Hyman Chai

Standardization of bronchial inhalation challenge procedures

A group of investigators interested in the standardization of inhalation challenge techniques was selected by the program directors of the Asthma and Allergic Disease Centers (AADC). This effort has been assisted by the National Institute of Allergic and Infectious Diseases of the National Institutes of Health. At the last meeting of the panel on February 15, 19’75, criteria for procedures and materials used were suggested in order to standardize bronchial inhalation challenges as they pertain to allergic disease.

the Effect on Asthma in Children of Experimental Separation from the Family

&NA; This experiment evaluated the effects on asthma in children of altering their psychological environment. Twenty‐five asthmatic children were studied medically and psychologically during periods in which they lived with their families and during an experimental separation in which they had no contact with their families but were cared for in their own homes by a substitute parent. It was predicted that 13 children would respond positively (show improvement) and that 12 would respond negatively (show no improvement in asthma) to separation. For the predicted positive group, all measurements of asthma indicated a statistically significant decrease in symptoms during the period of family separation followed by an increase in symptoms upon the familys return. For the group of 12 predicted negatives, only one (history of daily asthma) of four measurements suggested improvement during separation. It appears that a brief, specially designed, diagnostic interview may be useful in assessing the relevance of psychological variables to asthma.

Therapeutic and investigational evaluation of asthmatic children

Abstract Five areas commonly used in the measurement of asthma were examined. These are the clinical examination, history, pulmonary physiology, medication requirements, and school activity levels. Correlations between these measurements were possible by using two investigations in order to provide the necessary data. The value and shortcomings of each of these measures are discussed. The need for frequent observations has been shown in order to improve the low order of correlations obtained, even with those that are statistically significant. All five measurements are a requirement if research in this field is contemplated.

Effect of immunotherapy in chronic asthmatic children

Abstract Ten children with chronic intractable asthma whose airway sensitivity had been established by means of inhalation challenges to specific antigens were hyposensitized over a period of 5 to 12 months. Five additional asthmatic children acted as “controls.” Various aqueous antigens were used both for immunotherapy and for inhalational challenges. Therapy was given uninterruptedly. The total dose varied from 1,000 to 8,000 protein nitrogen units (PNU) in the controls and from 30,000 to 230,000 PNU in the subjects. Repeat challenges in the low-dose “control” group showed no changes in bronchial sensitivity. Ten children who received high total dosage all showed decreased bronchial sensitivity to specific antigens. Three children who were under study for 12 months could be evaluated clinically as well as physiologically since all four seasons were covered. There was no evidence of clinical, physiologic, or medication improvement in any of them, despite significant decreases in bronchial sensitivity. High-dose therapy appeared to decrease bronchial sensitivity significantly in all except two subjects. The effect was not related to the antigen dose but appeared to be an individual response of the subject.

The elimination of chronic cough by response suppression shaping

Abstract The study presents a case in which aversion therapy was successfully used to eliminate a chronic cough in a 15-yr-old boy. Treatment included electric shock aversion therapy employing a response suppression shaping paradigm to remove the cough, and ancillary family treatment to alter the reinforcement pattern which maintained the inappropriate behavior. The S has been free of cough for 1 1 2 yr since treatment. Significant aspects of the case relating to the use of aversion techniques are discussed.

Pulmonary and adrenal effects of alternate-day corticosteroid therapy☆

Abstract Within the total therapeutic spectrum for asthma, some patients (currently 46 percent of the resident population of patients at CARIH) require prolonged maintenance therapy with corticosteroids. After a daily minimal effective dose of a selected short acting cortisone analogue has been established, patients can generally control their asthma with prednisone or methylprednisolone taken every 48 hours in the early morning at doses slightly more than twice the amount previously taken daily. Such an alternate day regimen has been found to be associated with fewer clinical side effects and also with minimal adrenal cortical suppression. Pulmonary function of the patients on alternate-day treatment could be maintained at a satisfactory level throughout the 48 hour cycle, showing the physiologic circadian variations observed in healthy individuals. Ordinary stress, such as an acute febrile illness, was tolerated by patients on alternate-day therapy uneventfully. Severe stress—not noted among the patients studied—may still require additional corticosteroid therapy immediately. Acute exacerbations of asthma necessitated interruption of alternate-day therapy and the administration of additional steroids initially and repeatedly at intervals of 4 to 6 hours, in conjunction with all other appropriate therapy, for at least 24 to 48 hours or a few days. Patients adequately controlled on an alternate-day schedule should be and are being observed continuously in order to assess the ultimate benefits—or untoward effects—of alternate-day steroid therapy.

