Diagnosis, Diagnostics,
Immunodiagnosis & Immunodiagnostics:
3115.
Abrahamsen O.
Haas H. Schreiber J. Schlaak M. Differential mediator release
from basophils of allergic and non-allergic asthmatic patients after
stimulation with anti-IgE and C5a. Clinical & Experimental Allergy. 31(3):368-78, 2001 Mar.
Abstract
The differentiation between allergic and
non-allergic asthma is a common and important challenge for the clinician.
Until now, no in vitro diagnostic characteristics have been described to
distinguish between these types. To examine the diagnostic value of a basophil
stimulation test, we compared anti-IgE- and C5a-induced mediator release from
peripheral blood leucocytes in different types of bronchial asthma. Peripheral
blood leucocytes (PBL) from 10 aspirin-sensitive asthmatics (ASA), 12
non-allergic asthmatics without aspirin intolerance (NAA), seven allergic
asthmatics (AA), and nine healthy controls were prepared by dextran
sedimentation. After priming with interleukin-3 (IL-3) PBL were stimulated with
anti-IgE and C5a, and the release of histamine (HR) and sulfidoleukotrienes
(LTR) in the supernatant was compared. Additionally, purified leucocyte
fractions were studied to determine the cellular source of mediator release.
Upon stimulation with anti-IgE LTR was slightly, but not significantly, lower
in ASA and NAA compared to AA and controls. In contrast, C5a-triggered LTR was
significantly higher in ASA (14.4 +/- 12.88 pg/105 cells) and NAA (22.9 +/-
22.61 pg/105 cells) than in AA (9.6 +/- 3.29 pg/105 cells) and controls (7.5
+/- 7.19 pg/105 cells) (P < 0.05). This difference between ASA and NAA vs.
AA and controls was even more pronounced when determining the quotient
C5a-/anti-IgE-induced LTR (P < 0.001). At an optimal cut-off point of 1.0,
calculated by relative operating characteristics (ROC) analysis, the positive
predictive value for a donor to belong to ASA or NAA was 0.94. No significant
differences could be found in HR between the asthmatic patient groups and
healthy controls in either condition. As cellular source of LTR and HR the
basophil could be determined. Determination of anti-IgE- and C5a-induced LTR
from basophils allows us to discriminate between allergic and non-allergic
asthmatic patients. For diagnostic purposes the quotient C5a-/anti-IgE-induced
LTR is more significant than considering a single parameter. ASA cannot be
distinguished from NAA.
3116.
Ackerman MJ.
Wylam ME. Feldt RH. Porter CJ.
Dewald G. Scanlon PD. Driscoll DJ. Pulmonary atresia with
ventricular septal defect and persistent airway hyperresponsiveness. Journal of
Thoracic & Cardiovascular Surgery.
122(1):169-77, 2001 Jul.
Abstract
OBJECTIVE: We and others have observed
significant hyperinflation and airflow obstruction after the surgical repair of
pulmonary atresia and ventricular septal defect. This study sought to
objectively characterize this problem and determine the prevalence of airway
hyperresponsiveness in these patients. METHODS: We performed a prospective
study of children and young adults with pulmonary atresia and ventricular
septal defect between June 1996 and December 1998. The participants were
stratified into 2 distinct molecular genotypes on the basis of chromosome
22q11.2 microdeletion. A clinical diagnosis of asthma and an objective
assessment of airway hyperresponsiveness were determined by means of an asthma
inventory scale and methacholine challenge testing, respectively. Thirty-three
patients were enrolled. Thirteen had velocardiofacial syndrome, each with
chromosome 22q11.2 microdeletion. RESULTS: None of the nonsyndromic patients
had evidence for haploinsufficiency. Overall, 66.7% (22/33) met criteria for a
clinical diagnosis of airway hyperresponsiveness: 62% (8/13) from the
microdeletion genotype and 70% (14/20) from the nonsyndromic group.
CONCLUSIONS: We have identified an extremely strong association between
pulmonary atresia and ventricular septal defect and persistent airway
hyperresponsiveness. Haploinsufficiency at chromosome 22q11.2 did not
contribute to this predilection for airway hyperresponsiveness. These results
provide a basis to anticipate persistent respiratory difficulties after
operations in patients with pulmonary atresia and ventricular septal defect.
Moreover, this at-risk patient population may yield unique insights into
fundamental mechanisms involved in the pathogenesis of airway
hyperresponsiveness.
3117.
Adams R.
Wakefield M. Wilson D. Parsons J.
Campbell D. Smith B. Ruffin R. Quality of life in asthma: a
comparison of community and hospital asthma patients. Journal of Asthma. 38(3):205-14, 2001 May.
