The response of asthmatic subjects to isoproterenol inhaled at differing lung volumes

Asthmatics are usually instructed to use pressurized bronchodilator aerosols by delivering a bolus of drug at the beginning of a full inspiration. Because airways are better dilated near total lung capacity, the delivery of the drug near the end of a full breath might allow better penetration of particles into the lung and greater bronchodilatation. To test this hypothesis, 13 asthmatic subjects inhaled 400 mug of isoproterenol at 20 per cent (low) and at 80 per cent (high) vital capacity. The studies were done on 2 separate days when the severity of asthma was the same. Forced vital capacity, 1-sec forced expiratory volume, specific airway conductance and maximal flow at 50 per cent of viral capacity were measured at frequent intervals after drug administration. Ten min after drug delivery, there was a significantly greater (P less than 0.05) improvement in 1-sec forced expiratory volume after the drug was inhaled at the high lung volume compared to the response after delivery at the low lung volume. The differences in forced vital capacity, specific conductance, and maximal flow at 50 per cent of vital capacity were not significant. We concluded that inhaling a bronchodilator drug at the end of a full inspiration causes relatively greater bronchodilatation than inhaling the same dose at the beginning of inspiration.     

One year follow-up study of endocrine and lung function of asthmatic children on inhaled budesonide

Inhaled corticosteroids have become a mainstay in the management of chronic asthma. Their use had been considered safe, although some degree of adrenal suppression has been demonstrated after 2 and 4 weeks of treatment with either 400 microg x day(-1) of beclomethasone dipropionate or budesonide. To weigh the benefits and risks of long-term treatment, 12 children with moderately severe asthma were assessed in a follow-up study on budesonide 200 microg b.i.d. After 1 yr, the nocturnal cortisol production was significantly reduced by 19%, but no greater compared to 2 and 4 weeks of treatment. Growth and growth hormone levels were normal. Lung function tests were significantly better, not only versus baseline values but also versus 2 and 4 weeks of treatment. We conclude that systemic effects of inhaled corticosteroids in conventionally low doses do not accumulate with length of treatment, whilst lung function parameters will continue to improve. Therefore, inhaled corticosteroids once started in asthmatic children not controlled on other medications should be continued, but their use should be carefully considered and the minimal dose required to control the asthma employed.     

Prospective study of the value of transbronchial lung biopsy after lung transplantation

Transbronchial lung biopsy (TBB) has become the gold standard for the diagnosis of acute rejection and cytomegalovirus (CMV) pneumonia in lung transplant recipients. The aim of this study was to assess the value of regular surveillance TBB in stable asymptomatic patients and to establish the role of TBB as a follow-up procedure 1 month after a previous pathological biopsy result. We prospectively evaluated 76 TBBs performed in 17 lung transplant recipients. A definite pathological results was found in 14 of 15 TBBs performed for clinical indications: CMV pneumonia (5), acute rejection grade > or = A2 according to the criteria of the International Society for Heart and Lung Transplantation (ISHLT) (4), bronchiolitis obliterans (3), and desquamative interstitial pneumonitis (2). Fifteen of 45 surveillance TBBs performed in asymptomatic patients revealed significant abnormalities. Ten episodes of acute rejection ISHLT grade > or = A2 and three episodes of CMV pneumonia detected by TBB had direct therapeutic consequences. Nine of 16 follow-up TBBs performed 1 month after a pathological biopsy result again showed relevant pathological findings. With the exception of one severe haemorrhage, no life-threatening complications occurred. Our results suggest that transbronchial lung biopsies performed on a regular basis after lung transplantation are important for the detection of asymptomatic and/or persistent acute rejection or injection. In the long-term, this strategy might be the most effective tool in reducing the incidence of bronchiolitis obliterans, which is still the main obstacle for further improvement of long-term survival after lung transplantation.     

