状,检测肺功能及FeNO。结果：治疗8周后FeNO均值迅速下降,后逐渐缓慢下降。与治疗前比较,治疗8周、16周、24周、32周及40周后的FeNO均值显著降低,差异有统计学意义（P＜0.01）。急性发作时FeNO水平较发作前明显增高,待病情缓解后FeNO水平随之快速下降。相关性分析显示FeNO与第1秒用力呼气容积（FEV1）呈负相关(r=-0.193,P＜0.05)。受试者工作曲线提示当FeNO为35.5 ppb时,FeNO预测哮喘未控制的敏感性为87.9%,特异性是80%;FeNO为20.5 ppb时,敏感性为97%,特异性为27.1%。结论：动态监测FeNO可以用于判断哮喘儿童气道炎症的控制水平;当FeNO值小于20.5 ppb时气道炎症可能控制良好,而当大于35.5 ppb时气道炎症很有可能处于未控制状态;FeNO的急性增高提示患儿有急性发作的可能。     

Blood eosinophil counts and arterial oxygen tension in acute asthma.

OBJECTIVE--To investigate whether during acute asthma episodes a decrease in blood eosinophil count could correlate with the severity of the disease. DESIGN--Prospective study on paediatric asthmatic patients admitted for acute asthma exacerbation between January 1992 and August 1993. All patients were regularly followed up in an outpatient clinic and had had a complete clinical evaluation < 1 month before admission. SETTING--Pulmonary division of the G Gaslini paediatric research institute, Genoa, Italy. SUBJECTS--21 asthmatic patients, 59 (SEM 9) months of age, admitted for acute asthma exacerbation. On the basis of clinical evaluation and the results of blood and microbiological tests performed during acute asthma exacerbations, patients were divided into two subgroups: infected (n = 13) and non-infected (n = 8). RESULTS--All but one of the patients showed a marked decrease in blood eosinophil count during the acute asthma episode, in comparison with recent count (< 1 month before admission) obtained in clinically stable conditions: 662 (116) v 210 (54) eosinophils/mm3, p < 0.0003. The decrease in the eosinophil count was more pronounced in the infected patients than in the non-infected patients, but the difference was not statistically significant (p > 0.05). Similarly, transcutaneous arterial oxygen pressure (PaO2) values measured during acute asthma exacerbations tended to be lower in infected patients, without, however, reaching statistical significance: 8.6 (0.7) v 10.1 (0.9) kPa, p > 0.05). The correlation between the decrease in blood eosinophil count and PaO2 during the acute asthma exacerbations was significant in all the patients (r2 = 0.235, p = 0.022) and in the non-infected patients (r2 = 0.653, p = 0.015), but not in infected patients. In this latter subgroup, a significant negative correlation was found between blood neutrophil counts during acute asthma exacerbations and PaO2 (r2 = 349, p = 0.026). CONCLUSIONS--During acute asthma exacerbations in atopic patients without clinical evidence of infection, the decrease in blood eosinophil count correlates significantly with the decrease in PaO2, further supporting the role of eosinophils in allergic asthma.     

呼出气一氧化氮在儿童哮喘中的临床价值

哮喘是一种气道慢性炎症性疾病,已成为儿童中最常见的慢性疾病之一.临床上对哮喘的诊断及治疗主要依据临床表现及肺功能,但两者并不能反映气道炎症.呼出气一氧化氮(exhaled nitric oxide,eNO)作为气道炎症的标志物,与气道炎症有显著相关性.eNO检测方法具有无创、简单、方便、特异性好等优点,在临床应用方面具有明显优势.该文介绍了NO在气道中的代谢及其作用,并从哮喘的诊断及鉴别诊断、哮喘管理方面阐述eNO检测在儿童哮喘临床应用中的研究进展.     

Usefulness of monitoring lung function in asthma.

There is no firm evidence from randomised controlled trials that routine monitoring of lung function improves asthma control in children. Guidelines for management of asthma consistently recommend routine home monitoring of peak expiratory flow (PEF) in each patient. However, changes in PEF poorly reflect changes in asthma activity, PEF diaries are kept very unreliably, and self management programmes including PEF monitoring are no more effective than programmes solely based on education and symptom monitoring. PEF diaries may still be useful in isolated cases of diagnostic uncertainty, in the identification of exacerbating factors, and in the rare case of children perceiving airways obstruction poorly and exacerbating frequently and severely. If a reliable assessment of airways obstruction in asthma is needed, forced expiratory flow-volume curves are the preferred method. Monitoring of hyperresponsiveness and nitric oxide cannot be recommended for routine use at present. Clinical judgement and expiratory flow-volume loops remain the cornerstone of monitoring asthma in secondary care.     