Abstract
This study compares the quality of life of a
community sample of people with asthma in South Australia, using population
norms, people suffering from other chronic diseases, and a sample of asthma
patients from two hospital clinics. A representative population survey was
performed by trained interviewers in spring 1995 of 3001 respondents aged >
or = 15 years. A physician's diagnosis of current asthma was reported by 299
(9.9%). The hospital clinic sample had a physician's diagnosis and lung
function evidence of asthma (n = 293). All completed the SF-36 health survey.
Standardized SF-36 scores, adjusted for age, sex, and social class, were
significantly lower for respondents with asthma, compared with population
norms, across all subscales of the SF-36 (p < 0.05). Physical component
summary (PCS) and mental component summary (MCS) scores were not significantly
different in people in the community sample with asthma from scores in people
with diabetes and arthritis. PCS and MCS scores did not differ for those with
similar symptom frequency in the community and hospital asthma samples, except
that hospital patients with frequent symptoms had significantly lower MCS
scores (p < 0.01). Asthma has a major impact on the health-related quality
of life in the community, comparable to other chronic diseases. The SF-36
performs uniformly in asthma in different situations.
3118.
Adams RJ.
Fuhlbrigge A. Finkelstein
JA. Lozano P. Livingston JM. Weiss
KB. Weiss ST. Impact of inhaled
antiinflammatory therapy on hospitalization and emergency department visits for
children with asthma. Pediatrics. 107(4):706-11,
2001 Apr.
Abstract
OBJECTIVE: Although the efficacy of inhaled
antiinflammatory therapy in
improving symptoms and lung function in childhood asthma has been shown
in clinical trials, the effectiveness of these medications in real-world
practice settings in reducing acute health care use has not been
well-evaluated. This study examined the effect of inhaled antiinflammatory
therapy on hospitalizations and emergency department (ED) visits by children
for asthma. DESIGN: Defined population cohort study over 1 year. Setting. Three
managed care organizations (MCOs) in Seattle, Boston, and Chicago participating
in the Pediatric Asthma Care-Patient Outcome Research and Treatment II trial.
Participants. All 11 195 children, between 3 to 15 years old, with a diagnosis
of asthma who were enrolled in the 3 MCOs between July 1996 and June 1997.
OUTCOME MEASURES: We identified children with 1 or more asthma diagnoses using
automated encounter data. Medication dispensings were identified from automated
pharmacy data. Multivariate logistic regression analysis was used to calculate
effects of inhaled antiinflammatory therapy on the adjusted relative risk (RR)
for hospitalization and ED visits for asthma. RESULTS: Over 12 months, 217
(1.9%) of children had an asthma hospitalization, and 757 (6.8%) had an ED
visit. After adjustment for age, gender, MCO, and reliever dispensing, compared
with children who did not receive controllers, the adjusted RRs for an ED visit
were: children with any (>/=1) dispensing of cromolyn, 0.4 (95% confidence
interval [CI]: 0.3, 0.5); any inhaled corticosteroid (ICS), 0.5 (95% CI: 0.4,
0.6); any cromolyn or ICS combined (any controller), 0.4 (95% CI: 0.3, 0.5).
For hospitalization, the adjusted RR for cromolyn was 0.6 (95% CI: 0.4, 0.9),
for ICS 0.4 (95% CI: 0.3, 0.7), and for any controller 0.4 (95% CI: 0.3, 0.6).
A significant protective effect for both events was seen among children with 1
to 5 and with >5 antiinflammatory dispensings. When the analysis was
stratified by frequency of reliever dispensing, there was a significant
protective effect for controllers on ED visits for children with 1 to 5 and
with >5 reliever dispensings and on the risk of hospitalization for children
with >5 reliever dispensings. CONCLUSIONS: Inhaled antiinflammatory therapy
is associated with a significant protective effect on the risk for
hospitalization and ED visits in children with asthma. Cromolyn and ICSs were
associated with similar effects on risks.asthma drug therapy, inhaled
antiinflammatory agents, health maintenance organizations, hospitalization,
emergency department.
3119.
Adcock IM. Glucocorticoid-regulated transcription
factors. [Review] [76 refs] Pulmonary Pharmacology & Therapeutics. 14(3):211-9, 2001.
