William E. Pierson

Incidence of exercise-induced asthma in children

The incidence of exercise-induced asthma (EIA) was studied in 134 asthmatic, 102 nonasthmatic atopic, and 56 nonatopic children. Pulmonary function tests measuring forced vital capacity (FVC) and one-second forced expiratory volume (FEV1) were performed on each child prior to and serially for 20 minutes following free running exercise. The incidence of the EIA among the asthmatic and atopic nonasthmatic children was 63% and 41% respectively, and 7% among control subjects. Airway function was studied prior to and after a standardized free running exercise test. Forty-one percent of the nonasthmatic and 63% ofthe asthmatic atopic children had a significant decrease in airway function as compared to 5% of the nonallergic subjects.

Effects of SO2 plus NaCl aerosol combined with moderate exercise on pulmonary function in asthmatic adolescents

Eight adolescent subjects with a diagnosis of extrinsic asthma and exercise-induced bronchospasm were exposed for 30 min at rest followed by 10 min of moderate exercise on a treadmill to the following experimental modes: (a) filtered air, (b) 1 ppm of sulfur dioxide (SO2) and 1 mg/m3 of sodium chloride (NaCl) droplet aerosol, or (c) 1 mg/m3 of NaCl droplet aerosol alone. All exposures were at ⩾75% relative humidity and 22°C. Functional measurements of total respiratory resistance (RT), maximal flow at 50 and 75% expired vital capacity (Vmax50 and Vmax75), forced expiratory volume in 1 sec (FEV1.0), and functional residual capacity (FRC) were recorded before and after exposure. Statistically significant changes were seen in RT, Vmax50 and Vmax75, and FEV1.0 following exposure to SO2  NaCl droplet aerosol during exercise. The changes seen were greater than those seen in the same subjects during exposure at rest or in healthy adult subjects exposed to various air pollutants.

A double blind trial of the effect of cromolyn sodium on exercise-induced bronchospasm

Abstract Nineteen children with atopic airway disease who had a demonstrable post-exercise decrease in forced expiratory volume in one second (FEV 1 ) using a standardized stress on a cycloergometer were treated with disodium cromoglycate (cromolyn sodium) in a double blind crossover study with a placebo control. Significant reduction of post-exercise bronchospasm was obtained by a single dose of 20 mg. of the drug inhaled one hour before exercise; the effect of the single dose was enhanced if preceded by 3 weeks of daily medication. No side effects were detected during the prolonged use of the drug. The significance of cromolyns effect on the phenomenon is discussed.

Methacholine bronchial challenge in children

Methacholine sensitivity was evaluated in 166 young subjects who had normal resting spirometric values but who presented problems suggesting lower airways hyperreactivity. Fifty-eight patients (35%) did not have significant sensitivity. The diagnosis of asthma was excluded in this subgroup. Forty-one patients (25%) had mild methacholine sensitivity, 49 (30%) had moderate sensitivity, and 18 (11%) had extreme methacholine sensitivity. Many patients who reacted had chief complaints of cough, bronchitis, or other low respiratory-tract symptoms and did not complain of wheezing. Methacholine challenge helped to clarify appropriate therapy in these individuals. One-year follow-up of these patients showed most patients to be continuing the therapeutic regimen that had been prescribed initially. Methacholine bronchoprovocation was a useful adjunct to management of this large outpatient population of children and young adults and deserves attention as a procedure relevant to patients care, not solely as an investigational test.

Respiratory effects of air pollution on allergic disease

Allergic patients have an increased susceptibility to the adverse effects of both natural and man-made air pollutants. This goes for both indoor and outdoor air pollutants and manifests itself with biochemical, cellular, and pathophysiologic expressions of adverse health effects in allergic individuals. Also occupationally induced allergic diseases will remain very important. This area has been reviewed recently by Cullen et al. Since allergic patients comprise somewhere between 15% and 20% of the population, this increased susceptibility is of crucial importance not only for medical care and research but for legislative and regulatory consideration to protect these vulnerable individuals.

Acute effects of inhaled SO2 plus NaCl droplet aerosol on pulmonary function in asthmatic adolescents

Abstract Nine adolescent subjects with a diagnosis of extrinsic asthma were exposed at rest for 60 min to the following experimental modes: (a) filtered air; (b) 1 ppm of sulfur dioxide (SO 2 ) and 1 mg/m 3 of sodium chloride (NaCl) droplet aerosol; c 1 mg/m 3 of NaCl droplet aerosol alone. All exposures were at 75% relative humidity and 22°C temperature. Functional measurements of total respiratory resistance ( R T ), maximal flow at 50 and 75% of expired vital capacity ( V _. max50 and V _. max75 ), forced expiratory volume in 1 sec (FEV 1.0 ) and functional residual capacity (FRC) were recorded before, during, and after exposures. Significant decreases in V _. max50 and V _. max75 were seen when the group was exposed to the SO 2 plus NaCl droplet aerosol. No significant changes were seen during exposure to filtered air or NaCl droplet aerosol alone. The results suggest that the site of effect of the SO 2 NaCl droplet aerosol was in small airways. The asthmatic adolescents appeared to be more sensitive to the SO 2 droplet aerosol than were healthy nonsmoking adults previously studied.

