Toshiko Itazawa

Association between the Results of the Childhood Asthma Control Test and Objective Parameters in Asthmatic Children

Objective. The Childhood Asthma Control Test (C-ACT), a seven-item, self-administered questionnaire, has been used as a tool to assess the control level in children with asthma. The aim of this study was to determine whether the C-ACT reflects airflow limitation and airway inflammation in addition to clinical manifestations. Methods. Asthmatic children aged 5–11 years who were able to perform the lung function test and fractional exhaled nitric oxide (FeNO) evaluation correctly were recruited during their regular visits. Children and their parents were asked to answer the officially developed Japanese version of the C-ACT. Results. Among 258 children (176 boys, median age 9 years), there was a significant positive correlation between the C-ACT score and the percent predicted forced expiratory volume in 1 s (%FEV1) (r = 0.317, p < .001). The accuracy of the C-ACT for identifying asthmatic subjects with normal lung function (%FEV1 >80%) described as the area under the receiver operating characteristic curve was 71.5% (95% CI = 62.8–80.2%, p < .001), and based on the Youden index the optimal cutoff score was 23 (sensitivity of 78% and specificity of 54%). In contrast, there was no relationship between the C-ACT score and the FeNO value. Conclusions. These results suggest that a cutoff score of 23 for the C-ACT could be useful for identifying children with well-controlled asthma and normal lung function. Further studies are warranted to develop an easy-to-use questionnaire to assess the extent of airway inflammation in children.

Association of overweight with asthma symptoms in Japanese school children.

Background:  Most studies regarding the association of obesity with asthma have been performed in the Western countries. This study is a nationwide survey conducted in Japan.

Association between obesity and asthma in Japanese preschool children.

To cite this article: Okabe Y, Adachi Y, Itazawa T, Yoshida K, Ohya Y, Odajima H, Akasawa A, Miyawaki T. Association between obesity and asthma in Japanese preschool children. Pediatric Allergy Immunology 2012: 23: 550–555.

Cedar and cypress pollen counts are associated with the prevalence of allergic diseases in Japanese schoolchildren.

Patients allergic to pollen have been known to become more symptomatic during pollen season compared with the nonpollen season. However, there are few studies regarding whether higher exposure to pollen might increase the prevalence of allergic diseases.

Ability of preschool children to use dry powder inhalers as evaluated by In‐Check Meter

Background: Although current guidelines recommend the pressurized metered‐dose inhaler with a spacer for preschool children with asthma, dry powder inhalers (DPI) may be a valuable treatment alternative.

MxA-based recognition of viral illness in Febrile children by a whole blood assay

Febrile children are often given antibiotics empirically and unnecessarily. MxA is a protein induced in peripheral lymphoid cells by type 1 interferons during active viral infection. The ability of a whole blood ELISA assay for MxA to identify children with viral illness was studied in 122 children who presented with acute onset fever and 52 age-matched healthy controls. The febrile children were divided into three groups according to their final diagnoses: etiologically diagnosed viral infection, clinically diagnosed viral infection, and bacterial infection. MxA levels in the bacterial infection group and controls were similar and low (90.9 ± 69.7 and 76.9 ± 63.2 ng/mL, respectively). In contrast, mean MxA levels in the two viral infection groups were higher than in both the bacterial and control groups (719.2 ± 386.4 and 827.0 ± 651.1, respectively). A receiver operating characteristic analysis showed that the area under the curve of the MxA level was greater than under the curves of both the white blood cell count and the C-reactive protein concentration. Whole blood assay of MxA is a clinically useful tool for diagnosing viral illness in febrile children and should help reduce use of unnecessary antibiotics.

Factors associated with asthma control in children: findings from a national Web-based survey

Although achieving and maintaining control of asthma is considered to be the goal of asthma treatment, determinants of asthma control are not fully understood. Our aim was to assess factors associated with asthma control among paediatric patients in the general population.

Rhinitis has an association with asthma in school children.

Background A relevant relationship exists between the upper and lower airway, indicating the concept of a unified airway. This study aimed to evaluate whether rhinitis has an association with asthma in children. Methods A cross-sectional nationwide survey was performed among children 6–7, 13–14, and 16–17 years old, using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire in Japan. According to the responses to the ISAAC core questions, a child who had experienced nasal symptoms in the past 12 months in the absence of a cold was defined as having current rhinitis. Results After excluding 11,475 children because of incomplete data, 136,506 children were analyzed. Even after adjusting for demographics, sex, and obesity, children with current rhinitis were more likely to have asthma (adjusted odds ratio [OR], 3.10 [95% CI, 2.92–3.30] in children aged 6–7 years; OR, 3.76 [95% CI, 3.45–4.10] in children aged 13–14 years; and OR, 3.59 [95% CI, 3.33–3.88] in children aged 16–17 years). Children whose daily activities were more impaired by rhinitis symptoms had a significantly higher prevalence of severe asthma. The adjusted ORs for severe asthma among asthmatic children whose daily activities were severely impaired by rhinitis symptoms were 3.66 (95% CI, 2.29–5.85) in children aged 6–7 years, 2.55 (95% CI, 1.64–3.96) in children aged 13–14 years, and 1.87 (95% CI, 1.24–2.82) in children aged 16–17 years compared with asthmatic children whose daily activities were not impaired at all. Conclusion There was a close association between rhinitis and asthma in young children to adolescents. Asthma should be examined in children with rhinitis symptoms.

Comparison of exhalation time methods (6 sec vs. 10 sec) of a hand-held exhaled nitric oxide analyzer.

Standard exhalation time for measuring fractional exhaled nitric oxide (FeNO) is 10 sec, but this is not easy for younger children. We aimed to investigate the agreement between FeNO values during 10‐sec (FeNO‐10) and 6‐sec (FeNO‐6) exhalation and the feasibility of measuring FeNO‐6, using a hand‐held analyzer, NIOX‐MINO®. FeNO values measured during 10‐ and 6‐sec (random order) were compared. Success rates of the two different time modes were also evaluated. In 119 asthmatic children (median age 8 years [range 4–15]) who had been already accustomed to NIOX‐MINO®, median FeNO‐10 (29 ppb [IQR 15.2–42.0]) and FeNO‐6 (27 ppb [IQR 16.0–43.5]) did not differ significantly (P = 0.90), and there was a good correlation between both values (r = 0.984, P < 0.001). Mean difference (FeNO‐10–FeNO‐6) was −0.151 ppb (95% CI: −0.95 to 0.65, limits of agreement: −8.8 to 8.5). In 46 asthmatic children (median age 7 years [range 4–15]) who had never used any FeNO analyzers, all the children aged 8 years and more (n = 21) succeeded in measuring FeNO on both time modes, whereas for children aged younger than 8 years (n = 25) success rates of the 10‐ and 6‐sec mode were 60.0% and 92.0%, respectively. In conclusion, we showed good agreement between FeNO‐10 and FeNO‐6, and the 6‐sec mode of NIOX‐MINO® is more feasible than 10‐sec mode for measuring FeNO in younger children. Pediatr Pulmonol. 2010; 45:1005–1008.

New sandwich-type enzyme-linked immunosorbent assay for human MxA protein in a whole blood using monoclonal antibodies against GTP-binding domain for recognition of viral infection.

To develop a clinically significant and practical enzyme‐linked immunosorbent assay (ELISA) for the detection of MxA protein in human whole blood, a biological marker of viral infection.