Abstract
Glucocorticoids are the most
effective antiinflammatory drugs used in the treatment of asthma. They act by
binding to a specific receptor (GR) that, upon activation, translocates to the
nucleus and either increases (transactivates) or decreases (transrepresses)
gene expression. Inhibition of pro-inflammatory transcription factors such as
activator protein (AP)-1, signal transducers and activators of transcription
(STATs), nuclear factor of activated T cells (NFAT) and nuclear factor
(NF)-kappa B is thought to be a major action of glucocorticoids. Acetylation of
histones allows unwinding of the local DNA structure and enables RNA polymerase
II to enhance gene transcription. Histone acetylation is regulated by a balance
between the activity of histone acetyltransferases (HATs) and histone
deacetylases (HDACs). GR acts as a direct inhibitor of NF-kappa B-induced HAT
activity and also by recruiting HDAC2 to the NF-kappa B/HAT complex. A
sub-group of patients with glucocorticoid-insensitive asthma have an inability
to induce histone acetylation in response to dexamethasone suggesting reduced
expression of a GR-specific HAT. This suggests that pharmacological
manipulation of specific histone acetylation status is a potentially useful
approach for the treatment of inflammatory diseases. Identification of the
precise mechanism by which activated GR recruits HDAC2 may reveal new targets
for the development of drugs that may dissociate the antiinflammatory actions
of glucocorticoids from their side effects that are largely due to gene induction.
Copyright Academic Press. [References: 76]
3120.
Amdekar YK. Cough and asthma. Indian Journal of
Pediatrics. 68 Suppl 2:S20-5, 2001 Apr.
Abstract
Cough is a common symptom in office
practice. Though troublesome, it serves to maintain normal function of
respiratory tract. Chronic or recurrent cough may be caused by variety of
diseases, asthma being the most common amongst them. Cough, wheeze and
breathlessness are classical features of asthma syndrome. Many diseases may
lead to this syndrome. Asthmatic children present with cough of variable
intensities and patterns. At times, wheeze and breathlessness may not be
clinically apparent. It was well known that all that wheezes is not asthma but
now it is well understood that every asthmatic child does not wheeze. In an
acute attack of asthma, cough often starts at the end of wheezing episode. It
leads to expulsion of thick, stringy mucus often in the form of casts. Though
cough is a minor symptom during acute attack, it ensures removal of secretions
and avoid complications. Cough is a prominent symptom in persistent asthma
especially between acute exacerbations. Episodic nocturnal cough may be the
only symptom of chronic asthma. Children with cough variant asthma do not
wheeze. It is postulated that they have milder degree of airway
hyperresponsiveness and higher wheezing threshold. However, they show all the
characteristics of asthma on laboratory tests. Cough represents bronchial
hyperresponsiveness and is not a measure of asthma. Hence it may be caused by many
diverse etiologies such as gastroesophageal reflux, enlarged adenoids,
sinusitis or tropical eosinophilia. Cough in such conditions mimicks asthma and
relevant tests may be necessary for proper diagnosis.
3121.
Arimura A.
Yasui K. Kishino J. Asanuma F.
Hasegawa H. Kakudo S. Ohtani M.
Arita H. Prevention of allergic inflammation by a novel prostaglandin
receptor antagonist, S-5751. Journal of Pharmacology & Experimental
Therapeutics. 298(2):411-9, 2001 Aug.
Abstract
Prostaglandin (PG) D2, the major cyclooxygenase
metabolite generated from immunologically stimulated mast cells, is thought to
contribute to the pathogenesis of allergic diseases due to its various
inflammatory effects. However, since no DP receptor antagonist has been
developed as an antiallergic drug, the role of PGD2 in the pathogenesis of
allergic diseases remains uncertain. Here, we report the in vivo efficacy of
our newly established DP receptor antagonist, S-5751
[((Z)-7-[(1R,2R,3S,5S)-2-(5-hydroxy benzo[b]thiophen-3-ylcarbonylamino)-10-norpinan-3-yl]hept-5-
enoic acid)], using various allergic inflammation guinea pig models. In
allergic rhinitis models, oral administration of S-5751 dramatically inhibited
not only early nasal responses, as assessed by sneezing, mucosal plasma exudation,
and nasal blockage, but also late responses such as mucosal plasma exudation
and eosinophil infiltration. Even when S-5751 was administered after recovery
from the early responses, these late phase responses were almost completely
suppressed. In addition, S-5751 alleviated allergen-induced plasma exudation in
the conjunctiva in an allergic conjunctivitis model and antigen-induced
eosinophil infiltration into the lung in an asthma model. These findings
provide evidence for the crucial role of PGD2 as a mediator of allergic
inflammation in guinea pigs and suggest that DP receptor antagonists may be
useful in the treatment of allergic diseases triggered by mast cell activation.
3122.
Bhave SY. Approach to recurrent respiratory
infections. Indian Journal of Pediatrics.
