Asthma, inhaled corticosteroid treatment, and growth.

To evaluate the effects on growth of inhaled corticosteroid treatment (ICT) and of the quality of control of asthma, height velocity was studied in 58 prepubertal children attending a specialist asthma clinic because of chronic asthma that was difficult to control. The height velocity standard deviation (SD) score was maximal when the asthma was well controlled both before (0.01) and after (-0.07) starting ICT. It was least when the asthma was poorly controlled both before (-1.50) and after (-1.55) starting ICT. The effectiveness of control correlated significantly with the height velocity SD score, both before and after ICT was started. No evidence was found that the administration of ICT has an adverse effect on growth.     

Asthma in children: classification and treatment

OBJECTIVES: To review concepts, classification based on severity, and long term treatment for children with asthma. METHODS: To identify precipitating factors of acute asthma attacks and classify the disease in order to establish long term treatment. RESULTS: Different plans of management according to its classification: mild, moderate and severe asthma. Antiinflammatory therapy is reserved to moderate and severe asthma. CONCLUSIONS: The identification and control of the etiologic and precipitating factors are important tasks in the management of asthma. The inhalatory route is the most appropriate to treat patients suffering from asthma. The usual drugs indicated in asthma treatment are reviewed. Precocious treatment with inhaled glucocorticosteroids is recommended by several authors.     

Asthma in children: Prevalence, treatment, and sensitization

This study compares the prevalence of asthma and sensitization in children from two Swedish regions with different climates: Göteborg on the southwest coast and Kiruna in the northern inland, north of the Arctic Circle. The 412 children of a population‐based sample, 203 in Göteborg and 209 in Kiruna, were investigated at age 7–8 and 12–13 years. Questionnaire reports and interviews were obtained from all children at 7–8 years of age, and 192 children were skin‐prick tested for common aeroallergens in Göteborg and 205 in Kiruna. At the follow‐up, 5 years later, almost all the children were re‐investigated. The prevalence of asthma, wheeze, and sensitization had increased with increasing age during the follow‐up period. The questionnaire reports revealed that the prevalence of asthma was 8.5% at 12–13 years of age. All children who in the questionnaire reported current asthma, were using asthma medication. The interviews indicated that the prevalence of a clinically significant asthma might be even higher, reaching ≈ 12%. Asthma and wheeze were as common in Göteborg as in Kiruna despite large differences in prevalence of sensitization. Sensitization, and especially sensitization to animals, was far more common in Kiruna than in Göteborg. This study shows that asthma and wheeze are increasingly prevalent even in school age children and that sensitization does not necessarily reflect the prevalence of asthma in a population.     

Update on National Asthma Education and Prevention Program pediatric asthma treatment recommendations

The National Asthma Education and Prevention Program (NAEPP) published an update on selected topics from the 1997 Guidelines for the Diagnosis and Management of Asthma and provided new evidence-based recommendations for asthma treatment. Selected topics on the long-term management of asthma in children addressed the efficacy of inhaled corticosteroids (ICSs) compared with other asthma medications (i.e., as-needed beta(2)-adrenergic agonists and other controllers) in mild and moderate persistent asthma and the safety of long-term ICS use. The effects of early intervention with ICSs on asthma progression also were evaluated. An important new aspect of the treatment update entails the recommendation of ICSs as the controller medication of choice for all severities of persistent asthma in children. Additionally, on the basis of studies in adults, the Expert Panel suggested that long-acting beta(2)-adrenergic agonists are now the preferred adjunct to ICSs in children with moderate or severe persistent asthma. Based on long-term data in children, ICS therapy was deemed safe in terms of growth, bone mineral density, ocular effects, and hypothalamic pituitary adrenal axis function. Although members of the NAEPP Expert Panel determined that the effects of early intervention with ICSs on decline in lung function have not been adequately studied, they found that the effects on asthma control were substantial.     

The National Asthma Campaign Manchester Asthma and Allergy Study

The ^NACManchester Asthma and Allergy Study is a prospective study of the development of asthma and allergies in childhood. The subjects (995 children at age 3 years) were recruited in utero by screening parents in the antenatal clinic using skin prick testing and a questionnaire regarding allergic diseases. Children were assigned to risk groups according to parental atopic status (high risk, both parents atopic; medium risk, one parent atopic; low risk, neither parent atopic). A subgroup of those at high risk (with no pets in the home) was randomized to stringent environmental control (allergen impermeable covers for the parental and infant bed, hot washing of bedding weekly, HEPA vacuum cleaner, hard floor for the nursery), and the remainder followed a normal regime. The children have been followed prospectively. The environmental influences are very clearly defined. Measurements of environmental exposures include levels of house dust mite; cat and dog allergens during pregnancy and early life; pet ownership and exposure; childcare arrangements; number of siblings; vaccination uptake; thorough dietary questionnaire; and endotoxin exposure. Further unique objective outcome in the cohort is the assessment of lung function in preschool children using specific airways resistance, which at age 3 years clearly reflects both genetic and environmental influences.     

