Long-term Treatment with Corticosteroids/ACTH in Asthmatic Children

ABSTRACT. Skeletal maturation in severe bronchial asthma was studied in 15 children during and after treatment with depot tetracosactrin and in 6 children during treatment with prednisolone. Attained skeletal maturity before treatment was below the reference mean in the majority of children. Skeletal maturation was enhanced during treatment with depot tetracosactrin, which led to more advanced attained skeletal maturity at withdrawal than at start of treatment. There was a tendency towards larger increases of skeletal maturity than of height. The influence of adrenal androgens, released by ACTH-stimulation and good control of the disease are probably relevant factors for the acceleration of skeletal maturation. After withdrawal of depot tetracosactrin the rate of skeletal maturation normalized. During prednisolone treatment there was a delay of skeletal maturation leading to a progressive relative decrease of attained skeletal maturity, and closely related to a delay in linear growth. Treatment with depot tetracosactrin may thus induce enhancement of skeletal maturation, but with the treatment regimen found to be efficacious in bronchial asthma, the effect is not very pronounced and does not perceptibly affect the ultimate outcome of growth.     

Childhood Asthma in Thailand

Asthma is common in Thai children with a prevalence of about 4%. A prospective study of 2,000 Thai asthmatic children showed boys to be more frequently affected than girls, and fifty percent of patients experienced their first attack within the first 2 years of life. Attacks usually occurred in winter and the rainy season. 63.15% of patients had asthma associated with other allergic diseases and 79.25% had a family history of allergic diseases. Positive skin tests to important antigens were noted in 93.7% of cases, and house dust was the most common. Pharmacokinetic studies of theophylline were made in Thai asthmatic children after oral administration revealed that the elimination half-life of theophylline was longer than that observed in subjects in Western countries. Long-term follow up of 247 Thai asthmatic children revealed that in 37.2% of patients, symptoms ceased at the age of 15 years. The factors which indicated a favorable prognosis included male sex, mild or moderate illness, negative skin tests or positive skin tests to only a few allergens.     

Role of Synbiotics in the Treatment of Childhood Constipation: A Double-Blind Randomized Placebo Controlled Trial

Objective

Constipation is a common problem in children. There is some clinical evidence for the role of probiotics and prebiotics in the treatment of constipated children. This is the first study on the therapeutic effect of synbiotics (combination of probiotics and prebiotic) in treatment of childhood constipation.

Methods

In a double-blind randomized placebo controlled study 102 children aged 4–12 years with functional constipation were assessed according to Rome III criteria for 4 weeks. They were divided into 3 groups: Group A, received 1.5 ml/kg/day oral liquid paraffin plus placebo, group B, 1 sachet synbiotic per day plus placebo and group C, 1.5 ml/kg/day oral liquid paraffin plus 1 sachet synbiotic per day. Frequency of bowel movements (BMs), stool consistency, number of fecal incontinence episodes, abdominal pain, painful defecation per week, success of treatment and side effects were determined in each group before and after treatment.

Findings

The frequency of BMs per week increased in all groups (P<0.001), but it differed between groups and was higher in group C (P=0.03). Stool consistency increased and number of fecal incontinence episodes, abdominal pain and painful defecation per week decreased in all groups similarly and there was statistically no difference between them. No side effects were reported in group B; the main side effect in group A and C was seepage of oil (P<0.001). Treatment success was similar in all groups without any significant difference between them (P=0.6).

Conclusion

This study showed that synbiotics have positive effects on symptoms of childhood constipation without any side effects.     

Long-term Treatment with Corticosteroids/ACTH in Asthmatic Children

Hypothalamic-pituitary-adrenal (HPA) function was studied in 23 children with severe bronchial asthma during and after long-term treatment with prednisolone and/or ACTH_1-24 (depot tetracosactrin) by means of ACTH stimulation test and insulin tolerance test. In the 14 children primarily treated with depot tetracosactrin, the Cortisol levels in insulin tests were within normal limits both during and after treatment. An enhanced response to ACTH stimulation was found during the treatment period. During treatment with prednisolone a marked impairment of the adrenocortical function was found, with low basal plasma Cortisol levels and subnormal response to ACTH stimulation, more marked the lower the age at the start of treatment and the higher the dose per kg body weight. After substitution with depot tetracosactrin the HPA-function was restituted, with plasma Cortisol levels within normal limits. Growth hormone levels after insulin induced hypoglycemia were ±7 ng/ml during and after treatment with depot tetracosactrin. As long-term treatment with depot tetracosactrin has little side-effects in terms of suppression of the HPA-axis it is a useful alternative to oral prednisolone in severe asthma in children.     

