Reiko Muramatsu

EFFECTS OF SKIN CARE WITH SHOWER THERAPY ON CHILDREN WITH ATOPIC DERMATITIS IN ELEMENTARY SCHOOLS

Abstract:  For elementary school children with atopic dermatitis, a skin care program using shower therapy was performed during the school lunch break for 6 weeks from June to July in 2004 and 2005. All 53 participants showed an improvement in their atopic dermatitis during the 6‐week periods studied. Skin care with daily showering at an elementary school was thus found to be effective for the treatment of atopic dermatitis.

Reference Values for Japanese Children's Respiratory Resistance Using the LMS Method

BACKGROUND The forced oscillation technique (FOT) is useful for studying pulmonary function in children, as well as in school children with asthma. However, the standard values for respiratory resistance (Rrs) in Asian school children remain unknown. We evaluated the standard Rrs using a type of FOT, impulse oscillometry (IOS), in healthy Japanese children at elementary and junior high schools. METHODS A total of 795 children (age range: 6-15 years; mean age ± SD: 11.1 ± 2.4 years; 404 boys, 391 girls) at elementary and junior high schools participated in the study. Of the 795 children, we evaluated the Rrs of 537 children aged 6-15 years (mean ± SD: 10.8 ± 2.4 years) using IOS. RESULTS Regression analyses with three IOS parameters, Rrs at 5Hz (R5), Rrs at 20Hz (R20), and Rrs difference between 5Hz and 20Hz (R5-R20), for age, height, weight, and degree of obesity as independent variables demonstrated the strongest correlation between each parameter and childrens height. All parameters decreased with increasing height. Using the lambda-mu-sigma (LMS) method, we created standard curves for the Rrs values based on height. CONCLUSIONS Our standard curves could be useful for diagnosis and control evaluation of childhood asthma.

Changes in the highest frequency of breath sounds without wheezing during methacholine inhalation challenge in children.

A breath sound analyser was used to detect bronchoconstriction without wheezing during methacholine inhalation challenge in children. The highest frequency of inspiratory breath sounds increased significantly during bronchoconstriction and decreased after inhalation of a bronchodilator. The highest frequency of inspiratory breaths sounds was correlated with bronchial reactivity.

Relationship between bronchial hyperreactivity and asthma remission during adolescence

BACKGROUND Many children with asthma outgrow this disease after the onset of puberty. However, the precise mechanism of outgrowing asthma in children is still unclear. OBJECTIVE To evaluate the characteristics of respiratory physiology during adolescence. METHODS The results of the lung function test and methacholine inhalation challenge were prospectively evaluated in adolescent patients with asthma with and without symptoms. One hundred sixty children with asthma participated. Twenty-eight children had symptom-free adolescent asthma (i.e., remission asthma) (boy to girl ratio, 16:12; mean age, 14.6 years), 25 had intermittent adolescent asthma (boy to girl ratio, 16:9; mean age, 14.9 years), and 47 had symptomatic adolescent asthma (boy to girl ratio, 27:20; mean age, 12.7 years). For comparison purposes, 60 younger children with symptomatic asthma participated. The parameters of bronchial hyperresponsiveness, baseline respiratory resistance, threshold of methacholine (Dmin) (bronchial sensitivity), and speed of bronchial constriction (Sm) (bronchial reactivity) were measured by methacholine inhalation challenge using the continuous oscillation method. RESULTS There was no significant difference in lung function results, such as forced vital capacity and forced expiratory volume in 1 second, between the intermittent asthma and the remission asthma groups. Also, there was no significant difference in baseline respiratory resistance and Dmin between the 2 groups. However, the value of Sm of the remission asthma group was significantly lower than that of the intermittent asthma group (P = .02) and the symptomatic asthma group (P = .02). CONCLUSIONS These data show that the adolescents with asthma remission showed a significant decrease of Sm, whereas Dmin was not changed. These results suggest one of the mechanisms by which asthma is outgrown in children and explain the common clinical aspects of adolescent asthma, such as symptom-free but bronchial hyperresponsive asthma.

Relationship between Exhaled Nitric Oxide and Small Airway Lung Function in Normal and Asthmatic Children

BACKGROUND In children, exhaled nitric oxide (eNO) is usually confounded by factors such as age and height. We evaluated the relationship between eNO and lung function by minimizing the effects of aging and height. METHODS In Study 1, the subjects comprised 738 elementary school children and junior high school children (aged 6 to 15 years, 366 males and 372 females). They were divided into two groups according to age (6-10 years and 11-15 years). A height range was determined by a histogram of height in each group. In Study 2, lung function, respiratory resistance and eNO level were measured in age- and height-limited groups. RESULTS In Study 1, total of 148 younger children ranging in height from 120 to 130 cm and 180 older children ranging in height from 148 to 158 cm participated in Study 2. The level of eNO among asthmatic children was higher than that of normal children in both the younger and the older groups. The decrease in forced expiratory volume in 1 second (FEV(1)) and other parameters of central airway resistance did not correlate with the eNO level. However, the small airway parameters of MMEF and V(25)/HT in older asthmatic children, and V(25)/HT and R(5)-R(20) in younger asthmatic children inversely correlated with eNO. CONCLUSIONS Our data suggest that eNO level inversely correlates with small airway narrowing, and airway inflammation has a significant effect on small airway lung function in asthmatic school children.