68 Suppl 2:S26-32, 2001 Apr.
Abstract
Rational approach to diagnosis and
management of recurrent respiratory infections is needed, or else the child is
subjected to unnecessary investigations and multiple drugs. Repeated
respiratory symptoms do not mean a respiratory infection. A diagnosis of viral
infection does not justify prescription of an antibiotic. Recurrent viral
infections are part of the growing up process of any child. Giving antibiotics
at every episode to cover "so-called superadded bacterial infections"
will lead to "recurrent antibiotics" and adverse effects on growth.
Systematic approach should be used to find the underlying cause. An otoscopic
examination of a child should form part of a pediatric examination in all cases
of respiratory infections. Antibiotics should be judiciously chosen depending
on age, socioeconomic status, severity of infection and the type of organism
expected and always given in adequate doses and proper duration. Treatment
should be specific and symptomatic. Adequate drainage of the sinuses is an
important adjuvant therapy. Use of cough syrups with various combinations
should be avoided. Efforts should be made to diagnose and treat manifestations
of hyperactive airway or allergy, role of CEA (cough equivalent asthma) and
WLRI (Wheeze associated lower respiratory infections). Investigations are
needed in recent lower respiratory infections and adverse effect on growth,
school performance, abnormal physical findings. CBC, CRP, ESR, nasal smear,
appropriate cultures, tests for TB, X-Rays, barium studies, milk scan, ultra
sound, CT, MRI, bronchoscopy in selected cases.
3123. Bhure U N, Kenia P N, Pitale
S M, Mistry S G, Bhatt B M, Lahiri K R Melgiri S R, Desai S A. ventilation –
perfusion (V/Q) scans in chronic persistent asthma: an objective modality. Indian J nucl Med. 15(3), 90,2000.
No Abstract.
3124.
Boushey HA Jr.
Experiences with monoclonal antibody therapy for allergic asthma. [Review] [19
refs] Journal of Allergy & Clinical Immunology. 108(2 Suppl):S77-83, 2001 Aug.
Abstract
Identification of the central role IgE plays
in the pathogenesis of allergic diseases made it a key target for therapy. The
first selective anti-IgE therapy, a unique humanized monoclonal anti-IgE
antibody (omalizumab), binds with high affinity to the Fc(epsilon)RI receptor
binding site on IgE, thereby reducing the amount of free IgE available to bind
to Fc(epsilon)RI receptors on mast calls, basophils, and other cells. In
addition, administration of omalizumab indirectly reduces Fc(epsilon)RI
receptor density on cells involved in allergic responses. In two
bronchoprovocation trials involving patients with mild allergic asthma,
omalizumab attenuated both early- and late-phase allergic responses. Omalizumab
was subsequently evaluated as a treatment for asthma in large, multicenter,
randomized, double-blind phase II and III trials involving patients with
moderate to severe asthma who required corticosteroid therapy. When added to
treatment with oral or inhaled corticosteroids, omalizumab reduced symptoms and
exacerbations, improved lung function and quality of life, and reduced the need
for rescue medications. These benefits persisted even in the
"corticosteroid reduction" phase of these trials, when omalizumab
treatment was shown to allow patients to reduce or discontinue their inhaled
and/or oral corticosteroids. These effects of omalizu-mab in improving asthma
control, as well as its excellent safety profile, may ultimately make this
agent a useful addition to the physician's armamentarium of treatments for
asthma. [References: 19]
3125.
Cates C. Higher dose inhaled steroids in
childhood asthma. Why isn't titration advocated more often in delivery of
inhaled drugs?. BMJ. 322(7301):1546,
2001 Jun 23. No Abstract.
3126.
Celedon JC.
Palmer LJ. Xu X. Wang B.
Fang Z. Weiss ST. Sensitization
to silk and childhood asthma in rural China. Pediatrics. 107(5):E80, 2001 May.
Abstract
OBJECTIVE: Sensitization to perennial
aeroallergens is associated with asthma in industrialized countries with a
Western lifestyle. Because silk products are commonly used in Chinese society,
we were interested in examining the relation between sensitization to silk and
asthma. DESIGN: Cross-sectional study of 871 children in 503 families living in
Anqing, a predominantly rural province of China. RESULTS: After adjustment for
age, gender, familial correlations, and sensitization to other aeroallergens,
skin test reactivity to silk was an independent predictor of asthma (odds ratio
= 2.6; 95% confidence interval = 1.2-5.7). This association became stronger
after inclusion of the eosinophil count and history of parasitic diseases of
the participants in the multivariate model (odds ratio = 3.6; 95% confidence
interval = 1.4-8.9). CONCLUSION: Because sericulture is an important activity
in China and other countries throughout the world, sensitization to silk may
influence the pathogenesis and severity of asthma in people living in these
nations.
