L. Sette

Changes in Bronchial Reactivity in Asthmatic Children After Treatment with Beclomethasone Alone or in Association with Salbutamol

Airway inflammation is consistently present in patients with severe asthma. The combination of inhaled steroids and bronchodilators may be useful both for treating symptoms and improving the underlying inflammatory condition. We have compared the effect of beclomethasone dipropionate (BDP) combined with salbutamol (S), BDP alone, and placebo, on the severity of bronchial responsiveness in 30 children with allergic asthma during the period of specific allergen exposure. In children treated with BDP alone, PC20-FEV1 methacholine was 0.66 +/- 0.54 at the beginning and 1.91 +/- 2.11 at the end of the study period (p greater than 0.05). In children treated with BDP + S PC20, methacholine was 1.21 +/- 1.43 at the beginning and 4.22 +/- 3.88 at the end of the study (p less than 0.05). The group of children treated with placebo had a PC20-FEV1 methacholine of 0.79 +/- 0.61 at the beginning of the study and 0.80 +/- 0.46 at the end of the study. The results of the present study show that maintenance treatment with inhaled beclomethasone combined with salbutamol may lead to greater improvement in bronchial hyperreactivity than treatment with inhaled beclomethasone dipropionate alone.

The efficacy and tolerability of fluticasone propionate aqueous nasal spray in children with seasonal allergic rhinitis

Fluticasone propionate aqueous nasal spray (FPANS) contains fluticasone propionate, which is a new topically active glucocorticoid with approximately twice the potency of beclomethasone dipropionate. In this European multicentre study, 143 children with seasonal allergic rhinitis were recruited: 47 received FPANS 100 jag once a day (od), 46 received FPANS 200 μg od, and 50 patients received placebo od, for 4 weeks. Treatment efficacy was assessed using diary card nasal symptom scores for sneezing, rhinorrhoea, blockage and itching, and eye watering/irritation. Patients receiving FPANS 100 μg or FPANS 200 μg demonstrated statistically significant improvements in median nasal symptom scores in all the symptoms recorded, when compared with placebo. There were no statistically significant differences between the FPANS 100 μg and FPANS 200 μg groups in improvement in nasal symptom scores. There was no effect on eye watering/irritation symptoms which could be attributed to either FPANS 100 μg or FPANS 200 μg when compared with placebo. Use of rescue antihistamine medication was significantly reduced in the FPANS 100 μg group when compared with placebo. The adverse events profile was similar in all three treatment groups, and the events reported were generally mild and related to the patients’ rhinitis.

Effects of allergen exposure-avoidance on inflammation in asthmatic children

Inflammation of the airways has long been known to be the classic pathologic feature of asthmatics who have died in status asthmaticus (1, 2). However, it has recently been appreciated, from studies of bronchial lavage and bronchial biopsies, that inflammatory changes are present in even mildly symptomatic adult patients (3). Experimental evidence has linked the induction of bronchial hyperresponsiveness (BHR) to the presence of inflammation (4-7). The recognition of allergic airways inflammation, as a cause of both transient and persistent airway hyperresponsiveness, has led to increased appreciation of importance of atopy in the pathogenesis of asthma (4-8). Recently, it has been shown that eosinophil counts in lavage fluid are correlated with histamine reactivity in children (9) as well as in adults (3). Furthermore, ultrastructural examination of the airways of two asthmatic children undergoing open lung biopsy during clinical remission showed features similar to lung tissue from two children who had died in status asthmaticus with the exception of a larger number of submucosal eosinophils and more extensivedenudation ofthe epithelium in fatal asthma (10). Evidence from these findings suggest that airways-inflammation may play a role also in asthmatic children. This hypothesis can be further supported by studies which have shown that allergen avoidance can improve BHR and asthma symptoms both in adults (11-12) and children (13-15) with asthma. Because of the importance of better understanding the correlation of allergen exposure with BHR and inflammation we evaluated changes in BHR and serum markers of inflammation when allergic asthmatic children sensitive to house dust mites moved from an environment rich in allergens (sea level) to an environment free from mites at a high altitude (Istituto Pi0 XII, Misurina 1756111) (16-17) and back again to sea level. The migration of asthmatic children from sea level to the alpine environment and back again, offers a natural allergen exposureavoidance-exposure challenge model.

Vocal Cord Dysfunction in an Asthmatic Child: Case Report

Acute functional narrowing of the glottis frequently leads to an inappropriate diagnosis of asthma. Only 2 cases have been reported of patients with asthma and concomitant vocal cord dysfunction. We present the case of an adolescent boy with asthma, who exhibited a worsening of wheezing and a reduction in peak expiratory flow rate out of proportion to symptoms due to a vocal cord dysfunction.

Double‐blind evaluation of effectiveness and safety of flunisolide aerosol for treatment of bronchial asthma in children

A double‐blind study was carried out in 20 asthmatic children in order to evaluate the therapeutic efficacy and safety of inhaled corticosteroid flunisolide. 0.5 mg of the drug was administered by a jet nebulizer twice daily for 2 months. Respiratory symptoms. pulmonary function values and methacholine PC2‐FEV2 were evaluated, as also morning cortisol levels, plasma cortisol increase alter ACTH test, and 24‐h urinary cortisol excretion. The data obtained show the efficacy of the drug in reducing symptoms. No significant difference was observed in pulmonary function values and in bronchial reactivity results between the two groups. No effect of flunisolide was observed on hypothalamic‐pituitary‐adrenal function. This study confirms the efficacy and safety of flunisolide (0.5 mg b.i.d.) in the treatment of asthmatic children.

