J. van der Laag

Bacille–Calmette–Guerin vaccination and the development of allergic disease in children: a randomized, prospective, single‐blind study

Background The increase in the prevalence of allergic diseases in countries with a so‐called western lifestyle may be due to a decrease in exposure to infectious agents in early life.

Insulin-like growth factors and leucine kinetics during exercise training in children with cystic fibrosis.

Background Little is known about the metabolic effects of exercise training in children with cystic fibrosis. The hypothesis for the current study was that in patients with declining clinical status, exercise increases circulating insulin-like growth factors (IGFs) and improves protein kinetics. Methods This was a prospective intervention study in 10 children with cystic fibrosis who participated in a structured isoenergetic exercise (cycling) training program for 3 months. Measurements of IGFs, protein kinetics (using intravenous [13C]-1-leucine tracer infusions) and nutritional balance studies were conducted at baseline and after 3 months. Results Standard deviation scores of plasma IGF-I, IGF-II, and IGF binding protein (BP)-3 were all decreased at baseline (mean ± SE: −2.0 ± 0.2, −2.0 ± 0.2, −0.6 ± 0.2, respectively). IGF-I and IGF-II concentrations were significantly higher after exercise training (standard deviation scores −1.4 ± 0.3 and −1.3 ± 0.1, respectively; compared with baseline: one-tailed t-test P = 0.03 and 0.002). The standard deviation score of the IGF-I/IGF BP-3 ratio, an indicator of free IGF-I in the circulation, normalized during exercise training (0.0 ± 0.6 vs. −1.3 ± 0.2 SD units at baseline, one-tailed t-test P = 0.04). There was no significant difference in protein intake and fasting protein breakdown, oxidation, and protein synthesis or in energy balance and fat absorption. Conclusions These results show that isoenergetic exercise training can be safely recommended to patients with cystic fibrosis. It provides a positive anabolic stimulus to IGF status but is not sufficient to adequately augment protein accretion in patients with diminished nutritional status.

ADOLESCENTS WITH CYSTIC FIBROSIS IN THE NETHERLANDS

ABSTRACT. In a survey‐study of all living Dutch patients with cystic fibrosis (CF) born before 1971 data have been gathered on sex, age, age at diagnosis; height and weight; treatment and social development. The group consists of 102 schoolchildren (8–11 years), 179 adolescents (12–21 years) and 28 young adults (22–40 years). Males are in the majority, especially in the 12 to 17 age group (61 %). In 51% of all patients CF was diagnosed before the age of 2, and in 75% before the age of 5. Male CF patients are on average 6 cm (0.84 SD) shorter than normal and female patients 3 cm (0.48 SD). As far as weight for height is concerned, 54 % of the CF patients fall below the 10th percentile. Weight for height is slightly lower in females than in males. CF patients usually leave primary school at an older age than their healthy peers. In comparison to healthy adolescents of the same age, adolescents with CF attend full‐time day‐school for a longer time, more of them receive general education and fewer take vocational training. Adolescents and young adults with CF do not stay longer than normal in the protective environment of their parental home.

Cystic fibrosis and outpatient treatment with parenteral antibiotics in children

Despite recent key insights into the pathogenesis of cystic fibrosis, the treatment of patients suffering from this disease remains largely symptomatic. Control of respiratory infections is a vital part of patient management, involving daily physiotherapy and administration of mucolytics, bronchodilators and oral or intravenous antibiotics as necessary. For those patients requiring frequent courses of intravenous antibiotics, home treatment appears preferable to repeated hospital admissions. A home care programme for cystic fibrosis has been running at the Wilhelmina Childrens Hospital in Utrecht since 1991, with the aid of two specialist nurses to provide support and instruction for children and their parents. While parents of younger children were often reluctant to accept the increased responsibility for their childs care, children who had received a period of home treatment were enthusiastic about its use and eager for the programme to continue. However, anxiety of patients and parents and medical instability may be of such importance in certain circumstances that treatment is not always given at home, even after former successful periods of home care.

From the authors

C. Butler and L.G. Heaney raise several important points regarding our recent report 1, which identified risk factors of frequent exacerbations in difficult-to-treat asthma. First, they questioned why we excluded patients on oral corticosteroids from the analysis. In our clinic, and in most other pulmonary clinics, it is common practice to taper oral corticosteroids to the lowest possible dose whenever possible, and to increase the dose no more than strictly necessary in case of the worsening of asthma symptoms. This is a continuing process, mostly initiated by the patients themselves, without interference of a pulmonologist. We chose not to include patients on oral corticosteroids, because we felt that initial exacerbations could not be distinguished clearly from …The study by TEN BRINKE et al. [1] reported an association between exacerbation and reflux (odds ratio (OR) 4.9), but a definition based on the presence of reflux on pH profiling or severe reflux symptoms with response to treatment was used. Only 39 of the initial 136 patients underwent 24-h pH monitoring. It is well documented that the absence of reflux symptoms is not an accurate predictor of the absence of this condition, since many asymptomatic patients will have ‘‘silent’’ reflux [6]. TEN BRINKE et al. [1] highlight this in their discussion, with only 36% of the patients who underwent 24-h pH measurement reporting symptoms of reflux, but 77% of these had reflux using objective pH criteria. Therefore, it seems surprising that, in the other subjects, the presence or absence of reflux were accepted on clinical grounds alone. Debate exists as to whether the treatment of this condition actually has any bearing on asthma control [7, 8], and the study by TEN BRINKE et al. [1] does not appear to add significantly to this debate.