3127
Celotti F. Laufer S. Anti-inflammatory drugs: new
multitarget compounds to face an old problem. The dual inhibition concept.
[Review] [100 refs] Pharmacological Research.
43(5):429-36, 2001 May.
Abstract
In this short review we have tried to focus
on some new relevant aspects of the pharmacological control of inflammation.
The clinical availability of new drugs able to produce a selective inhibition
of type 2 cyclooxygenase (COX-2), the enzyme thought to be mainly responsible
for generating arachidonic-acid-derived inflammatory mediators, has been the
origin of much hope. However, expectations of having an effective and
completely safe non-steroidal anti-inflammatory drug (NSAID) have been only
partially fulfilled. Emerging information has challenged some aspects of the
original hypothesis indicating COX-2 as devoid of 'housekeeping' physiological
functions. Moreover, the recently available clinical studies have indicated
only a relatively small improvement in the tolerability of the newer
'selective' COX-2 inhibitors over the classical COX-1/COX-2 mixed type NSAIDs.
The new appreciation of the role of other arachidonic acid derivatives, the
leukotrienes (LTS), in producing and maintaining inflammation has generated
considerable interest in drugs able to block LTS receptors or to produce a
selective inhibition of 5-lipoxygenase (5-LO), the initial key enzyme of the
leukotriene pathway. These drugs are now included among the effective therapies
of asthma but appear, in the few clinical studies performed, to be an
insufficient single therapeutic approach in other inflammatory diseases. Drugs
able to block equally well both COX and 5-LO metabolic pathways (dual
inhibitors) have been developed and experimentally evaluated in the last few
years, but none are available on the market yet. The pharmacological rationale
at the basis of their development is strong, and animal studies are indicative
of a wide range of anti-inflammatory activity. What appears most impressive
from the available studies on dual inhibitors is their almost complete lack of
gastric toxicity, the most troublesome side effect of NSAIDs. The mechanism of
the gastric-sparing properties of these drugs is not yet completely understood;
however, it appears that leukotrienes significantly contribute to gastric
epithelial injury particularly when these compounds represent the major arachidonic
acid derivatives present in the gastric mucosa after inhibiton of prostanoid
production. Copyright 2001 Academic Press. [References: 100]
3128
Centanni S.
Santus P. Di Marco F. Fumagalli F. Zarini S. Sala A. The
potential role of tocopherol in asthma and allergies: modification of the
leukotriene pathway. [Review] [57 refs] Biodrugs. 15(2):81-6, 2001.
Abstract
Metabolism of arachidonic acid
via the 5-lipoxygenase (5-LO) pathway leads to the formation of
hydroperoxyeicosatetraenoic acids (HPETEs) and leukotriene (LT) A4. This
unstable allylic epoxide can be further converted by secondary enzymes into
LTB(4) and cysteinyl LTs. LTs represent a family of potent biologically active
compounds synthesised by specific cell types and by transcellular biosynthetic
mechanisms. Cysteinyl LTs are involved in the pathogenesis of asthma, and
recent data indicate that individuals with asthma may have enhanced basal
excretion of urinary LTE4 compared with normal individuals. Tocopherol (vitamin
E) and tocopherol acetate strongly inhibit potato 5-LO in an irreversible and
noncompetitive way, and, by affecting the redox state of cells possessing 5-LO,
they may influence the production of biologically active LTs. It has been
reported that normal plasma levels of tocopherol may enhance the lipoxygenation
of arachidonic acid, whereas higher tocopherol levels exert a suppressive
effect that is consistent with its role as a hydroperoxide scavenger.
Receptor-mediated activation of neutrophils in individuals with asthma results
in the synthesis of LTs. This activation is inhibited by tocopherol in a
concentration-dependent manner. Additional controlled studies are needed to
assess the effect of tocopherol on leukotriene production in asthmatic
individuals. The results of these studies may be useful in developing new
therapeutic approaches in asthmatic/allergic patients. [References: 57]
3129
Chakurkar A B. Paediatric asthma : An overview of pathogenesis and
treatment. Paediat Today. 3(9): 589-94,2000. No Abstract.
3130
Chandran R.
Should we prescribe antibiotics for acute bronchitis?. American Family
Physician. 64(1):135-8, 2001 Jul 1. No Abstract
3131
Charpiot B.
Bitsch F. Buchheit KH. Channez P.