Influence of Baseline Lung Function on Exercise-Induced Response in Childhood Asthma

ABSTRACT. The dependence of bronchial reactivity to exercise on baseline lung function was studied in 84 asthmatic children aged 7–16 years. The percentage fall in PEF values after a standard exercise running test was 8.4± 8.6 % in the 39 children with an attack rate of less than 10 per year and 29.6±23.3% in the 45 children with an attack rate of 10 or more per year (p<0.001). A significant negative correlation (r=-0.46, p<0.001) was found for pre-exercise MMEF and other sensitive tests of airway calibre with the response to exercise, but no such correlation was found between baseline PEF or SG_aw values and the exercise response. These results show that bronchial hyperreactivity to exercise is dependent on residual airway obstruction, but a wide variety of reactivity can occur. If the baseline flow-values are less than three standard deviations below the mean reference, however, a clinically significant response to exercise can be predicted.     

Asthma from Childhood to Adult Age

ABSTRACT. Twenty young men with a mean age 24.9 years, who had moderate to severe asthma during childhood, underwent a follow-up examination of their clinical status and pulmonary function. Comparison was made with data obtained at a mean age of 10.9 years. Eight of twenty showed a clinical improvement and 12 no change in their asthma. During childhood 12 of 20 boys had been on longterm ACTH or corticosteroid treatment. In the present study no one was given systemic steroid treatment. The static lung volumes (VC, TLC, FRC RV) were within normal limits for children and adults. In spite of clinical improvement, the expiratory flow rates (FEV₁, FEV%) were still significantly reduced ( p <0.005). Thus, the clinical improvement was not accompanied by a corresponding improvement in expiratory flow rates.     

Zinc Supplementation in Severe Acute Lower Respiratory Tract Infection in Children: A Triple-Blind Randomized Placebo Controlled Trial

Objective  

To evaluate the efficacy of zinc supplementation on duration of illness in children with severe acute lower respiratory tract infection (ALRTI).     

Intravenous Corticosteroids Versus Intravenous Gammaglobulin in the Treatment of Acute Immune Thrombocytopenic Purpura

Debate continues over the most appropriate treatment for children with acute immune thrombocytopenic purpura (ITP). An institutional review of all admissions for acute ITP between 1986 and 1991 found 61 children treated with intravenous (IV) IgG or IV steroids with a bone marrow aspirate consistent with ITP, an age of 21 years or younger, and an admission platelet count of P20,000/ mm³. The efficacy of these two agents was compared in the described population. A response was defined as achieving a platelet count of 50,000/ mm³. A significantly greater percentage of patients responded to IV IgG compared to IV steroids during the first 36 hr of therapy; however, by 72 hr of treatment there was no significant difference. The cost of hospitalization was 3/2 times greater for the patients responding to IV IgG vs. IV steroids.     

Treatment and Complications of Childhood Asthma in Japan

Recently the prevalence of asthma and emergency hospital admissions are increasing, but most childhood asthma can be controlled with appropriate therapy. Children can maintain their normal life cycle by outpatient treatment. There are two main complications of childhood asthma. One is the result of pathophysiological features and the other related to therapy. Status asthmaticus is the most serious complication and may be fatal.     

普米克气雾剂治疗儿童哮喘疗效观察

目的　观察普米克气雾剂治疗儿童哮喘前后的最高呼气峰流速值 (PEF)及血清嗜酸细胞阳离子蛋白 (ECP)的变化。方法　对 113例儿童哮喘病人 ,使用普米克气雾剂 [(2 0 0～ 80 0 ) μg/d],3月～ 1年。采用峰流速仪监测PEF ,并用荧光免疫法 ,使用PharmaciaCAP系统 (瑞典 )测定部分病儿治疗前后的血清ECP。结果　使用普米克治疗后 ,PEF明显增高 ,3个月、6个月、1年的PEF占预计值的百分比 (PEF % )分别为 (93.6± 5 .4) ,(93.0± 4.2 ) ,(94.5± 4.5 ) ,与治疗前 (70 .4± 19.1)比较 ,差异有显著性 ,P <0 .0 1。治疗后ECP为 (7.5± 2 .7)μg/L ,比治疗前 (2 4.0± 17.1) μg/L明显下降 ,P <0 .0 1,差异有显著性。结论　普米克气雾剂治疗儿童哮喘副作用小、安全有效、方法简便 ,用于儿童哮喘的中、长期防治 ,值得推广。     