Estimation of total and vacuolated eosinophil counts in childhood asthma

Total eosinophil count (TEC) and vacuolated eosinophil count (VEC) alone with stool examination were done in 300 bronchial asthma patients and 50 age matched healthy control children. In fifty normal children TEC ranged from 75–250/cu mm. while VEC was nil and stool examination was also normal of the 300 cases of bronchial asthma absolute eosinophil count of more than 400/cu. mm was noted in 45.3 percent and vacuolated eosinophil count of more than 10 percent was present in 23 percent cases. It concluded that vacuolated eosinophil count is more significant as compared to absolute eosinophil count. Fifty percent cases of bronchial asthma had ascarids and ten percent has mixed parasitic infestation, These cases reponded to the treatment and repeate TEC and VEC was normal and children were symptom free. This suggested close association of parastic infestation and asthma in childhood.     

Ratio of eosinophil cationic protein/eosinophil count as a new marker in children with acute asthma

BACKGROUND: It is a matter of concern whether serum eosinophil cationic protein (ECP) can be considered as a disease marker in children with acute asthma being treated without corticosteroids. METHODS: Fourteen children (nine male, five female, aged 6-12 years) with acute asthmatic exacerbation, administered the appropriate drugs, with the exception of systemic or inhaled corticosteroids, were examined. They were all free from apparent asthmatic attacks during a follow-up period of 1 month. Serum ECP, eosinophil count and forced expiratory volume in 1 s (FEV1) were measured at referral, on the day of discharge, 1 week and 4 weeks after discharge, respectively. RESULTS: The ratio of ECP/eosinophil count (ECP:Eo ratio), expressed as micrograms of ECP (microgram/L)/the number of eosinophil (/microL) x 1000, was also evaluated as a marker of eosinophil activation. Compared with the value at referral, FEV1 (% predicted) significantly increased on the day of discharge (P < 0.05), 1 week after (P < 0.05) and 4 weeks after discharge (P < 0.05). However, serum ECP concentrations showed no significant changes during the follow-up period. Eosinophil count showed no significant changes on the day of discharge or 1 week after discharge, but significantly increased 4 weeks after discharge (P < 0.05). In contrast, the ECP:Eo ratio significantly decreased on the day of discharge (P < 0.05), 1 week after (P < 0.05) and 4 weeks after discharge (P < 0.05). CONCLUSION: These data suggest that serum ECP is a poor disease marker in asthmatic children with acute exacerbation who receive no corticosteroid therapy, probably due to marked changes in the eosinophil count. However, the ECP:Eo ratio might be a better marker than serum ECP in such patients.     

上海嘉定地区支气管哮喘儿童常见过敏原分析

目的 探讨上海嘉定地区儿童哮喘的致敏原以及哮喘患儿年龄与过敏原的相关性.方法 351例哮喘儿童按年龄分组,用15种标准化的吸入性过敏原和食物性过敏原点刺液对所有患儿进行皮肤点刺试验,观察阳性率及不同年龄组过敏原情况.结果 (1)哮喘患儿吸入性过敏原阳性率为71.2%,其排序依次为粉尘螨(49.6%)、屋尘螨(49.0%...     

Transcutaneous oxygen monitoring in acute asthma

Arterial blood oxygen tensions (Pao₂) were compared with simultaneously obtained transcutaneous oxygen measurements (T_co₂) in 15 children during an acute asthma attack and in 18 children with an illness other than asthma. A close correlation between T_co₂ and Pao₂ was obtained in the non-asthmatic group but not in the asthmatics. It is suggested that impaired cutaneous blood flow may explain this poor correlation.     

Transcutaneous oxygen monitoring in acute asthma

Arterial blood oxygen tensions (Pao2) were compared with simultaneously obtained transcutaneous oxygen measurements (TcO2) in 15 children during an acute asthma attack and in 18 children with an illness other than asthma. A close correlation between TcO2 and PaO2 was obtained in the non-asthmatic group but not in the asthmatics. It is suggested that impaired cutaneous blood flow may explain this poor correlation.     