Mazzoni L. Mueller T. Vachier I.
Naef R. Disease activated drugs: a new concept for the treatment of
asthma. Bioorganic & Medicinal Chemistry.
9(7):1793-805, 2001 Jul.
Abstract
Disease activated drugs (DAD)
are pro-drugs of one active principle or combinations of two drugs, which have
a proven efficacy for the treatment of the target disease. In opposition to
pro-drugs, DAD are activated in inflamed but not normal tissues. Due to the
disease specific activation, the amount of locally released drug(s) should be
related directly to the severity of the inflammation. To test this concept in
asthma a PDE4 inhibitor, an isoquinoline derivative, was chemically derivatized
into pro-drugs or combined with corticosteroids. These new compounds were more
readily cleaved into active PDE4 inhibitor, in bronchoalveolar lavage fluid
(BALF) from Brown-Norway rats with lung inflammation than in BALF from rats
without airway inflammation. The DAD concept (local selective release and
improved therapeutic window) was validated in vivo using the inhibition of
methacholine induced bronchoconstriction in guinea pigs with or without ozone
induced lung inflammation. An example of DAD hydrolysis
(isoquinoline-dexamethasone) was also examined in BALF from asthmatics and
healthy volunteers.
3132
Chen CF.
Wu KG. Hsu MC. Tang RB. Prevalence and relationship between
allergic diseases and infectious diseases. Journal of Microbiology, Immunology
& Infection. 34(1):57-62, 2001 Mar.
Abstract
In order to determine the prevalence of
childhood allergic diseases, infectious diseases, and the relationship between
them, 8723 children from three junior high schools in Tou-Cheng City, Taipei
County, were studied using questionnaires developed according to the
International Study of Asthma and Allergies in Childhood (ISAAC) criteria
combined with supplementary questions about infectious diseases. Students and
their parents completed the questionnaires at home. The age of the children
ranged from 10 to 18 years old (14.12 +/- 0.89 years), the majority (96.03%)
was aged from 13 to 15 years old. The 12-month prevalences of self-reported
allergic disease symptoms were: asthma symptom 8.2%, allergic rhinitis symptom
39.6%, and atopic dermatitis symptom 5.9%. The prevalences of diagnosis of the
allergic diseases were: asthma 8.7%, allergic rhinitis 24.1%, and atopic
dermatitis 3.9%. The 12-month prevalences of diagnosis of infectious diseases
were: pneumonia 0.6%, bronchitis 7.2%, sinusitis 7.2%, purulent conjunctivitis
2.5%, otitis media 4.3%, encephalitis or meningitis 0.4%, gastroenteritis
14.5%, acne 23.9%, purulent dermatitis 1.3%, and other infectious diseases
1.2%. Lifetime admission rates of children due to infectious diseases were:
pneumonia 1%, bronchitis 1.8%, sinusitis 0.3%, purulent conjunctivitis 0.2%,
otitis media 0.3%, encephalitis or meningitis 0.3%, gastroenteritis 2.1%, and
other infectious diseases 0.6%. The prevalence of infectious diseases was
significantly higher in children with allergic disease symptoms (defined as
asthma, allergic rhinitis, or atopic dermatitis). These results demonstrated
the presence of a link between allergic diseases and infectious diseases, which
may have some important clinical implications.
3133
Chugh K. Clinical approach to a patient with
cough. Indian Journal of Pediatrics.
68 Suppl 2:S11-9, 2001 Apr.
Abstract
A number of disorders of the respiratory
tract and some even outside the respiratory tract can cause cough. A systematic
approach towards a patient of chronic cough consisting of detailed history,
physical examination of upper as well as lower respiratory tract, complete
blood counts, tuberculin test, chest X-ray, and peak flow rate testing will
give the diagnosis in majority of children. Pulmonary tuberculosis and asthma
are the two commonest conditions diagnosed. If the initial work up is
inconclusive, further laboratory testing and imaging studies should be
considered. Thus, radiolabelled milk scan, barium swallow and 24-hour pH
monitoring would diagnose gastroesophageal reflux. Spirometry,
methacholine/exercise challenge test or a therapeutic trial may be required for
confirming bronchial asthma. Flexible bronchoscopy is useful for evaluation for
suspected aspiration syndromes and any anatomical or dynamic problem of the
airway (e.g. tracheomalacia). Spiral and high resolution computed tomography
(HRCT) along with magnetic resonance imaging are the modern day imaging
techniques used for studying mediastinal masses, airway obstruction and even
lung parenchyma (HRCT). Sputum examination for type of cells and bacteria can
be useful, especially if pseudomonas or acid-fast bacilli are identified.