Childhood asthma and atmospheric conditions

Bronchial asthma is the most common chronic respiratory illness in childhood. It is characterized by paroxysmal bronchospastic periods. There are many studies giving reasons to explain the bronchospasm periods. One of the reasons, atmospheric conditions, is effective in creating a clinical picture of asthmatic patients. In the present study, the correlation between atmospheric conditions and asthmatic symptoms in children was investigated using peak expiratory flow rate (PEFR) as the respiratory function test. Twenty-one children with bronchial asthma were monitored in the study. They were followed as outpatients of the Ege University Medical Faculty, Department of Pediatric Allergy and Pneumotology, between November 1993 and June 1994. Atmospheric conditions were recorded from the local meteorology center. Complaints and the PEFR of children were compared with the meteorological data. Asthmatic symptoms were increased by low temperatures in all asthmatic children. An increase was detected in the extrinsic group by relative humidity and ratio of cloud, but in the intrinsic group only by relative humidity.     

鼻炎与支气管哮喘发病的关系

目的探讨小儿鼻炎与支气管哮喘发病的关系。方法鼻炎患者130例分成2组,单纯鼻炎组60例,鼻炎并哮喘组70例,分析两组年龄、性别、既往湿疹史、毛细支气管炎史、吸烟家族史、哮喘家族史、变应原检测、外周血总IgE及嗜酸性粒细胞(EOS)计数等方面的差别。并用Logistic回归分析进一步确定鼻炎患者发生哮喘的危险因素。结果将两组比较,发现既往毛细支气管炎史、哮喘家族史、母亲哮喘及变应原屋尘、粉尘螨阳性在鼻炎并哮喘组中更多见。此外,外周血总IgE和EOS计数在鼻炎并哮喘组高于单纯鼻炎组。Logistic回归分析发现,外周血总IgE和EOS计数增高是鼻炎并哮喘的重要的危险因素。结论若鼻炎患者存在既往毛细支气管炎史、哮喘家族史、变应原检测阳性,尤其是外周血总IgE和EOS计数增高者,应视为哮喘的前驱表现,需及早防治。     

口服茶碱类药物治疗小儿哮喘的系统评价证据

目的 对口服茶碱类药物治疗d＇JL哮喘的疗效进行循证的系统评价。方法 使用相关的检索词检索Cochrane Library（1996～2006．6）、Medline（1985—2006．6）、EMBASE（1996—2006．6）,获得关于茶碱类药物治疗小儿哮喘的随机对照研究;用系统评价的专用统计分析软件ReVman4．2对纳入文献的资料作Meta分析。结果 共纳入34篇随机对照研究,将茶碱类药物与安慰剂、β受体激动剂、吸入皮质激索、色甘酸钠、酮替酚进行对比。结论 茶碱类药物在治疗小儿慢性轻至中度哮喘时,给予足够的剂量及疗程可以缓解哮喘的症状。未发现茶碱类药物且有影响小儿行为方面的不良反应．     

Increased glycosaminoglycans in the urine of asthmatic children on inhaled corticosteroids

Increased extracellular matrix (ECM) deposition in the airway wall contributes to the airway remodeling in asthmatics. Glycosaminoglycans (GAGs) are polysaccharides attached to a protein core in order to form proteoglycans, a component of the ECM. In this study, we investigated the possible influence of long-term treatment with inhaled corticosteroids (ICS) on urinary GAGs levels of asthmatic children. Seventy asthmatic children (41 boys), aged 6.8-12.5 yr, participated in the study. About 44 were treated with inhaled budesonide via turbuhaler for 2-35 months (median 12 months) and 26 were on relief medications. About 30 healthy controls were also studied. GAGs were precipitated from early morning urine samples, collected, isolated and quantified using uronic acid-carbazole reaction and expressed as uronic acid (UA) in microg/g/Cr(u)/m2. Urinary GAGs values did not differ significantly between controls and asthmatics but significant differences were found between children on ICS and asthmatics on relief medications (p < 0.001). There was a positive correlation between the daily dose of inhaled budesonide and the urinary GAGs values (r = 0.32, p = 0.037) whereas a threshold distinguishing 'low' vs. 'high' doses of ICS was found to be at 300 microg/m2 per day with a significant difference in urinary GAGs secretion (p = 0.006). Our data show that urinary GAGs secretion is reduced in asthmatic children that used only relief medication but it is increased in those on long-term treatment with ICS. A dose dependent effect of ICS was also detected.     

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.