Total lung capacity by N2 washout from high and low lung volumes in ventilated infants and children

Although there is a strong rationale for the assessment of the subdivisions of lung volume, lung function testing has focused on the measurement of FRC alone in ventilated infants and children. To assess the feasibility, reproducibility, and accuracy of measurements of total lung capacity (TLC), FRC, and their ratio, we determined both lung volumes in 50 critically ill, intubated, and paralyzed infants (mean age [SEM]), 19.9 [4.6] mo) with a variety of lung diseases, by a modified N2 washout technique from end-exhalation and from +40 cm H2O inspiratory pressure, respectively. In the same infants, we also defined TLC by adding inspiratory capacity, measured by pneumotachograph during a passive exhalation from +40 cm H2O to FRC measured by N2 washout. Respiratory mechanics were measured by single-breath occlusion, and the patients were classified according to clinical picture and lung function into groups without lung disease or with restrictive or obstructive disease. The TLC data obtained by both methods showed good agreement for the infants without lung disease or restrictive disease (limits of agreement [LOA]: -3.8/4.6 and -2.9/3.2 ml/kg, respectively). The agreement was less in the infants with airflow obstruction where the N2 washout gave slightly higher values (LOA: -7.1/11.3 ml/kg). Mean FRC/TLC was significantly elevated in the obstructive group, whereas mean FRC alone did not differ from the group without lung disease. Our results suggest that TLC can be measured by both methods in intubated infants, but with limited agreement in obstructive disease. FRC/TLC ratios allow an estimation of the degree of pulmonary hyperinflation.     

Pathophysiology of changes in absolute lung volumes

Changes in absolute lung volumes are common in lung disease and result in significant impacts on gas exchange, respiratory muscle function, the sensation of dyspnoea, and limitations to maximal exercise. Though our knowledge regarding the magnitude and determinants of changes in lung volumes in health and disease has increased in the past 20 years, a number of important questions remain unanswered. Consideration of the limitations of specific methods for measuring lung volumes is essential when analysing published studies regarding absolute lung volumes in infants, children and adults. Though functional residual capacity is most commonly measured in children and adults with the subject awake and at rest, increasingly attention is being directed to making these measurements under clinically more relevant conditions (e.g. during exercise, sleep, anesthesia, or mechanical ventilation). The relationships between dynamic changes in functional residual capacity, flow limitation during tidal breaths, sensation of dyspnoea and exercise limitation are important to understand, and are the focus of current and future research. Improved understanding of these relationships may lead to improvements in therapy of patients with acute and chronic lung disease and are likely to be particularly important for evaluating the efficacy of and optimal patient selection for new modes of therapy, such as lung volume reduction surgery.     

Prospective predictors of parenting satisfaction for fathers and mothers with young children.

Data from husbands and wives from 48 couples with young children (mean age?=?2.71 years) were used to assess whether each spouse's parenting satisfaction assessed 8 years after marriage (Year 8) was predicted by parents' personality characteristics, marital quality, and social support assessed at the beginning of the marriage (Year 1). With controls for all other variables, fathers' Year 8 parenting satisfaction was predicted by their own Year 1 instrumentality, whereas mothers' Year 8 parenting satisfaction was predicted by their own Year 1 expressiveness. These prospective relations were not moderated by child-related characteristics and persisted with controls for Year 8 marital satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spontaneous IgE production in asthmatic children

In this study, we demonstrated spontaneous IgE production by peripheral blood mononuclear cells of asthmatic children. In 26 asthmatic children, the level of spontaneous IgE ranged 0.1-15.0 IU/ml and in 5 healthy normal children showed under 0.051 IU/ml. In 5 of asthmatic children, specific antibody of Dermatophagoides farinae was detected from PBMC by CAP RAST. In healthy normal children, specific antibody of Df was not detected. Spontaneous IgE production by PBMC and serum IgE level showed well correlation (gamma = 0.835, p < 0.001). Spontaneous IgE production and specific antibody of Df by PBMC also showed well correlation (gamma = 0.717, p < 0.001) IgE production of asthmatic children was inhibited by IFN-gamma.     

Prospective study of post-traumatic stress disorder in children involved in road traffic accidents

OBJECTIVE: To determine the prevalence of severe psychological trauma --that is, post-traumatic stress disorder--in children involved in everyday road traffic accidents. DESIGN: 12 month prospective study. SETTING: Accident and emergency department, Royal United Hospital, Bath. SUBJECTS: 119 children aged 5-18 years involved in road traffic accidents and 66 children who sustained sports injuries. MAIN OUTCOME MEASURE: Presence of appreciable psychological distress; fulfillment of diagnostic criteria for post-traumatic stress disorder. RESULTS: Post-traumatic stress disorder was found in 41 (34.5%) children involved in road traffic accidents but only two (3.0%) who sustained sports injuries. The presence of post-traumatic stress disorder was not related to the type of accident, age of the child, or the nature of injuries but was significantly associated with sex, previous experience of trauma, and subjective appraisal of threat to life. None of the children had received any psychological help at the time of assessment. CONCLUSIONS: One in three children involved in road traffic accidents was found to suffer from post-traumatic stress disorder when they were assessed 6 weeks after their accident. The psychological needs of such children after such accidents remain largely unrecognised.     