Controlled study of iodotherapy for childhood asthma

Abstract Two doses of potassium iodide (KI) and an idcntical placebo tablet were given three times daily by mouth to 52 children with intractable asthma, ranging from 8 to 16 years of age. Each patient received in random order 12 week courses of KI, 900 and 300 mg. daily, and placebo given in coded form, according to a double-blind design. During each treatment period several indicators of the severity of asthma were recorded weekly and scored by methods described. Serum iodide levels and several aspects of thyroid function were assayed regularly. Evidences of side effects, including thyroid enlargement and acne, were also monitored. Examination of the results of individual responses, and the use of improvement and condition scores indicated that in the population as a whole asthmatic symptoms were improved by KI, particularly at the high dose level. There was, however, considerable variability in the responses observed in individual children. It is estimated that asthma improved significantly in 18 per cent, and moderately in another 46 per cent. The remaining 36 per cent did not seem to be influenced by KI with respect to symptoms of asthma. Moderate or marked thyroid enlargement occurred in 4 per cent of the children during treatment with KI, and barely palpable goiters in another 14 per cent, within three to six weeks after therapy was initiated. The enlargements were not clearly related to dose level, but no goiters occurred during placebo therapy. Acneform skin lesions were produced or aggravated primarily among the adolescents. While the mechanisms of action of KI in asthma remain unclear, the evidence presented here indicates that 300 mg. three times a day is a tolerable and effective dose for many children in the age ranges and population described. The efficacy is great enough to warrant further studies of the optimal uses of this drug.

Mnemonic Effects of Asthma Medication in Children

Asthmatic children receiving theophylline or steroid-theophylline combination therapy and normal nonasthmatics were given tests of visual retention and paired-associate learning. The performance of children receiving combination therapy was significantly worse than that of the nonasthmatics 6-8 hours after receiving steroid medication, but not 22-24 or 46-48 hours after medication. Children receiving theophylline alone did not differ from nonasthmatics on these tasks. These observations suggest that steroid-inclusive medication regiments can affect cognitive performance.

Apparent cross-reactivity of airborne molds and the dermatophytic fungi

Abstract Forty-one asthmatic children, 10 to 16.5 years of age, were studied for evidence of infection with dermatophytic fungi. No evidence of past or current infection could be obtained, yet 16, or 39 per cent, showed an immediate allergic reaction to a galactomannan peptide (trichophytin) extracted from Trichophyton mentagrophytes . Thirteen of these 16 children (81 per cent) also had immediate allergic reactions to antigens extracted from nonpathogenic, airborne molds. The antibody, presumably IgE, responsible for type I allergic reactions to airborne molds, apparently crossreacts with antigens from the fungi pathogenic for human skin.

Clinical methods for the longitudinal study of asthma

Abstract Clinical variables used to estimate the severity of asthma, such as the patients history, physical examination, maximal expiratory flow rates, and a record of treatments needed, appear to be associated statistically. A combination of (a) the patients personal account of his condition during a week, which provides a record of continuity, and (b) the determination of maximal expiratory flow which objectively records changes in respiratory function, was found to provide a highly reliable index of change, i.e., positive or negative improvement. None of the procedures evaluated could be considered unrelated to improvement and therefore be discarded. While it may be desirable to include other types of information in scoring the severity of asthma, or to obtain more frequent recording of data, weekly records (graded numerically) of history, physical examination, maximal expiratory flow rate, and treatments received are useful and sensitive indices of change in longitudinal studies.