Asthma and pneumonia

Chest pain remains a common complaint among children seeking care in the United States. Asthma and lower respiratory tract infections such as pneumonia can be significant causes of chest pain. Children with chest pain caused by either of these pulmonary etiologies generally present with associated respiratory symptoms, including cough, wheezing, tachypnea, respiratory distress, and/or fever. Although analgesic medications can improve chest pain associated with pulmonary pathologies, the mainstay of therapy is to treat the underlying etiology; this includes bronchodilator and/or steroid medications in children with asthma and appropriate antibacterial administration in children with suspicions of bacterial pneumonia. The chest pain generally resolves along with the resolution of other respiratory symptoms.     

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夜间哮喘于15世纪首次被提出,一直是哮喘的普遍现象,是指支气管哮喘在夜间发作和(或)症状加重。TurnerWarvick[1]调查约8000例门诊哮喘病人,发现39%病人每晚均有哮喘发作。据统计哮喘病人至少有3次哮喘夜间发作,74%病人每周至少有1次夜间发作,据统计哮喘病人因哮喘死亡者,70%发生在睡眠相关的时段(晚10时至次日晨8时)。因此,哮喘与睡眠关系密切,并日益受到重视。睡眠本身对呼吸的影响表现为通气轻度降低,血氧水平降低,对呼吸中枢的驱动减少,气道阻力增加。在正常人不会产生明显的影响,但在哮喘患者中则会导致不良变化。夜间哮喘的发病机制…     

Excessive growth and growth hormone deficiency after treatment for craniopharyngioma

Some children grow normally or excessively after extirpation of a craniopharyngioma, despite growth hormone deficiency. We report a 4-year-old girl with suprasellar craniopharyngioma. Removal of the tumor resulted in panhypopituitarism. For the next 5 years growth continued at a rate of 8.4-10.6 cm/year and then decreased progressively to 1.2 cm/year. Administration of growth hormone increased growth rate to 9.3 cm/year.     

Asthma treatment in schoolchildren: lung function in different therapeutic groups

Dynamic spirometry and peak expiratory flow were measured in 297 school-aged children with asthma during their control visit at the outpatient clinic in 1993. Sixty (20%) children had no maintenance drugs, 169 (57%) used cromoglycate ( n = 97) or nedocromil ( n = 72), and 68 (23%) budesonide. The treatment of each child had been selected on clinical grounds according to the principles of the international consensus statement from 1989. The mean values of peak expiratory flow (PEF), forced vital capacity (FVC) and forced expiratory volume in 1s (FEV₁) were over 95% of the height-related reference values in all treatment groups. The lower limits of the 95% confidence intervals were at the level of more than 90% of those predicted. The mean FEV₁/FVC ratio (FEV%) was over 85%, and the mean maximal mid-expiratory flow (MMEF) over 75% of the reference values. Decreased PEF values (<75%) were present in 10%, decreased FVC, FEV₁, or FEV% (<75%) values in 4–6%, and decreased MMEF ((65%) values in 18%. Only minor differences between the different therapeutic groups were observed. Our results show that the clinical selection of children between the three therapeutical groups was adequate. In our area up to 70% of children requiring maintenance therapy for asthma can be treated with cromones.     

小儿哮喘与家族哮喘的关系

目的调查分析小儿哮喘与家族哮喘的关系。方法对本院儿童哮喘门诊就诊的3 500例哮喘患儿,采用自拟家族哮喘病史调查问卷进行调查,分别从有无家族哮喘史,一级亲属及二级亲属中有无哮喘史等方面进行统计分析。结果无哮喘家族史1 659例,占47.4%;有哮喘家族史1841例,占52.6%。有哮喘家族史患儿略高于无哮喘家族史者。在有哮喘家族史1 841例患儿中,一级亲属中有哮喘病史多于二级亲属。母系亲属患病率为59.9%,父系亲属患病率为40.1%,母系亲属患病率明显高于父系亲属(P<0.05)。结论遗传对哮喘发病有着直接联系。母系亲属有家族哮喘史小儿患哮喘可能性极大,值得重视。