Exercise-induced bronchoconstriction in rhinitis children without asthma.

Background: Exercise-induced bronchoconstric-tion (EIB) is a condition that leads to limited participation in sports. Prevalence of EIB ranges from 5-20% in general population to 40 - 90% in asthmatic patients. But the prevalence among rhinitis children with EIB remains debatable. We aimed to determine the prevalence of EIB in non-asthmatic children with rhinitis. Methods: A cross-sectional study was performed on 53 rhinitis patients without known asthma who attended the Pediatric Allergy Clinic between March 2009 and February 2010.They all underwent physical examination, skin prick test, pulmonary function tests and an exercise challenge test (ECT) on a treadmill. A positive ECT was defined as a decrease in FEV1 > 10% after exercise. baseline pulmonary function and the decline in FEV1 after exercise. Results: The patients’ mean age was 12.3±2.6 years. Most of them (60.4%) had moderate to severe persistent rhinitis. Eleven out of 53 patients (20.7%) had EIB. The peak time for occurrence of EIB was 10 minutes after exercise. Most of the EIB episodes observed were of mild degree. Patients who had persistent symptoms and a short duration of rhinitis treatment prior to the ECT day had more positive ECT results (72.7% vs. 28.6%, p 0.013, 0.2 years vs.1.9 years, p 0.012, respectively). The history (Hx) was not a reliable means of identifying children who had EIB (ECT+/Hx+ 54.6%, ECT-/Hx+ 54.8%). There was no significant relationship between Conclusion: The prevalence of EIB in rhinitis children without asthma is 20.7%. History, physical examination and pulmonary function are insufficient to diagnose EIB.

The stability and sterility of epinephrine prefilled syringe.

The commercially available auto-injector epinephrine is considerable expensive. Epinephrine prefilled syringe is an alternative treatment for anaphylaxis patients. The objective of the present study was to evaluate the stability and sterility of epinephrine prefilled syringe. Epinephrine prefilled syringe was kept in the pencil box to prevent from light exposure. The active ingredients, integrity and level of potency were measured by highperformance liquid chromatography (HPLC). The sterility was accessed by aerobic bacteria and fungi culture. The epinephrine concentration at 1, 2 and 3 months after the preparation was 101.36, 99.31 and 101.09%, respectively (acceptable range 90 - 110%). The pH was 3.17 - 3.23 (acceptable range 2.8 - 3.6). Nor-epinephrine was undetected. The cultures for bacteria and fungus were both negative. Consequently, epinephrine prefilled syringe was stable and sterile at least three month after preparation. Epinephrine prefilled syrine is an alternative low cost treatment for anaphylaxis patient.

Cytokine responses during exacerbation compared with stable phase in asthmatic children.

Bronchial asthma is a chronic inflammatory disorder of the airways. Balancing in Th1 and Th2 response is a target in the treatment. Recent studies show that interleukin-10 (IL-10) has an important role in the regulation of Th2 and allergic responses and its amount was found to decrease in asthmatic patients. This study was to focus on cytokine responses, including interferon-gamma (IFN- γ), IL-4 and IL-10 in asthmatic children during acute exacerbation compared to stable period. Peripheral blood mononuclear cells (PBMCs) from fourteen asth-matic children during exacerbation and stable phase were stimulated with phytohemagglutinin (PHA) and mite allergen (Der p) for 72 hours. Levels of IFN-γ, IL-4 and IL-10 in cell culture supernatants were measured using en-zyme-linked immunosorbent assay. The median level of IL-10 in PBMCs stimulated with PHA was significantly low-er in acute asthma exacerbation compared with stable phase (464 vs. 859.5 pg/ml, p= 0.03). However, there was no difference in the level of IL-10 in PBMCs stimulated with Der p. The level of IFN-γ and IL-4 were not different between exacerbation and stable phase both in PHA and Der p-stimulated PBMCs. The decrease of IL-10 production in asthmatic children during acute exacerbation may emphasize the role of IL-10 in immune regulation in allergic disease.

Serum TGF-beta1 in atopic asthma.

Asthma is a chronic inflammatory disease of the airway. Pathological repair of chronic inflammation leads to airway remodeling. Transforming growth factor-beta (TGF-beta), a profibrotic cytokine, plays an important role in promoting the structural changes of airway remodeling. TGF-beta effects on the proliferation, differentiation and extracellular matrix (ECM) metabolism of airway structural cells. This study assessed serum TGF-beta1 in different severity of atopic asthma compared to non-atopic controls. Thirty-one atopic asthmatic patients and 34 non-atopic controls, aged 7-18 years, were recruited as to the asthma severity: steroid naïve mild asthma, moderate asthma, and asthma in remission. Serum TGF-beta1 was measured by enzyme-linked immunosorbent assay. There was a significant difference between serum TGF-beta1 in asthmatic patients and that in control patients (39.59 ng/ml vs. 0.26 ng/ml, p < 0.001). Serum TGF-beta1 was highest in steroid naïve mild asthma group when compared to the moderate asthma and asthma in remission groups (47.44 ng/ml vs. 38.64 ng/ml and 47.44 ng/ml vs. 35.94 ng/ml, p = 0.013 and 0.001, respectively). There were no correlations among serum TGF-beta1 and pulmonary function test parameters, duration of asthma, and duration of inhaled corticosteroid treatment. These data support the role of TGF-beta1 in airway remodeling in asthma.

Risk factors of relapse within eight weeks after an acute asthma exacerbation in Thai children.

BACKGROUND: Acute asthma relapse following treatment and discharge from hospital remains a substantial problem. Various potential risk factors for relapse have been reported including age, sex, frequency of hospitalization and emergency medications. All these factors, however, may not be generalized for all patients because of difference in prevalence, trigger factors, types of allergens, medical accessibility and psychosocial problems. OBJECTIVE: To identify factors associated with relapse following treatment for acute asthma within the next 8 weeks in Thai children. MATERIAL AND METHOD: The authors prospectively followed 91 children discharged from Ramathibodi Hospital after treatment of an asthma attack from June 1999 to December 2000. Parents were surveyed concerning their child's medical history, trigger factors, psychosocial and economic variables. Data on severity of the attack, asthma scores, emergency treatment, and response to treatment were recorded. Investigations included eosinophil count, total IgE, serum eosinophil cationic protein (ECP), skin test, methacholine bronchial challenge test, and IQ test were performed and recorded. RESULTS: Within the first week, only 6.6 per cent had relapsed and increased to 29.7 per cent by 8 weeks. Patients who suffered relapse were more likely associated with age at asthma diagnosis (OR, 2.90; 95% CI, 1.1-7.5) and 6 years of age or under (OR 4.49, CI 1.22-16.54). From the investigation results including eosinophil count, total IgE, serum ECP, skin test, methacholine bronchial challenge test, and IQ test, there was no significant difference in the factors between patients who suffered relapse and those who did not. From the psychosocial evaluation, 18 out 39 (46.2%) studied cases had significant psychosocial disorders. They were 4 cases with delayed development and mental retardation, 9 cases with parent-child relation problems, and 2 cases with serious intrafamilial disorders. Most of these patients were non-relapse cases. However, the relationship between asthma relapse and psychosocial disorders could not be ascertained since psychosocial evaluation was only performed in one-third of the study population. CONCLUSION: Among patients following acute asthma therapy, 29.7 per cent will have a relapse. The authors identified the age at onset of asthma before the age of 6 years as an important risk factor. This may help to decrease the relapse rate by more intensive and comprehensive management among patients at high risk.