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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.


  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.


  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.


 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.


 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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


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