Relationship between bronchial hyperresponsiveness and lung function in children age 5 and 6 with and without asthma

It is unknown whether wheezy children have bronchial hyperresponsiveness (BHR) or which lung function parameters are correlated with BHR in children. We evaluated the relationship between BHR parameters and the lung functions by minimizing the effects of age and height in asthmatic, non‐asthmatic wheezers and healthy children.

Consistently high levels of exhaled nitric oxide in children with asthma

Background:  Exhaled nitric oxide (eNO) levels in children are unstable because they are regulated by many potent factors. The purpose of the current study was to evaluate the reliability of eNO levels between a long interval and other lung functions in normal and asthmatic children.

Evaluation of out-in skin transparency using a colorimeter and food dye in patients with atopic dermatitis

Background  Atopic dermatitis is a disease of skin barrier dysfunction and outside stimuli can cross the skin barrier.

Effect of aging on the relationship between asthma severity and bronchial hyperresponsiveness in children with asthma

An association between asthma and bronchial hyperresponsiveness (BHR) has been demonstrated. It is possible that the relationship between asthma severity and BHR in children with asthma is different in infants and in adolescents. The aim of this study is therefore to evaluate the effect of aging on the relationship between the severity of asthma and BHR in children with asthma. We measured BHR in 386 subjects ranging from 2 to 20 years of age. The subjects consisted of 323 children with asthma (boys : girls = 193 : 130, mean age 9.7 years) and 63 age-matched controls (boys : girls = 25 : 38, mean age 8.2 years). BHR was measured using the methacholine inhalation challenge by measuring the transcutaneous oxygen pressure (tcPO2) in children less than 6 years of age (Dmin-PO2) and by measuring the respiratory resistance (Rrs) in children 6 years of age and older (Dmin-Rrs). Throughout the whole age range, both the Dmin-PO2 and Dmin-Rrs in each asthma severity group were higher than those in the controls. In the asthmatics aged 2–5 years, the Dmin-PO2 levels in the mild asthma group were higher than those in the moderate and severe asthma groups (p < 0.001, p < 0.001, respectively), and the Dmin-PO2 levels in the moderate asthma group were also higher than those in the severe asthma group. This tendency was also found in the age ranges of 6–9 years and 10–13 years. In the asthmatics aged 14–20 years, the Dmin-Rrs levels were not significantly different among the three groups. Taken together, these data show that aging has an effect on the relationship between the severity of asthma and BHR during childhood and that BHR may not be the sole determinant for the severity of asthma in adolescence.

Evaluation of bronchial hyperresponsiveness by monitoring of transcutaneous oxygen tension and arterial oxygen saturation during methacholine challenge in asthmatic children.

Background. Bronchial hyperresponsiveness (BHR) is a key feature of asthma, but the measurement of BHR is hampered by the fact that most tests of airway caliber are difficult to conduct at a young age. Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be assessed noninvasively by transcutaneous oxygen pressure (tcPO2) and pulse oximetry. Evaluating BHR by monitoring tcPO2 instead of respiratory resistance (Rrs) has been used over a wide age range in childhood. Objective. To investigate whether there is a consistent relationship between changes in arterial oxygen saturation (SaO2) and respiratory resistance (Rrs) similar to the relationship between tcPO2 and Rrs during methacholine challenge in young children and to assess the usefulness of SaO2 as a parameter for the indirect measurement of BHR. Method. We performed methacholine inhalation challenge by monitoring SaO2, tcPO2 and Rrs in 37 asthmatic children 5 to 7 years of age. Consecutive doses of methacholine were doubled until a 10% decrease in tcPO2 from the baseline was reached. We recorded the cumulative dose of methacholine (Dmin) at the inflection point of tcPO2 (Dmin-tcPO2), SaO2 (Dmin-SaO2), and Rrs(Dmin-Rrs). Results. The mean value of Dmin-Rrs was 4.27 ± 2.02 units, the mean value of Dmin-tcPO2 was 4.48 ± 2.01 units, and the mean value of Dmin-SaO2 was 4.57 ± 0.20 units. Inhalation of increasing doses of methacholine raised Rrs curvilinearly and depressed tcPO2 and SaO2. There were no significant differences between any of the parameters. There were significant relationships between Dmin-tcPO2 and Dmin-Rrs (r = 0.914, p < 0.001) and between Dmin-SaO2 and Dmin-Rrs (r = 0.905, p < 0.001) and a relationship between Dmin-tcPO2 and Dmin-SaO2 (r = 0.949, p < 0.001). Conclusion. We concluded that measurement of SaO2 and/or tcPO2 during methacholine inhalation challenge may be used to assess bronchial hyperresponsiveness. This study showed that both SaO2 and tcPO2 monitoring are safe, useful, and tolerable for use in children who are too young to cooperate with lung function tests.