Endotoxin exposure and symptoms in asthmatic children

Osteoporosis is not an inevitable accompaniment of aging. Rather, it evolves silently over a lifetime, with its attendant morbidities occurring late in life. It is no longer the standard of care to wait until the primary morbidity strikes to begin therapy. A better outcome is always achieved when the individuals at risk are identified early, lessening or even preventing morbidity such as osteoporotic fractures. Recent surveys show a reluctance on the part of many physicians to diagnose or treat osteoporosis in their patients. A second level of resistance is often seen even after fractures occur. Either scenario is particularly unfortunate as therapies currently exist that can significantly reduce future morbidity and probably mortality. Physicians must recognize that patients who have had one fracture are at significantly greater risk to sustain more fractures and are more likely to suffer chronic debilitating musculoskeletal failure. Therefore, in the elderly fracturing patient, even more intensive intervention (fracture prevention) is required.     

Prospective follow-up study of 423 children born after intracytoplasmic sperm injection

In order to evaluate the safety of the intracytoplasmic sperm injection (ICSI) procedure, a prospective follow-up study of 423 children born after ICSI was carried out. The aim of this study was to compile data on karyotypes, congenital malformations, growth parameters and developmental milestones. Before starting the infertility treatment, couples were asked to participate in a follow-up study including genetic counselling and prenatal diagnosis. The follow-up study of the child was based on a visit to the paediatrician-geneticist at birth or at 2 months of age, at 1 year and at 2 years of age when a physical examination for major and minor malformations and a psychomotoric evaluation were done. Between April 1991 and September 1994, 320 pregnancies obtained after ICSI led to the birth of 423 children (222 singletons, 186 twins and 15 triplets). Prenatal diagnosis determined a total of 293 karyotypes, one of which was abnormal (0.3%), and four were benign familial structural aberrations, all inherited from the paternal side. A total of 14 (3.3%) major malformations were observed, defined as those causing functional impairment or requiring surgical correlation. Neurological or developmental problems at the age of 2 months were found in 14 children, four of whom were multiples. Compared to most registers of children born after assisted reproduction and to registers of malformations in the general population, the figure of 3.3% major malformations is within the expected range. Before drawing any firm conclusion, further careful evaluations of the available data are necessary.     

Are asthmatic children educationally handicapped?

Discusses the impact of asthma on children's educational experiences. Respiratory arrest or hypoxia may lead to neuropsychological changes in a few cases, and some medications may produce mild, temporary changes, affecting learning and classroom performance. For most asthmatic children, their illness does not result in permanent brain function changes that compromise their educational adaptation and performance. Increased school absence, stress of chronic illness, isolation from peers, diminished physical activities, reduced adult expectations and self esteem, and depression can compromise children's academic adaptation and progress. Co-occurrence of factors like severe illness, poverty, and family dysfunction may increase the risk for educational and psychosocial impairment. Systematic and comprehensive education of asthmatic patients, their parents, and school personnel is crucial to improving the control of asthma and activity level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sulphur dioxide sensitivity in South African asthmatic children

Sulphur dioxide (SO2) is a well-known precipitant of asthmatic attacks. Many foodstuffs are preserved with SO2 and other sulphites. In this study 37 asthmatic children attending the Allergy Clinic at the Red Cross Children's Hospital were challenged with SO2 in apple juice in a dose similar to that commonly ingested in soft-drinks containing this preservative. The responses of these children were compared with the responses of 22 asthmatics challenged with apple juice alone. Sixteen out of 37 children (43.2%) challenged with SO2 reacted with a fall in forced expiratory volume in 1 second (FEV1) of more than 10% compared with none of the 22 control asthmatic children challenged with apple juice alone (P = 0.0016). Girls were found to be more sensitive than boys. A 20% or more fall in FEV1 occurred in 8 (21.6%) of the children challenged with SO2 compared with none in the control group (P = 0.039). There was an individual variability in the responses of sensitive individuals to the SO2 challenge. Reactions occurred in spite of maintenance medication and occurred within 5-30 minutes of challenge. Since sulphite sensitivity is common in asthmatic children, ingestion of sulphites should be avoided.     

