Y.S. Adachi

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.

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.

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.

A case of mite-ingestion-associated exercise- induced anaphylaxis mimicking wheat-dependent exercise-induced anaphylaxis.

We present a case of mite-ingestion-associated exercise-induced anaphylaxis mimicking wheat-dependent exercise-induced anaphylaxis (WDEIA). A 17-year-old boy was referred for an episode of anaphylaxis while jogging, 1.5 h after having eaten okonomiyaki (a Japanese pancake). Laboratory measures revealed a slightly elevated specific immunoglobulin E (IgE) antibody against omega-5 gliadin (0.41 kUA/l) and a marked elevation of specific IgE antibody against house-dust mite, Dermatophagoides farinae (142 kUA/l). A detailed interview revealed that, in spite of the referring doctors advice to discontinue postprandial exercises, he continued his jogging routine after consuming foods containing wheat and also that his younger brother, who had mild intermittent asthma, had suffered a mild asthma attack 2 h after eating the same food. We therefore examined the okonimiyaki mix, which had been stored for several months after opening the package until this episode, under a microscope, and we found an abundant number of live mites, D. farinae. Finally, a diagnosis of mite-ingestion-associated exercise-induced anaphylaxis was made. This clinical entity should be excluded when making a diagnosis of WDEIA.

Safety and usefulness of a novel eMotion electric mesh nebulizer in children with asthma.

BACKGROUND A new electronic mesh nebulizer, eMotion® is known to have higher performance compared to conventional nebulizers. However, there are some concerns about whether too much delivered dose might cause side effects with higher frequency. METHODS To evaluate the safety and usefulness of the nebulizer, we measured changes in heart rates and lung functions of 73 asthmatic children when they inhaled 1μg/kg of procaterol with eMotion® or a conventional nebulizer, Junior BOY®. RESULTS In 34 children with mild asthma exacerbation, physical findings, lung function and transcutaneous oxygen saturation levels were improved after inhalation using both nebulizers. No adverse effects including significant increase of heart rate were found. Improvements in the rates of the parameters were comparable. When response to beta2-agonist inhalation was checked in 39 children in stable condition, similar degrees of improvement in lung function were observed, and heart rates did not change after inhalation with either nebulizers. CONCLUSIONS Safety and efficacy was comparable between eMotion® and a conventional nebulizer when it was used to administer beta2-agonists in asthmatic children. However, from the fact that eMotion® needs only 3-4 minutes to inhale 2mL solution, eMotion® could be more useful for most children who usually do not prefer longer inhalation time with conventional compressor nebulizers.