Clinical ecology: Approved by the executive committee of the American academy of allergy and immunology

Summary An objective evaluation of the diagnositic and therapeutic principles used to support the concept of clinical ecology indicates that it is an unproven and experimental methodology. It is time-consuming and places severe restrictions on the individuals life-style. Individuals who are being treated in this manner should be fully informed of its experimental nature. Advocates of this dogma should provide adequate clinical and immunologic studies supporting their concepts, which meet the usually accepted standards for scientific investigation.

Efficacy of azelastine in perennial allergic rhinitis: Clinical and rhinomanometric evaluation

Azelastine is a chemically novel medication that has been demonstrated to be clinically effective for asthma and seasonal allergic rhinitis. In a 10-week, multicenter, double-blind, placebo-controlled, crossover study, the efficacy and safety of azelastine, 1 mg and 2 mg twice daily, were evaluated in 192 patients with symptoms of perennial allergic rhinitis. Patients maintained daily symptom and adverse-experience diaries and were evaluated every 2 weeks by the investigators. Pseudoephedrine, 30 mg, was provided as backup medication. Amelioration of most individual symptoms and a decrease in the total symptom scores were observed with both dosages of azelastine; greater improvement with 2 mg twice daily than with 1 mg twice daily, was observed. Nasal congestion, as a symptom and as reflected by rhinomanometric assessment, was the least improved parameter. Backup decongestant medication decreased during treatment with azelastine and increased during the placebo regimen. There were no major adverse effects.

The effects of sulfur oxides on nasal and lung function in adolescents with extrinsic asthma

Ten adolescent subjects with extrinsic asthma were exposed during intermittent exercise to filtered air, 0.5 ppm of sulfur dioxide (SO2), or 100 micrograms/m3 of sulfuric acid (H2SO4) on 5 separate days. The purpose of the study was to compare changes in nasal power (the work of nose breathing) with pulmonary functional changes depending on the route of inhalation of the sulfur oxide pollutants, oral inhalation through a rubber mouthpiece or oronasal inhalation via a face mask. Nasal power was measured with a modified skin diving mask equipped with two differential pressure transducers. Statistically significant changes in total respiratory resistance, FEV1, and maximum flow calculated at 50% and 75% vital capacity were observed after all exposures to SO2 and H2SO4. The magnitude of change in FEV1 and maximum flow calculated at 50% vital capacity was higher after oral compared to oronasal inhalation of SO2. The nasal work of breathing increased 32% after SO2 exposure by mouthpiece and 30% after SO2 exposure via face mask (p less than 0.05). The nasal power changes after the H2SO4 exposures were not different from the sham exposures. We conclude that oronasal inhalation of 0.5 ppm of SO2 produces a significant increase in the nasal work of breathing and that the route of exposure reduces but does not eliminate the lower airway reactions observed on oral exposure.

Cromolyn versus triamcinolone acetonide for youngsters with moderate asthma

Although both cromolyn (C) and inhaled corticosteroids are anti-inflammatory therapies for childhood asthma, there are few controlled comparisons of these medications for asthma therapy in children. None were conducted in the United States, and none specifically study triamcinolone acetonide (T) versus C. This 12-week evaluation followed 31 youths, aged 8 to 18 years, with moderate asthma who were assigned to receive C or T according to a prerandomized and blinded code. Patients were instructed to take two inhalations from the study metered-dose inhaler (active T or placebo) and to inhale the contents of one study-provided ampule (C, 20 mg, or placebo) from a compressor-driven home nebulizer three times per day. Patients also used albuterol, two inhalations from a metered-dose inhaler, three times a day (before study medication) and, additionally, if needed. Patients maintained a daily diary, recording extra medication use, adverse experiences, peak flow rates morning and night, and asthma symptom scores. Laboratory assessment of pulmonary function was done at 1, 4, 8, and 12 weeks. Cosyntropin challenge and methacholine bronchoprovocation challenge were performed at the beginning and end of the study. C and T provided similar, adequate asthma control. Symptoms of wheezing, cough, and chest tightness decreased, and daily peak expiratory flow rate increased with both regimens compared to during a 2-week baseline when patients received medication only as needed. There was no significant change in methacholine sensitivity and no change in endocrine function, as measured with fasting plasma control before and after administration of cosyntropin.(ABSTRACT TRUNCATED AT 250 WORDS)