Bronchial inhalation challenge by plethysmography in asthmatic children

A new technique for breath-by-breath controlled bronchial inhalation test is described, using the body plethysmographic method. The values of airway resistance (Raw) and of thoracic gas volume at resting expiratory level (TGV) have been compared to the data of total pulmonary flow resistance (R1), measured with the intraesophageal catheter method, and of functional residual capacity (FRC). The dynamic lung compliance (C1 dyn) was calcualted, too; the mechanical parameters of breathing (R1; Raw; C1 dyn) have been investigated on the same breathing cycles before, during and after respiratory challenges in symptom-free asthmatic children. Regarding the breath-to-breath variation of the parameters, a respiratory challenge is usually considered as positive, if the R1 or Raw values increase 100% or more. Out of 39 assays, "positive" challenges were observed in 14 casis regarding R1 values and in 11 cases regarding Raw values. "Doubtful" tests - i.e. +50% less than or equal to R1 or Raw less than 100% - were observed in 5 assays regarding R1 and in 7 cases regarding Raw. A decrease of more than 40% of C1 dyn was observed in 12 out of the 19 'positive' or 'doubtful-positive' challenges; the largest spontaneous breath-to-breath variation being +/- 25%. Such a decrease of C1 dyn is suggested as a sign of peripheral bronchial obstruction. An increase of more than 25% of TGV was observed in 11 out of 19 assays, considered "positive" or "doubtful-positive". A correlation being observed between C1 dyn decrease and TGV increase this latter parameter is suggested to be an additional sign of bronchial obstruction. Beside the practical problem of the interpretation of a respiratory challenge, these results are discussed from the phatophysiological point of view.     

Measurement of absolute lung volumes by imaging techniques

In this paper, the techniques available for estimating total lung capacities from standard chest radiographs in children and infants as well as adults are reviewed. These techniques include manual measurements using ellipsoid and planimetry techniques as well as computerized systems. Techniques are also available for making radiographic lung volume measurements from portable chest radiographs. There are inadequate data in the literature to support recommending one specific technique over another. Though measurements of lung volumes by radiographic, plethysmographic, gas dilution or washout techniques result in remarkably similar mean results when groups of normal subjects are tested, in patients with disease, the results of these different basic measurement techniques can differ significantly. Computed tomographic and magnetic resonance techniques can also be used to measure absolute lung volumes and offer the theoretical advantages that the results in individual subjects are less affected by variances of thoracic shape than are measurements made using conventional chest radiographs.     

Effect of erythromycin on theophylline clearance in asthmatic children

Fifteen asthmatic children (mean age = 14.5 years) who required daily theophylline therapy were studied for effect of erythromycin ethyl-succinate on theophylline clearance. After a one week course of EES, there was 25.8 +/- 18.4% reduction in theophylline clearance rate (P less than 0.001), and a concomitant elevation in steady-state serum theophylline concentration of 40.0 +/- 35.3% (P less than 0.01). Three subjects reached serum theophylline concentrations greater than 20 micrograms/ml. Patients receiving therapeutic doses of theophylline are at considerable risk of theophylline toxicity if EES is co-administered.     

Mania in young children

OBJECTIVE: To establish safety and immunogenicity of a reformulated whole cell pertussis based diphtheria-tetanus-pertussis vaccine (DTPw) at the 18-month booster stage following a 2, 4, and 6-month primary immunization course. METHOD: Open trial in suburban Melbourne in 100 healthy children initially recruited through maternal and child health centres. Thirty-five subjects were bled prior to vaccination, and 4-6 weeks after vaccination. A 7-day diary card was used to record subject temperatures and other systemic and local clinical signs. RESULTS: The increase in antibody geometric mean titres (GMT) after boosting was 19.5-fold (95%ci 14.2, 27.2) for tetanus and 26.5-fold (95%ci 16.6, 42.4) for diphtheria. Pertussis antibody GMTs also all showed substantial increases following the booster, with mean fold changes in titre ranging from 7.3 (Agg2) to 31.3 (Fha). Seventeen percent of subjects (95%ci 10%, 26%) experienced axillary temperatures > or = 38 degrees C during the 24-h period following vaccination. Low rates of significant (> 25 mm) injection site redness (13%) and swelling (8%) were recorded at 24 h postvaccination. CONCLUSION: This vaccine was well tolerated by children at 18 months of age, and showed substantial boosting of antibody to all components.