Effect of beclomethasone dipropionate nasal aerosol on serum markers of bone metabolism in children with seasonal allergic rhinitis

Thirty‐nine children with grass pollen hay fever were randomly treated with nasal inhaled beclomethasone dipropionate (BDP) 200 or 400μg‘day or sodium cromoglycate (SCG) 30 ing/day for 2 months during the pollen season. Scrum osteocalcin (OC), parathyroid hormone (PTH). total alkaline phosphatase (AP). hone alkaline phosphatase (BAP) and type I collagen telopcptide (ICTP) were measured immediately before, I and 2 months after treatment and 1 week after stopping the therapy. No significant changes in OC, PTH, AP, BAP and ICTP serum level occurred within each group. Minor and probably clinically insignificant between group differences were occasionally found. Our study shows that BDP nasal spray has no significant effect on common markers of bone metabolism.

Early bronchopulmonary involvement in Crohn disease: a case report

BackgroundBronchopulmonary manifestations of Crohn disease have been rarely described in children, including both subclinical pulmonary involvement and severe lung disease.Case presentationA 6.5-year-old girl is described with early recurrent bronchopulmonary symptoms both at presentation and in the quiescent phase of Crohn disease. Pulmonary function tests (lung volumes and flows, bronchial reactivity and carbon monoxide diffusing capacity) were normal. Bronchoalveolar cytology showed increased (30%) lymphocyte counts and bronchial biopsy revealed thickening of basal membrane and active chronic inflammation.ConclusionsClinical and histological findings in our young patient suggest involvement of both distal and central airways in an early phase of lung disease. The pathogenesis of Crohn disease-associated lung disorders is discussed with reference to the available literature. A low threshold for pulmonary evaluation seems to be advisable in all children with CD.

Maximal inspiratory pressure and inspiratory muscle endurance time in asthmatic children : Reproducibility and relationship with pulmonary function tests

Respiratory muscle strength, assessed by maximal inspiratory mouth pressure (Pi,max), and endurance, assessed as the length of time a subject could breathe against inspiratory resistance with a target mouth pressure ≥70% of Pi,max (Tlim), were measured in 20 symptomless asthmatic children, in order to assess the reproducibility of such measurements and their relationship to traditional pulmonary function tests or tests of bronchial hyperresponsiveness. After recording lung volumes and bronchial response to methacholine, Pi,max and Tlim were measured twice in the same morning, with a 30‐minute interval between each experimental trial.

Effect of pattern of preceding inspiration on FEV1 in asthmatic children

In adults, both peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1) are significantly influenced by the time course of the inspiration preceding the forced expiration. The aim of this study was to evaluate the effects of three different inspiratory manoeuvres on PEF, FEV1, and forced vital capacity (FVC) in asthmatic children. Twenty five symptomless asthmatic children performed forced expiration preceded by three different inspiratory manoeuvres, which consisted of: a rapid inspiration with a 2 s end-inspiratory breathhold (Manoeuvre No. 1); a rapid inspiration without an end-inspiratory breathhold (Manoeuvre No. 2); and a slow inspiration lasting about 5 s with an end-inspiratory breathhold of at least 4 s (Manoeuvre No. 3). All manoeuvres were performed in a randomly assigned sequence each morning for three consecutive days. In each session, the manoeuvres were repeated three times and the highest value was chosen. Both FVC and FEV1 obtained with Manoeuvre No. 3 were significantly lower than the corresponding values obtained with Manoeuvre Nos. 1 and 2. The mean (SD) FVC values were 2.76 (0.66) L with Manoeuvre No. 1, 2.67 (0.58) L with Manoeuvre No. 2 and 2.52 (0.52) L with Manoeuvre No. 3. The corresponding values of FEV1 were 2.25 (0.53), 2.22 (0.53) and 2.07 (0.44) L, respectively. By contrast, the values of PEF, obtained with a portable peak flow meter, were similar with the three different inspiratory manoeuvres. The results of this study show that in symptomless asthmatic children the preceding inspiratory manoeuvre may influence forced vital capacity and forced expiratory volume in one second. Hence, in order to reduce variability due to interference by physiological factors and so improve reproducibility of pulmonary function tests, the inspiratory manoeuvres must be accurately standardized.

Inhibition of different dosages of oxatomide or placebo on skin prick test and nasal allergen provocation.

In this two-stage, double-blind study, we evaluated the effects of different dosages of oxatomide (1 and 2 mg/kg/day) on nasal provocation and skin reaction wheal induced by grass-pollen challenge. Children with a positive history of allergic rhinoconjunctivitis and positive responses to skin prick test and nasal provocation test to grass pollen were studied out of season. The results obtained with 1 mg/kg/day of oxatomide demonstrated no significant difference in wheal areas and nasal secretion induced by allergen challenge between treated and untreated patients. The administration of 2 mg/kg/day demonstrated a significant suppression in wheal reaction and nasal secretion induced by specific challenge.