Pseudomonas suggests cystic fibrosis (an uncommon disease in India) which can
be confirmed by sweat chloride test and gene mutation studies.
3134
Cui H. Wu
W. A brief introduction to researches on treatment of hormone-dependent asthma
with traditional Chinese medicine. [Review] [16 refs] Journal of Traditional
Chinese Medicine. 21(2):153-9, 2001
Jun. No Abstract
3135
Dweik RA. The promise and reality of nitric oxide
in the diagnosis and treatment of lung disease. [Review] [15 refs] Cleveland
Clinic Journal of Medicine. 68(6):486,
488, 490, 493, 2001 Jun.
Abstract
Endogenously produced nitric oxide plays a
major role in lung physiology and pathology. Inhaled nitric oxide given
exogenously has been studied extensively as a treatment for many lung diseases,
and the results suggest that it may help improve oxygenation in some patients.
Several issues need to be addressed, however, before it can be used in routine
clinical practice. [References: 15]
3136
Esposito S.
Principi N. Asthma in children: are chlamydia or mycoplasma involved?.
[Review] [77 refs] Paediatric Drugs.
3(3):159-68, 2001.
Abstract
Asthma aetiology is complex, involving
interactions between genetic susceptibility, allergen exposure and external
aggravating factors such as air pollution, smoking and respiratory tract
infections. Available evidence supports a role for acute Chlaymdia pneumoniae
or Mycoplasma pneumoniae respiratory tract infection as a trigger for 5 to 30%
of wheezing episodes and asthma exacerbations. It also appears that acute infections
with C. pneumoniae and M. pneumoniae can initiate asthma in some previously
asymptomatic patients; however, the quantitative role for these atypical
bacteria as asthma initiators is unknown at the present time. Whether chronic
infections with these agents play an important role in persistent asthma
symptoms and/or to asthma severity is unclear and additional information should
be acquired before definite conclusions can be reached. Improvement in asthma
symptoms after antimicrobial therapy active against C. pneumoniae and M.
pneumoniae has been observed. In some studies C. pneumoniae seems to be more
important for asthma pathogenesis and exacerbations than M. pneumoniae; in
other reports the role of M. pneumoniae appears to be more significant. However,
a number of questions remain unanswered. Carefully controlled randomised trials
are clearly warranted to determine whether infection with atypical bacteria is
really associated with asthma and to define the appropriate role of
antimicrobial treatment. [References: 77]
3137
Fowler C. Preventing and managing
exercise-induced asthma. [Review] [13 refs] Nurse Practitioner. 26(3):25, 29-33; quiz 34-5, 2001 Mar.
Abstract
Managing exercise-induced asthma is a
challenge for the patient and the clinician. As the incidence of
exercise-induced asthma increases, health care providers need effective
protocols to diagnose and treat these patients in outpatient settings. This
article discusses the incidence, risk factors, pathophysiology, diagnosis, and
treatment of exercise-induced asthma. Both traditional and new methods of
disease diagnosis and treatment in the outpatient setting are explored.
[References: 13]
3138
Galant SP.
Wilkinson R. Clinical prescribing of allergic rhinitis medication in the
preschool and young school-age child: what are the options?. [Review] [54
refs]Biodrugs.15(7):453-63, 2001.
Abstract
Allergic rhinitis (AR) is the most common
chronic condition in children and is estimated to affect up to 40% of all
children. It is usually diagnosed by the age of 6 years. The major impact in
children is due to co-morbidity of sinusitis, otitis media with effusion, and
bronchial asthma. AR also has profound effects on school absenteeism,
performance and quality of life. Pharmacotherapy for AR should be based on the
severity and duration of signs and symptoms. For mild, intermittent symptoms
lasting a few hours to a few days, an oral second-generation antihistamine
should be used on an as-needed basis. This is preferable to a less expensive
first-generation antihistamine because of the effect of the latter on sedation
and cognition. Four second-generation antihistamines are currently available
for children under 12 years of age: cetirizine, loratadine, fexofenadine and
azelastine nasal spray; each has been found to be well tolerated and effective.
There are no clearcut advantages to distinguish these antihistamines, although
for children under 5 years of age, only cetirizine and loratadine are approved.