不同Apgar评分新生儿振幅整合脑电图动态监测的临床意义

目的 了解不同Apgar评分新生儿振幅整合脑电图(amplitude-integrated electroencephalogram,aEEG)的变化,探讨aEEG对窒息新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的诊断价值.方法 2010年12月至2011年10月对我院新生儿病房住院的56例不同Apgar评分足月患儿,根据生后1 min Apgar评分将患儿分为观察组(Apgar评分0～7分)36例,对照组(Apgar评分8 ～10分)20例.分别在生后6h内、2d、3d、7d对患儿进行aEEG描记,分析aEEG的变化及其对新生儿HIE的诊断价值.结果 对照组20例患儿生后6h aEEG正常17例(85％)、轻度异常3例(15％),无重度异常;观察组36例患儿中,生后6 h aEEG正常18例(50％),轻度异常13例(36.1％),重度异常5例(13.9％),观察组aEEG异常率显著高于对照组(x2=5.3,P＜0.001).观察组36例患儿中,34例诊断为HIE,生后6 h aEEG监测结果与HIE临床分度有相关性(Spearman等级相关系数为0.867,P＜0.01).动态aEEG监测56例患儿,生后6h有21例aEEG异常,其中15例(71.4％)患儿于病程48～72h aEEG恢复正常,有4例(7.1％)第7天aEEG呈重度异常.结论 对足月HIE新生儿进行生后动态aEEG监测,能早期预测HIE病情轻重程度.     

Usefulness of monitoring lung function in asthma

There is no firm evidence from randomised controlled trials that routine monitoring of lung function improves asthma control in children. Guidelines for management of asthma consistently recommend routine home monitoring of peak expiratory flow (PEF) in each patient. However, changes in PEF poorly reflect changes in asthma activity, PEF diaries are kept very unreliably, and self management programmes including PEF monitoring are no more effective than programmes solely based on education and symptom monitoring. PEF diaries may still be useful in isolated cases of diagnostic uncertainty, in the identification of exacerbating factors, and in the rare case of children perceiving airways obstruction poorly and exacerbating frequently and severely. If a reliable assessment of airways obstruction in asthma is needed, forced expiratory flow-volume curves are the preferred method. Monitoring of hyperresponsiveness and nitric oxide cannot be recommended for routine use at present. Clinical judgement and expiratory flow-volume loops remain the cornerstone of monitoring asthma in secondary care.     

Altered eosinophil levels as a result of viral infection in asthma exacerbation in childhood

Respiratory viral infection is known to be a significant cause of asthma exacerbation. Eosinophils have been considered to play an important role in the pathogenesis of virus-induced asthma exacerbations. To determine how often asthma exacerbation is caused by virus infections and to examine the relationship between eosinophilia and asthma episode, we investigated 64 children who experienced asthma attacks between October 1999 and March 2000. We used rapid enzyme immunoassays to detect antigens of respiratory syncytial virus (RSV), influenza A virus, and adenovirus in nasopharyngeal secretions (NPS) of these children, and enumerated eosinophils in the blood and NPS. We detected RSV in 27% and influenza A virus in 17% of the patients. No adenovirus infection or RSV/influenza A co-infection was detected. RSV-infected children were younger (3.85 ± 0.83 years old) than influenza A virus-infected patients (5.23 ± 1.34 years old). Eighty-two per cent of patients in the RSV group and 36% of patients in the influenza A virus group had moderate-to-severe asthma episodes (p < 0.05). In RSV-infected children, the eosinophil counts in NPS were higher in the 'severe' group, and younger patients had a greater number of eosinophils in their NPS than older patients (p < 0.05). These trends were not found in influenza A virus patients. In conclusion, our results indicate that, compared with influenza A virus-induced asthma attacks, RSV infection had a higher probability of being associated with asthma exacerbation in infants and younger children and induced attacks of greater severity. The increase in the number of eosinophils in the NPS of RSV-infected children may be responsible, in part, for these differences.     

Clinical monitoring of steatorrhoea in cystic fibrosis.

In 100 patients with cystic fibrosis the severity of steatorrhoea was assessed by three separate methods. Using chemical faecal fat assay as the gold standard, two other rapid and inexpensive methods were compared with it. The steatocrit method proved unreliable in our hands and gave little indication of the presence or severity of steatorrhoea. The more simple microscopy method was highly sensitive (97%) and only three of 80 patients with steatorrhoea were missed. All patients with severe steatorrhoea (greater than 60 mmol fat/day) were clearly demonstrated. The method is applicable to spot faecal samples and can readily be carried out on an outpatient basis. In centres where faecal fat assays are not available, the simple and cheap microscopic examination will give some indication of the response to enzyme treatment and may also help to identify non-compliant individuals.     

峰流速仪在测定哮喘患儿呼气峰流速中的临床价值

<正>支气管哮喘是一种常见的慢性气道可逆性阻塞性疾病,肺功能检查和峰流速仪监测是哮喘管理中重要的监测方法[1],在《全球哮喘防治创议》[2]和《儿童支气管哮喘诊断及防治指南》[3]中都占重要位置。肺功能仪对第1秒用力呼气容积(FEVl)的