Other agents include pseudoephedrine, an oral vasoconstrictor, for nasal
congestion, and the anticholinergic nasal spray ipratropium bromide for
rhinorrhoea. Sodium cromoglycate, a mast cell stabiliser nasal spray, may also
be useful in this population. For patients with more persistent, severe
symptoms, intranasal corticosteroids are indicated, although one might consider
azelastine nasal spray, which has anti- inflammatory activity in addition to
its antihistamine effect. With the exception of fluticasone propionate for
children aged 4 years and older, and mometasone furoate for those aged 3 years
and older, the other intranasal corticosteroids including beclomethasone
dipropionate, triamcinolone, flunisolide and budesonide are approved for
children aged 6 years and older. All are effective, so a major consideration would
be cost and safety. For short term therapy of 1 to 2 months, the
first-generation intranasal corticosteroids (beclomethasone dipropionate,
triamcinolone, budesonide and flunisolide) could be used, and mometasone
furoate and fluticasone propionate could be considered for longer-term
treatment. Although somewhat more costly, these second-generation drugs have
lower bioavailability and thus would have a better safety profile. In patients
not responding to the above programme or who require continuous medication,
identification of specific triggers by an allergist can allow for specific
avoidance measures and/or immunotherapy to decrease the allergic component and
increase the effectiveness of the pharmacological regimen. [References: 54]
3139
Gutgesell C.
Heise S. Seubert S. Seubert A.
Domhof S. Brunner E. Neumann C. Double-blind placebo-controlled
house dust mite control measures in adult patients with atopic
dermatitis.British Journal of Dermatology.
145(1):70-4, 2001 Jul.
Abstract
BACKGROUND: Avoidance of allergens has been
shown to be of benefit in patients with atopic asthma sensitized to indoor
allergens. In atopic dermatitis, there is so far little information about the
effect of house dust mite elimination strategies. OBJECTIVES: We therefore performed
a randomized controlled study of house dust mite control in patients with this
disease. METHODS: Twenty adult patients with moderate to severe atopic
dermatitis were included. Inclusion criteria were a positive RAST to house dust
mite antigen (CAP class > 3) and a concentration of > 2 microg g(-1) of
the house dust mite antigen Der p1 in the patient's mattress dust. Patients
were randomized to either the active treatment group (allergen-impermeable
mattress encasing, acaricide spray containing tannic acid and benzylbenzoate)
or a control group (allergen-permeable encasing, spray containing water and
traces of ethanol). Severity of disease was estimated every 2 months by an
established score (SCORAD), and eosinophil cationic protein (ECP) in the serum
was determined by enzyme-linked immunosorbent assay. Furthermore, the use of
topical steroids was quantified. Patients assessed daytime pruritus and
pruritus-induced sleeplessness weekly on a visual analogue scale. The study
lasted 1 year. RESULTS: At the end of the study, the active treatment group
showed a statistically significant reduction in Der p1 exposure as compared
with the control group. However, when comparing the change from the start to
the end of the study, there was no statistically significant difference between
active treatment and control groups as measured by the SCORAD score and by ECP
levels in the serum. Some patients in the active treatment group reported less
pruritus-induced sleeplessness, but there was no statistically significant difference
between the two treatment groups. CONCLUSIONS: For adult patients with atopic
dermatitis it was shown that 1 year of house dust mite avoidance reduced the
allergen exposure, but an improvement of overall disease activity was not
demonstrated.
3140
Hall CB.
Wakefield D. Rowe TM. Carlisle PS. Cloutier MM.Diagnosing pediatric asthma: validating the Easy
Breathing Survey.Journal of Pediatrics.
139(2):267-72, 2001 Aug.
Abstract
OBJECTIVE: To determine the sensitivity,
specificity, and predictive value of a simple, self-administered questionnaire
for the diagnosis of asthma in children. STUDY DESIGN: A questionnaire
specifically designed to assist primary care providers in making a diagnosis of
asthma in children was developed and administered in 4 different primary care
and subspecialty clinics, validated, and then used as part of an asthma
management program called Easy Breathing. Asthma diagnoses were made according
to recommended National Asthma Expert Panel Guidelines. RESULTS: Four questions
on the survey were shown to be sensitive and specific for asthma. The
sensitivity was greater for all levels (mild, moderate, and severe) of
persistent asthma than for mild, intermittent asthma. A positive response to
any 1 of the 4 questions was over 94% sensitive for asthma; a negative response
to all 4 questions was 55% specific for ruling out asthma. CONCLUSIONS: Patient
responses to 4 specific respiratory symptom questions can assist primary care
providers in diagnosing asthma in children. Primary care providers serving
pediatric populations at high risk for asthma should consider asking patients
or their parents these 4 questions regarding asthma symptoms on a regular
basis.
3141
Hall CB. Respiratory syncytial virus and
parainfluenza virus. [Review] [99 refs]
New England Journal of Medicine.
344(25):1917-28, 2001 Jun 21. No
Abstract.